Comm Eye Health Vol. 34 No. 111 2021 pp 25-26. Published online 20 July 2021.

Cleaning the operating theatre

Ciku Mathenge

Professor of Ophthalmology: University of Rwanda and Director of Training and Research: Rwanda International Institute of Ophthalmology, Rwanda.

Yadav Ganesh Prasad

Senior Manager (Operation Theatre): Dr Agarwal’s Group of Eye Hospitals, Rwanda.

A member of staff wearing green surgical scrubs, a hair net and a mask, mops the operating floor
Dedicated cleaning equipment is used to clean the surgical area RWANDA Kanagaraj R
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Cleaning the operating theatre is an essential part of keeping patients and staff members safe. Here is how.

Cleaning the operating theatre and its immediate environment minimises patients’ and health care workers’ exposure to potentially infectious microorganisms.

Cleaning happens at various times:

  • When preparing a new operating theatre
  • Every day, before surgery begins
  • Between patients
  • After the last operation of the day (known as terminal cleaning)
  • Deeper cleans are carried out once a week and/or once a month.

All areas must be cleaned: unrestricted, semi-restricted and restricted areas. Start in the operating theatre before moving to the scrub areas, anaesthetic and recovery rooms, and then the sterilising area. The toilet should be done last.

What you will need

Cleaning equipment must be in plentiful supply so that there is a set each for the theatre, the toilet, and ancillary rooms. Sets should be stored separately.

  • Mops and buckets
  • Hard scrubbing brush
  • Rubber pusher to remove excess water
  • Strong disinfectant. This must be a germicidal agent that will kill the majority of microorganisms that can remain dormant on equipment. Check with the pharmacy department what is available and use the best quality at an affordable price.
  • Absorbent dry and wet cleaning cloths
  • Oil for oiling of wheels.

Daily cleaning

A member of staff, wearing green surgical scrubs, a hair net, mask & gloves, wipes down electronic equipment.
Clean all electronic equipment (e.g., phaco machines) according to the manufacturer’s instructions. RWANDA Kanagaraj R

Before the day’s surgery begins

  • Clean the operating theatre every, every morning irrespective of whether it will be used or not.
  • The person cleaning the OT should change into a clean gown, cap, mask, and clean utility gloves.
  • Clean horizontal surfaces by wet wiping with a strong disinfectant. Every horizontal surface should be cleaned in the following pattern: top to bottom, then in to out. A damp cloth with hot, soapy water can also be used to wipe all surfaces, which are then dried using a dry cloth.
  • Clean the patient bed, its attachments, positioning devices, and patient transfer devices thoroughly using a damp cloth.
  • Clean the sterile containers as well as all antiseptic bottles and the trays in which they are kept.
  • Prepare waste bins by inserting colour-coded waste collection bags.
  • When the furniture and equipment are done, clean the floor by removing the excess dirt and dust and then mopping or using a hospital grade wet vacuum and the approved disinfectant. Take care not to agitate the dust, thereby spreading it.
  • Once the operating theatre is clean, keep the door closed for 10–15 minutes with ventilation equipment on.
  • Next, clean the scrub basin, tap, and surrounding walls using soap and water. Check any leaks. Clean the soap and antiseptic solution bottles at the scrub basin. Check that they are full and refill them if needed.Note: This can be done the evening before if the operating theatre is temperature controlled.
A staff member wearing green surgical scrubs, hair net, face mask and gloves wipes the surfaces of an operating microscope.
Clean microscope knobs, nosepiece, levels, control rods, microscope stand and other areas of the device regularly with either a damp cloth or a mild soap if stubborn dirt and oil cannot be removed. RWANDA Kanagaraj R

In between each patient

  • After each operation, clean the soiled areas of the floor by wet-vacuuming or damp-mopping.
  • Clean any furniture and equipment that came in contact with the patient or may have become soiled or damp, including the operating table, surgical lights, blood pressure cuffs, and tourniquets.
  • Damp mop the area of the floor within 1.5 metres of the operating table.
  • Collect and remove waste from the kick bucket and remove all other waste.
  • Replace all bin liners
  • Clean waste from equipment such as suction machines.

At the end of the day, after surgery

  • Use a cloth and hot soapy water to wash all the surfaces, including the tops of operating tables and all stools.
  • Switch equipment off at the mains. Wipe down electrical cables carefully using a cloth dampened with a small amount of alcohol or other disinfectant (to ensure minimal usage of fluid).
  • Clean the legs and wheels of trolleys and tables.
  • Damp dust hanging lights and other items on the ceiling.
  • Clean operating microscopes and operating lenses after each theatre session. Do not clean microscopes or lenses using soapy water, as soap residue can damage the lens. Use a soft, non-abrasive cloth for the lens and a cloth dampened with alcohol or disinfectant for the microscope, including the handles.
  • Clean anaesthesia machines and carts, IV poles, and patient monitors too.
  • Change hand towels, patient sheets, and blankets in the theatre and toilet area after every use.
  • Wash the floor using a mop and disinfectant.

Other areas

  • The toilets and changing rooms must be checked and cleaned throughout the day, and separate cleaning equipment must be kept for the toilets.
  • Tea rooms and kitchens (and the recovery area, if food is given) must be cleaned and all leftover food and crumbs must be removed so that insects are not attracted to the area.

Cleaning tip

Avoid using and storing aerosol cans in the operating theatre as these are flammable and release particles into the air.

Weekly cleaning

  • Remove all articles from shelves and clean all surfaces thoroughly using hot, soapy water. Note: Do not get sterile items wet, as this will make the packaging permeable and therefore no longer sterile.
  • Wash the floor using disinfectant.
  • Wash and dry instrument trolleys, including the wheels and the rungs.
  • Scrub bowls and gallipots.
  • Clean windows inside and outside.
  • Dust high surfaces, such as the tops of cupboards and windowsills, whether they are used or not. This is to prevent the build-up of dust.

Monthly cleaning

  • Move furniture such as cupboards or shelves away from the walls and clean the areas behind and under them. Clean the tops and the inside of cupboards, drawers and lockers. To prevent damage, remove all articles when doing so.
  • Check expiry dates are checked and rotate stock so that items with expiry dates in the near future are at the front.
  • Clean trolleys, IV stands, stools, microscopes, etc. if needed.
  • Wash curtains, if used in recovery areas, at least every three months.

Other considerationss

  • Pest control. Liaise with the administrator and the maintenance team to schedule regular pest inspections and/ or control measures to prevent pests. Any control measures need to be done when the OT is not used. For example, schedule this to take place a day before the weekend or a festival. This means the operating theatre can settle and any issues rectified before it is needed again.
  • Air conditioning units and filters. Ensure they are checked and cleaned, and change the filters as required.

The ‘Three-Bucket’ system

Kabindra Bajracharya Paediatric Ophthalmologist: Lumbini Eye Institute, Lumbini, Nepal.

Disinfectant can be inactivated by the presence of any dirt or biological material (known as ‘soil’) on a surface. For optimal results, it is important that a surface is visibly clean before applying disinfectant.

  1. First, mop the floor (or wipe the surface) with detergent and water solution to get rid of any dirt or grime
  2. Second, mop the floor with plain water to remove any residual detergent that may interact with the disinfectant
  3. Third, once the floor is dry, mop it floor with disinfectant solution, for example, 1% sodium hypochlorite solution. Start mopping from the corner of the room and work towards the door. Back away from the cleaned area.