CONTINUING EDUCATION

Implementing AORN
Recommended Practices for
Environmental Cleaning
GEORGE ALLEN, PhD, MS, BSN, RN, CNOR, CIC

2.0

www.aorn.org/CE
Continuing Education Contact Hours

Approvals

indicates that continuing education (CE) contact hours

are available for this activity. Earn the CE contact hours by
reading this article, reviewing the purpose/goal and objectives,
and completing the online Examination and Learner Evaluation
at http://www.aorn.org/CE. A score of 70% correct on the examination is required for credit. Participants receive feedback on
incorrect answers. Each applicant who successfully completes
this program can immediately print a certicate of completion.

This program meets criteria for CNOR and CRNFA recertication, as well as other CE requirements.
AORN is provider-approved by the California Board of
Registered Nursing, Provider Number CEP 13019. Check with
your state board of nursing for acceptance of this activity for
relicensure.

Event: #14517
Session: #0001
Fee: Members $16, Nonmembers $32

Conict of Interest Disclosures

The CE contact hours for this article expire May 31, 2017.
Pricing is subject to change.

Purpose/Goal
To provide the learner with knowledge specic to environmental cleaning and disinfection in the perioperative practice
setting.

Objectives
1. Discuss the AORN recommended practices for environmental cleaning.
2. Describe risks associated with infectious pathogens.
3. Identify factors to consider when selecting cleaning products.
4. Discuss frequency for cleaning different surfaces.
5. Describe enhanced cleaning procedures.

George Allen, PhD, MS, BSN, RN, CNOR, CIC, has no

declared afliation that could be perceived as posing a potential conict of interest in the publication of this article.
The behavioral objectives for this program were created by
Liz Cowperthwaite, senior managing editor, and Rebecca
Holm, MSN, RN, CNOR, clinical editor, with consultation
from Susan Bakewell, MS, RN-BC, director, Perioperative
Education. Ms Cowperthwaite, Ms Holm, and Ms Bakewell
have no declared afliations that could be perceived as
posing potential conicts of interest in the publication of
this article.

Sponsorship or Commercial Support

No sponsorship or commercial support was received for this
article.

Disclaimer
Accreditation
AORN is accredited as a provider of continuing nursing
education by the American Nurses Credentialing Centers
Commission on Accreditation.

AORN recognizes these activities as CE for RNs. This recognition does not imply that AORN or the American Nurses
Credentialing Center approves or endorses products mentioned
in the activity.

http://dx.doi.org/10.1016/j.aorn.2014.01.023

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RECOMMENDED PRACTICES
Implementing AORN
Recommended Practices
for Environmental
Cleaning
2.0
GEORGE ALLEN, PhD, MS, BSN, RN, CNOR, CIC

www.aorn.org/CE

ABSTRACT
In recent years, researchers have developed an increasing awareness of the role of
the environment in the development of health careeassociated infections. AORNs
Recommended practices for environmental cleaning is an evidence-based document that provides specic guidance for cleaning processes, for the selection of
appropriate cleaning equipment and supplies, and for ongoing education and quality
improvement. This updated recommended practices document has an expanded
focus on the need for health care personnel to work collaboratively to accomplish
adequately thorough cleanliness in a culture of safety and mutual support. Perioperative nurses, as the primary advocates for patients while they are being cared for
in the perioperative setting, should help ensure that a safe, clean environment
is reestablished after each surgical procedure. AORN J 99 (May 2014) 571-579.
AORN, Inc, 2014. http://dx.doi.org/10.1016/j.aorn.2014.01.023
Key words: environmental cleaning, health careeassociated infections, pathogenic
microorganisms, multidrug-resistant organisms, asepsis, disinfection.

esearchers have linked the development

of health careeassociated infections to
external sources, such as environmental
surfaces. The health care environment, including
the perioperative setting, is now well documented
as a primary source for infection.1-6 The accumulation of dust, debris, and other microbial contaminants on surfaces in health care settings is
a potential source for health careeassociated

infections. The risk for the transmission of pathogenic microorganisms, including multidrugresistant organisms (MDROs), is related to the
mere presence of pathogenic microorganisms on
environmental surfaces, their capacity to survive
for varying lengths of time on these surfaces, and
their ability to be transferred to many different types
of surfaces, including the hands of health care
personnel.7

