The Development of an Environmental Hygiene Management Audit Tool for Operating Rooms

Abstract

Background: The operating theatre environment is as complex as surgical and anaesthetic practices combined. The intra-operative environment may be one of the most contaminated areas in a hospital. Effective operating room environmental management is an important measure to prevent the spread of Surgical Site Infections (SSIs). Environmental cleaning teams require clear instructions and training, and simple methods of assessing cleanliness, which cannot be done by visual assessment. Despite the abovementioned recommendations, incorrect cleaning practices continue to occur for multiple reasons. Aim: The aim of this study is to contribute to a safe operating room environmental cleaning practices and management through the development of an environmental hygiene audit tool that could enhance the quality care of all patients in the operating room. Methods: An exploratory three- phase sequential mixed-methods design was conducted to meet the research objectives. 1) In Phase 1, a scoping review of literature was conducted guided by a framework proposed by Johanna Briggs Institute. Five data bases were searched for primary studies published in English between 2010 and 2020. 2) In-depth interviews were conducted with four purposively selected experts in the field of Infection Prevention and Control in the operating theatre, to gather multiple viewpoints on the intraoperative environmental cleaning practices and management in phase 2. 3) In Phase 3, an audit tool of an an environmental hygiene management was developed, based on the findings of phase 1 and 2. The development was guided by the Donabedian framework. Data analysis: Data were analysed following the thematic analysis in Phase 1 and Phase 2. Following data analysis, 5 major themes emerged in phase 1 and 4 themes in phase 2 of the study. Data from the 2 phases informed the development of the environmental hygiene management audit tool in phase 3. Summary of findings: The findings of this study indicated that the environmental hygiene in the operating room should be managed through specific cleaning practices, specific cleaning methods and cleaning intervals. It is also indicated that there are different types of chemicals/products with different strength that should be used for surfaces, equipment and floors. The equipment such as mops and cloths should also be cared for and handled in a 6 certain manner. This was backed up by the participants during the in-depth interviews and they even added on the aspect of cleaner safety, risks, training and responsibility. Conclusion: Operating theatre environment is a secondary reservoir for organisms with the potential for infecting patients undergoing surgery. This study recommends that thorough and frequent disinfection of surfaces with higher frequency of hand contact be done after each patient procedure.