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Although principles of asepsis and aseptic techniques are the cornerstone of practice in the OR,
procedures to prevent the development of surgical
site and other infections depend on maintaining
sanitary conditions. Consequently, health care providers should implement efcient and effective
cleaning procedures to maintain a clean and healthy
environment. Perioperative nurses, as the primary
advocates for patients while they are being cared
for in the perioperative setting, should help ensure
that a safe, clean environment is reestablished after
each surgical procedure. This article provides a
brief review of AORNs Recommended practices
for environmental cleaning,8 an evidence-based
document that can guide clinicians as they care for
patients in the perioperative setting.
WHAT IS NEW?
The AORN Recommended Practices Advisory
Board approved the updated Recommended practices for environmental cleaning in November
2013. The recommended practices (RP) document
was revised based on a review of available evidence. A medical librarian conducted searches of
the nationally and internationally recognized databases for English-language literature published between 2008 and 2013. The lead author, a masters
prepared perioperative nursing professional, together with the medical librarian also identied
relevant guidelines from government and standardssetting bodies to develop the recommendations.8
The evidence was appraised by using the AORN
Evidence Rating Model (Table 1) to assign evidence ratings:
1.
2.
3.
4.
5.

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Strong Evidence or Regulatory Requirement,

Moderate Evidence,
Limited Evidence,
Benets Balanced With Harm, or
No Evidence.

Evidence rating has emerged as an issue of critical

importance because of the growing demand that
health care decisions be based on the best evidence
available in the scientic literature.9
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The scope of the RP document includes all

perioperative areas, including the preoperative and
postoperative areas, ORs and procedure rooms, and
semirestricted areas, and the document now includes sterile processing areas as well. In addition
to providing guidance for environmental cleaning
and disinfection to minimize the exposure of surgical patients and health care personnel to potentially infectious pathogens, the updated document
has an expanded focus on the need for health
care personnel to work collaboratively to accomplish adequately thorough cleanliness in a culture
of safety and mutual support. Recommendations
relating to competency of personnel, policy and
procedures, and quality improvement have been
updated to incorporate the team approach. Other
new content addresses high-touch objects, enhanced environmental cleaning, cleaning methods,
and measurement of cleanliness.
RATIONALE
Historically, the perioperative environment has
been viewed as the singular area in the health care
setting where the highest degree of asepsis and
adherence to sterile technique is practiced. However, MDROs, such as
n
n

n
n
n

methicillin-resistant Staphylococcus aureus,

S aureus with resistance to vancomycin (ie,
vancomycin-intermediate S aureus, vancomycinresistant S aureus),
vancomycin-resistant enterococci,
extended-spectrum b-lactamaseeproducing
gram-negative bacilli, and
Clostridium difcile,

have become more prevalent,10 stay in the environment longer, are difcult to control, and increase
the incidence of both morbidity and mortality when
they are transmitted to patients. Surfaces that health
care providers frequently touch in the perioperative environment may present a high risk for these
pathogens to be transmitted, so routine and effective cleaning is essential. Thorough cleaning and
disinfection of perioperative areas can be facilitated

RP IMPLEMENTATION GUIDE: ENVIRONMENTAL CLEANING

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TABLE 1. AORN Crosswalk: Appraisal Score to Evidence Rating

Appraisal score
Research

Non-research

AORN Evidence Rating Model

Evidence rating

IA

IVA
Regulatory

1: Strong Evidence
1: Regulatory
Requirement

IB
IIA, IIB
IIIA, IIIB

IVB
VA, VB

2: Moderate
Evidence

IC
IIC
IIIC

IVC
VC

3: Limited Evidence

4: Benets Balanced
With Harms

5: No Evidence

Evidence requirements
Interventions or activities for which effectiveness has been
demonstrated by strong evidence from rigorously designed
studies, meta-analyses, or systematic reviews; rigorously
developed clinical practice guidelines; or regulatory requirements
n Evidence from a meta-analysis or systematic review of research
studies that incorporated evidence appraisal and synthesis of
the evidence in the analysis
n Supportive evidence from a single, well-conducted, randomized controlled trial
n Guidelines developed by a panel of experts that derive from an
explicit literature search methodology and include evidence
appraisal and synthesis of the evidence
Interventions or activities for which the evidence is less well
established than for those listed under 1: Strong Evidence
n Supportive evidence from a well-conducted research study
n Guidelines developed by a panel of experts that are primarily
based on the evidence but not supported by evidence appraisal and synthesis of the evidence
n Nonresearch evidence with consistent results and fairly denitive conclusions
Interventions or activities for which there currently is insufcient
evidence or evidence of inadequate quality
n Supportive evidence from a poorly conducted research study
n Evidence from nonexperimental studies with high potential
for bias
n Guidelines developed largely by consensus or expert opinion
n Nonresearch evidence with insufcient evidence or inconsistent
results
n Conicting evidence but where the preponderance of the evidence supports the recommendation
Selected interventions or activities for which the AORN Recommended Practices Advisory Board is of the opinion that the
desirable effects of following this recommendation outweigh
the harms
Interventions or activities for which no supportive evidence
was found during the literature search completed for the
recommendation
n Consensus opinion

Reprinted with permission from Introduction to the AORN recommended practices. In: Perioperative Standards and Recommended Practices. Denver,
CO: AORN, Inc; 2014:46.

by the implementation of the practice recommendations in the RP document. Because these recommendations are based on the best available
evidence and because perioperative personnel
have long embraced patient safety and reduction

in surgical site infections into their culture, incorporating the practice recommendations into the
routine policies and procedures of the organization can be accomplished with minimal disruptive culture shifts.
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Concepts and processes from this RP document

that are critical and that may be assessed by regulatory agencies include the following:

application of this recommendation. For example,

when selecting a cleaning product, the team should
evaluate the

There is a team and collaborative approach to

cleaning the OR.
n Cleaning procedures and schedules should be
developed and available in writing, including
the description of routine cleaning, enhanced
environmental cleaning, and terminal cleaning.
n Personnel safety and patient safety must be
addressed during the cleaning process, with
attention to the chemicals and detergents used,
the handling and mixing of these chemicals, and
the use of personal protective equipment (PPE)
to prevent exposures to blood and body uids11
and contact with chemicals.
n Training, competency evaluation, and a quality
improvement program are essential.

n
n
n
n
n
n

Environmental Protection Agency (EPA) registration and rating as hospital grade;

microorganisms affected;
required contact time;
manufacturers instructions for use;
compatibility with surfaces, equipment, and
cleaning materials;
patient population (eg, neonates and pediatric
patients, adults); and
safety of the product.

DISCUSSION
The updated RP document provides specic guidance for cleaning processes, for the selection of
appropriate cleaning equipment and supplies, and
for ongoing education and quality improvement.
More information about several of the recommendations is discussed in this section. Readers are
strongly encouraged to read the full RP document
for a more complete understanding of all of the
recommendations.

The team also should determine when enhanced

environmental cleaning should be implemented and
develop cleaning and disinfection procedures to use
during construction, renovation, repair, demolition,
or disaster recovery.
It is important for the team to establish the appropriate use of chemicals and disinfectants. For
example, personnel should not use high-level disinfectants or liquid chemical sterilants to clean and
disinfect environmental surfaces because they are
not intended for this use. Similarly, personnel
should not use alcohol to disinfect large environmental surfaces because alcohol is not an
EPA-registered disinfectant. Use of reusable or
single-use cleaning materials, including mop
heads and cloths, is acceptable.

Recommendation I
Recommendation I, a new recommendation, states
that a multidisciplinary team consisting of perioperative nurses and sterile processing, environmental
services, and infection prevention personnel should
establish cleaning procedures and frequencies in
the perioperative practice setting.8(p256) This includes developing guidelines for the selection of
cleaning detergents and chemicals, and for the
frequency of cleaning, including for high-touch
objects and surfaces.
The document provides operational procedures
for the multidisciplinary team to follow to facilitate

Recommendation II
New to the recommendation that patients should be
provided a clean, safe environment8(p258) is that
personnel should consider oors in the perioperative practice setting to be contaminated at all times.
Thus, personnel should consider items that touch the
oor for any amount of time to be contaminated, and
these should be disinfected before patient use.
Noncritical equipment and surfaces that are
difcult to clean or that cannot withstand disinfection (eg, computer keyboards) may be protected
from contamination by use of a barrier cover. After
each use, the barrier should be removed or cleaned

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RP IMPLEMENTATION GUIDE: ENVIRONMENTAL CLEANING

and disinfected according to the manufacturers
instructions for use.
Recommendation III
A clean environment should be reestablished after
the patient is transferred from the area.8(p260) This
requires the multidisciplinary team to establish
procedures for cleaning reusable noncritical, nonporous surfaces (eg, mattress covers, pneumatic
tourniquet cuffs, blood pressure cuffs, other patient
equipment) after each individual patient use and
according to the manufacturers recommendations.
High-touch areas, including control panels, switches,

www.aornjournal.org

knobs, work areas, and handles, should be cleaned,

and the oor and walls of ORs and procedure
rooms should be cleaned and disinfected after each
surgical or invasive procedure if soiled or potentially soiled as evidenced by the presence of splash,
splatter, or spray during the procedure. Examples
of cleaning frequencies for ORs and procedure
rooms are provided in Figure 1. Personnel should
clean preoperative and postoperative patient care
areas after each patient has left the area and clean
and disinfect transport equipment and other mobile equipment, including suction regulators, medical gas regulators, imaging viewers, radiology

Figure 1. Example of cleaning frequencies: operating and procedures rooms. Reprinted with permission from
Recommended practices for environmental cleaning. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2014:261.

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equipment, and warming equipment, after each

patient use.
Recommendation VII
The recommendation that procedures for environmental cleaning and disinfection and use of PPE
should be established for circumstances that may
require contact or airborne precautions has been
expanded to include circumstances that may
require special cleaning procedures (ie, multidrugresistant organisms, C difcile, prion diseases,
construction, environmental contamination).8(p266)
Enhanced environmental cleaning procedures
should be implemented after the care of patients
infected or colonized with MDROs. This involves
cleaning all high-touch objects, in addition to other
objects cleaned as part of routine cleaning, after the
patient has left the area. Cleaning personnel should
wear PPE (ie, gowns, gloves) when performing
enhanced environmental cleaning.
Personnel also should implement cleaning procedures to reduce dust and potential contamination
during internal or external construction, repair, and
renovation projects. Construction barriers should
be assessed for effectiveness. Disaster remediation

ALLEN
after a ood or other water-related emergency should
include performing terminal cleaning of affected
areas after water is removed.

The Final Three

The nal recommendations in each AORN RP
document discuss education/competency, policies
and procedures, and quality assurance/performance
improvement, as applicable. These topics are
integral to the implementation of AORN practice
recommendations.
Personnel should receive initial and ongoing
education and competency validation as applicable
to their roles. Implementing new and updated
recommended practices affords an excellent
opportunity to create or update competency
materials and validation tools. AORNs perioperative competencies team has developed the AORN
Perioperative Competency Verication Tools and
Job Descriptions12 to assist perioperative personnel
in developing competency evaluation tools and position descriptions.
Policies and procedures should be developed,
reviewed periodically, revised as necessary, and
readily available in the practice setting. New or
updated recommended practices may present an opEducational Resources
portunity for collaborative
efforts among nurses and
n AORN Video Library: Environmental Sanitation, Terminal
personnel from other deCleaning, and Disinfection [DVD]. http://cine-med.com/index
partments within the facility
.php?navaorn&catall.
to develop organization-wide
n AORN Video Library: Prevention of Transmissible Infections in
policies and procedures that
the Perioperative Practice Setting [DVD]. http://cine-med.com/
support the recommended
index.php?navaorn&catall.
practices. The AORN Policy
n Recommended Practices for Environmental Cleaning [Webinar].
and Procedure Templates,
AORN, Inc. http://www.aorn.org/Events/Webinars/Previously_
3rd edition,13 provides a
Recorded_Webinars.aspx#EnvironmentalCleaning.
collection of 30 sample
n Recommended practices for prevention of transmissible inpolicies and customizable
fections in the perioperative practice setting. In: Perioperative
templates based on AORNs
Standards and Recommended Practices. Denver, CO: AORN,
Perioperative Standards
Inc; 2014:385-417.
and Recommended Practices.14 Regular quality
Web site access veried March 13, 2014.
improvement projects are

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RP IMPLEMENTATION GUIDE: ENVIRONMENTAL CLEANING

necessary to improve patient safety and to help ensure safe, quality care. For details on the nal three
practice recommendations that are specic to the RP
document discussed in this article, refer to the full
text of the RP document.8

www.aornjournal.org

complete the room turnover cleaning process.

Reestablishing a clean environment after the patient leaves the room decreases the risk of crosscontamination and disease transmission.
HOSPITAL PATIENT SCENARIO
The perioperative team at Community Hospital is
conducting a quality assurance and performance
improvement activity to improve understanding of
and compliance with the principles and processes
of environmental cleaning.8(p270) After a surgical
procedure, the infection preventionist marks hightouch areas with a uorescent marker that is not
visible to the environmental support (EVS) team
members; subsequently, the efcacy of the cleaning
can be qualitatively evaluated by using a uorescent light. If the area is not adequately cleaned, then
the marking is visible under the uorescent light and
the infection preventionist can give immediate feedback to the EVS team.
Mr A, a 56-year-old black man who is obese and
has a history of hypertension, diabetes mellitus, and
coronary artery disease, is admitted for emergency

AMBULATORY PATIENT SCENARIO

The rst patient of the day at a busy free-standing
ambulatory surgery center is scheduled to undergo
repair of an inguinal hernia in OR #3 at 9 AM. The
RN circulator assigned to the procedure assesses
OR #3 to determine whether it is a clean and safe
environment for the procedure. She conrms that
all the ORs were terminally cleaned by the surgical
team members after the last scheduled procedures
were completed the previous day. The Centers for
Disease Control and Prevention recommends that
terminal cleaning and disinfection of the perioperative environment be performed after the last procedure has been completed to decrease the number
of pathogens, dust, and debris in the room.15
The RN circulator and scrub person methodically damp dust all horizontal surfaces in the room
(eg, furniture, surgical lights,
booms, equipment) from top
Resources for Implementation
to bottom by using a clean,
low-linting cloth moistened
n AORN Syntegrity Framework. AORN, Inc. http://www.aorn
with an EPA-registered,
.org/syntegrity.
hospital-grade disinfectant.
n ORNurseLinkTM. http://ornurselink.aorn.org.
After the damp dusting is
n Perioperative Competency Verication Tools and Job Decompleted, the scrub person
scriptions [CD-ROM]. Denver, CO: AORN, Inc; 2014. http://
brings the case cart with the
www.aorn.org/CompetencyTools.
supplies for the procedure
n Policy and Procedure Templates [CD-ROM]. 3rd ed. Denver,
into the room, and the RN
CO: AORN, Inc; 2013. http://www.aorn.org/Books_and_
circulator and scrub perPublications/AORN_Publications/Policy_and_Procedure_
son begin to set up for the
Templates.aspx.
procedure.
n The Roadmap to ASC Compliance [CD-ROM]. Denver, CO:
The procedure is unAORN, Inc; 2012. http://www.aornbookstore.org//Product/
eventful, and after the
product.asp?skuMAN543&dept_id1.
anesthesia professional and
RN circulator have transSyntegrity is a registered trademark and ORNurseLink is a tradeferred the patient to the
mark of AORN, Inc, Denver, CO.
postanesthesia care unit,
Web site access veried March 13, 2014.
the surgical team members

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surgery. Three weeks before, he was hospitalized

with profuse diarrhea and was diagnosed with C
difcile colitis. He was treated and discharged after
being hospitalized for six days. Now Mr A has
been readmitted with diarrhea and a suspected
bowel perforation.
Scheduling personnel notify the OR manager
that Mr A is being treated with contact isolation
precautions for C difcile. The perioperative team
prepares OR #1, the designated emergency room
for the day, for an exploratory laparotomy with
potential bowel resection. The OR manager noties
all personnel, including the RN circulator, scrub
person, OR transporter, resident, physician assistant, anesthesia professional, postanesthesia care
unit nurses, and EVS personnel that the patient
is being treated with isolation precautions for C
difcile. When the room is ready, the OR transporter transfers Mr A directly to OR #1, adhering
to isolation procedures. The RN circulator and the
physician assistant wear isolation gowns and gloves
while they transfer Mr A from the stretcher and
secure him to the OR bed.
After examining Mr As abdomen, the surgeon
performs a bowel resection. When the procedure
is complete, the RN circulator and anesthesia professional transfer Mr A to the isolation room in the
postanesthesia care unit. Before EVS personnel
are notied to clean the room, the infection preventionist tags several high-touch areas with the
uorescent marker. The EVS team dons isolation
uid-resistant gowns, gloves, and applicable PPE
according to the institutions approved policies and
procedures for cleaning an isolation room and the
Occupational Safety and Health Administration
Bloodborne Pathogens Standard11 requirements for
personnel safety. Because the pathogen has been
identied as C difcile, the EVS team uses an EPAregistered cleaning agent that is effective against
C difcile spores to clean the room.16 The EVS
personnel use a checklist to ensure that all the
critical equipment that requires cleaning is cleaned
adequately. After the EVS team completes the
room cleaning and the infection preventionist has
578 j AORN Journal

assessed the quality of cleaning with the uorescent

light, the OR manager veries that a clean and safe
environment has been reestablished and that the
room is ready to be used for another procedure.
As a way to further improve patient care and
ensure a clean environment, the team at Community
Hospital considers additional qualitative and
quantitative measures, including culture and adenosine triphosphate testing, as tools that perioperative
managers can use to implement quality improvement processes. The tests are particularly effective
because adenosine triphosate is present in all living
cells, so an adenosine triphosate monitoring system
can detect the amount of organic matter that remains
after cleaning has been completed. Such monitoring
procedures would allow the infection preventionist
to provide immediate feedback to EVS personnel
and facilitate compliance with the approved cleaning
policies and procedures of the institution.17
CONCLUSION
In recent years, researchers have developed an
increasing awareness of the role of the environment
in the development of health careeassociated infections, including surgical site infections, and the
increasing prevalence of MDROs. The Recommended practices for environmental cleaning can
be implemented in the many diverse settings in
which perioperative nurses practice as part of the
surgical team. Perioperative managers and leaders
must work collaboratively with the environmental
services leaders to promote a culture of safety
through environmental cleanliness in health care
settings.
References
1. Stiefel U, Cadnum JL, Eckstein BC, Guerrrero DM,
Tima MA, Donskey CJ. Contamination of hands with
methicillin-resistant Staphylococcus aureus after contact
with environmental surfaces and after contact with the
skin of colonized patients. Infect Control Hosp Epidemiol.
2011;32(2):185-187.
2. Dancer SJ. The role of environmental cleaning in the
control of hospital-acquired infection. J Hosp Infect.
2009;73(4):378-385.
3. Otter JA, Yezli S, French GL. The role played by contaminated surfaces in the transmission of nosocomial

RP IMPLEMENTATION GUIDE: ENVIRONMENTAL CLEANING

4.

5.

6.

7.

8.

9.

10.

11.

pathogens. Infect Control Hosp Epidemiol. 2011;32(7):

687-699.
Munoz-Price LS, Birnbach DJ, Lubarsky DA, et al.
Decreasing operating room environmental pathogen
contamination through improved cleaning practice. Infect
Control Hosp Epidemiol. 2012;33(9):897-904.
Rutala WA, Weber DJ; the Healthcare Infection Control
Practices Advisory Committee. Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008.
Atlanta, GA: Centers for Disease Control and Prevention;
2008. http://www.cdc.gov/hicpac/pdf/guidelines/Disin
fection_Nov_2008.pdf. Accessed March 12, 2014.
Faires MC, Pearl DL, Berke O, Reid-Smith RJ, Weese JS.
The identication and epidemiology of methicillinresistant Staphylococcus aureus and Clostridium difcile
in patient rooms and the ward environment. BMC Infect
Dis. 2013;13:342. http://www.biomedcentral.com/1471
-2334/13/342. Accessed March 12, 2014.
Cozad A, Jones RD. Disinfection and the prevention of
infectious disease. Am J Infect Control. 2003;31(4):
243-254.
Recommended practices for environmental cleaning. In:
Perioperative Standards and Recommended Practices.
Denver, CO: AORN, Inc; 2013:255-276.
Polit DF, Beck CT. Nursing Research: Generating and
Assessing Evidence for Nursing Practice. 9th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2012.
Allen G. Managing patients with multidrug-resistant organisms: implementing isolation precaution procedures
in the perioperative setting. Perioper Nurs Clin. 2010;
5(4):419-426.
Occupational Safety and Health Administration. Occupational exposure to bloodborne pathogens: nal rule.
Fed Regist. 1991;56:64003-64182 (29 CFR x1910.1030).

www.aornjournal.org

12. Perioperative Competency Verication Tools and Job Descriptions [CD-ROM]. Denver, CO: AORN, Inc; 2014.
13. Policy and Procedure Templates [CD-ROM]. 3rd ed.
Denver, CO: AORN, Inc; 2013.
14. Perioperative Standards and Recommended Practices.
Denver, CO: AORN, Inc; 2014.
15. Sehulster L, Chinn RY; CDC; HICPAC. Guidelines for
environmental infection control in health-care facilities.
Recommendations of CDC and the Healthcare Infection
Control Practices Advisory Committee (HICPAC). MMWR
Recomm Rep. 2003;52(RR-10):1-42.
16. Frequently asked questions about Clostridium difcile for
healthcare providers. Centers for Disease Control and
Prevention. http://www.cdc.gov/HAI/organisms/cdiff/
Cdiff_faqs_HCP.html. Accessed March 12, 2014.
17. Guh A, Carling P; Environmental Evaluation Workgroup.
Options for evaluating environmental cleaning. 2010.
Centers for Disease Control and Prevention. http://
www.cdc.gov/HAI/toolkits/Evaluating-Environmental
-Cleaning.html. Accessed March 12, 2014.

George Allen, PhD, MS, BSN, RN, CNOR,

CIC, is the director, infection control, at
Downstate Medical Center and a clinical assistant professor at SUNY College of Health
Related Professions, Brooklyn, NY. Dr Allen
has no declared afliation that could be
perceived as posing a potential conict of
interest in the publication of this article.

This RP Implementation Guide is intended to be an adjunct to the complete recommended practices document upon
which it is based and is not intended to be a replacement for that document. Individuals who are developing and
updating organizational policies and procedures should review and reference the full recommended practices
document.

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EXAMINATION

2.0

CONTINUING EDUCATION

Implementing AORN Recommended www.aorn.org/CE

Practices for Environmental Cleaning
PURPOSE/GOAL
To provide the learner with knowledge specic to environmental cleaning and
disinfection in the perioperative practice setting.

OBJECTIVES
1.
2.
3.
4.
5.

Discuss the AORN recommended practices for environmental cleaning.

Describe risks associated with infectious pathogens.
Identify factors to consider when selecting cleaning products.
Discuss frequency for cleaning different surfaces.
Describe enhanced cleaning procedures.

The Examination and Learner Evaluation are printed here for your convenience. To receive continuing education credit, you must complete the online
Examination and Learner Evaluation at http://www.aorn.org/CE.

QUESTIONS
1.

2.

The risk for the transmission of pathogenic microorganisms on environmental surfaces is related
to their
1. ability to be transferred to many different
types of surfaces.
2. ability to be transferred to the hands of health
care personnel.
3. capacity to survive for varying lengths of
time on surfaces.
4. mere presence.
a. 1 and 2
b. 3 and 4
c. 2, 3, and 4
d. 1, 2, 3, and 4
The updated AORN Recommended practices for
environmental cleaning has an expanded focus
on the need for health care personnel to work
collaboratively to accomplish adequately thorough

580 j AORN Journal 

May 2014

Vol 99

No 5

cleanliness in a culture of safety and mutual

support.
a. true
b. false
3.

Multidrug-resistant organisms
1. are difcult to control.
2. have become less prevalent.
3. increase the incidence of morbidity in
infected patients.
4. stay in the environment longer.
a. 1 and 2
b. 3 and 4
c. 1, 3, and 4
d. 1, 2, 3, and 4

4.

When selecting a cleaning product, some factors a

multidisciplinary team should evaluate include its
1. Environmental Protection Agency registration.
2. compatibility with surfaces, equipment, and
cleaning materials.
3. manufacturers instructions for use.

AORN, Inc, 2014

CE EXAMINATION
4.

www.aornjournal.org

required contact time.

a. 1 and 2
b. 3 and 4
c. 2, 3, and 4
d. 1, 2, 3, and 4

5.

Personnel should use alcohol to disinfect large

environmental surfaces.
a. true
b. false

6.

Items that touch the oor for _________ should

be considered contaminated and should be disinfected before patient use.
a. any amount of time
b. 5 seconds
c. 10 seconds
d. 15 seconds

7.

Based on the information in Figure 1, walls

should be cleaned
a. after every patient.
b. after every patient, if used.
c. when enhanced cleaning is indicated.
d. if soiled.

8.

Based on the information in Figure 1, _________

should be cleaned after every patient.

1.
2.
3.
4.
5.

anesthesia machine
IV poles
OR bed strap
Mayo stand
trash containers
a. 1 and 2
b. 1, 2, and 3
c. 1, 2, 3, and 5
d. 1, 2, 3, 4, and 5

9.

Based on the information in Figure 1, footstools

should be cleaned
a. after every patient.
b. after every patient, if used.
c. when enhanced cleaning is indicated.
d. if soiled.

10.

Special cleaning procedures may be required in

the presence of
1. construction.
2. environmental contamination.
3. prion diseases.
4. multidrug-resistant organisms.
a. 1 and 2
b. 3 and 4
c. 2, 3, and 4
d. 1, 2, 3, and 4

AORN Journal j 581

LEARNER EVALUATION

2.0

CONTINUING EDUCATION PROGRAM

Implementing AORN Recommended www.aorn.org/CE

Practices for Environmental Cleaning

his evaluation is used to determine the extent to

which this continuing education program met
your learning needs. The evaluation is printed
here for your convenience. To receive continuing
education credit, you must complete the online
Examination and Learner Evaluation at http://www
.aorn.org/CE. Rate the items as described below.
OBJECTIVES
To what extent were the following objectives of this
continuing education program achieved?
1. Discuss the AORN recommended practices for environmental cleaning.
Low 1. 2. 3. 4. 5. High
2. Describe risks associated with infectious pathogens.
Low 1. 2. 3. 4. 5. High
3. Identify factors to consider when selecting cleaning
products. Low 1. 2. 3. 4. 5. High
4. Discuss frequency for cleaning different surfaces.
Low 1. 2. 3. 4. 5. High
5. Describe enhanced cleaning procedures.
Low 1. 2. 3. 4. 5. High
CONTENT
6. To what extent did this article increase your knowledge of the subject matter?
Low 1. 2. 3. 4. 5. High
7. To what extent were your individual objectives met?
Low 1. 2. 3. 4. 5. High
8. Will you be able to use the information from this
article in your work setting? 1. Yes 2. No

582 j AORN Journal 

May 2014

Vol 99

No 5

9. Will you change your practice as a result of reading

this article? (If yes, answer question #9A. If no,
answer question #9B.)
9A. How will you change your practice? (Select all that
apply)
1. I will provide education to my team regarding
why change is needed.
2. I will work with management to change/
implement a policy and procedure.
3. I will plan an informational meeting with
physicians to seek their input and acceptance
of the need for change.
4. I will implement change and evaluate the
effect of the change at regular intervals until
the change is incorporated as best practice.
5. Other: ________________________________
9B. If you will not change your practice as a result of
reading this article, why? (Select all that apply)
1. The content of the article is not relevant to my
practice.
2. I do not have enough time to teach others
about the purpose of the needed change.
3. I do not have management support to make a
change.
4. Other: ________________________________
10. Our accrediting body requires that we verify
the time you needed to complete the 2.0 continuing education contact hour (120-minute)
program: _________________________________

AORN, Inc, 2014