DEMONSTRATE

THE PROCEDURE
OF TERMINAL
CLEANING

GROUP 2
TEAM MEMBER
L IFIA
O
THEN MEI NEE

LORITA

NORHAFIZA
H NUR HASMIZAH
DEMONSTRATE/SHOW
STEPS
 1. INITIAL CLEANING/PRELIMINARY CLEANING
 2. CONCURRENT/INTERIM-CLEANING OF

OPERATING ROOM.
 3. TERMINAL CLEANING
 4. DECONTAMINATION OF SPILLAGE
 5. MANAGEMENT OF USED SURGICAL

INSTRUMENTS.
 6. MANAGEMENT OF USED DRAPES
 7. MANAGEMENT OF CLINICAL WASTE
 OPERATING ROOM
CLEANING
I) PRELIMINARY CLEANING
II) CONCURRENT CLEANING
III) TERMINAL CLEANING
 TYPES OF CLEANING IN
OPERATING ROOM
1. Damp dusting (Preliminary/Initial Cleaning)
 Perform in the morning one hour before first case
start.
 It also apply before surgical supplies are brought into
the OR.
2. End of procedure cleaning and disinfecting
(Concurrent / interim Cleaning)
 cleaning and disinfecting between every patient during
the day.
3. Terminal cleaning and disinfecting
 cleaning and disinfecting done at the end of the day /
after all cases done(eg:elective ot)
 1. INITIAL CLEANING/PRELIMINARY
CLEANING
 Use a clean, low-linting cloth moistened with
disinfectant.
 Damp dust early in the morning before additional items
or equipment are brought into the room
 Damp dust follow the sequences and principle like from
top to bottom, higher to lower , clean to dirty.

Why need damp dust?

 removes dust from horizontal surfaces
 INITIAL CLEANING
PREPARATION:

1. Tablet “Dichlosep” @ “Precept” with right

dilution.
2. Use a clean, lint-free cloth
3. Operating room personnel wear PPE(Personal
Protective Equipment)
 PROCEDURE/STEPS
 Remove unnecessary tables and equipment from the room.
Arrange the appropriate furniture in an organized manner away
from the traffic pattern.
 Start at higher surfaces and work down in a clockwise @
counter clockwise cleaning.
1. OT Light
2. Wall/ Outlet channel
3. All equipment such as trolley, portable or mounted equipment
4. Tools & furniture
5. OT Table
6. Floor
 1
2
6

PRELIMINARY CLEANING
OR
INITIAL CLEANING
3

5
4
2. CONCURRENT CLEANING
(Cleaning Operating Rooms in between Cases)
 Cleaning and disinfecting the OR or procedural room
between patients throughout the day
 Also called as “room turnover cleaning”
 This step is very important to stopping the spread

of germs from one patient to the next patient.

 It can decreases the amount of germs in the
environment
 CONCURRENT CLEANING
(In between each cases)
PREPARATION
 Tablet “Dichlosep” @ “Precept” dilute as order
 Special mop use only inside OT
 STERISORB POWDER ( for spillage usage)
 Operating personnel wear PPE
 Equipment and Supplies
 Gather the correct equipment and supplies needed to clean and
disinfect the operating room :

-detergents and disinfectants (check the expiration

date)
-low-linting cloths
-mop
-single-use disposable wipes
PROCEDURE/STEPS
 Cleaning done only at operating site and around/ nearest
operating table follow sequences below :

1. OT LIGHT
2. EQUIPMENT LOCATED NEAREST THE
OPERATING TABLE.
3. WALL / OUTLET CHANNEL
4. OT TABLE
5. FLOOR AROUND OPERATING TABLE
CONCURRENT CLEANING
2. WALL & OURLET 3. EQUIPMENT NEAREST OT
1. OT LIGHT CHANNEL TABLE

4. GA MACHINE 5. OT TABLE 6. FLOOR

CLEANING OR
in the OR or Procedural Room
What should be cleaned first?
 Clean from
 top to bottom
 clean to dirty areas

 Clockwise or counter-clockwise cleaning may be

performed when used along with clean-to-dirty
and top-to-bottom cleaning methods
3. TERMINAL CLEANING
(At the completion of the day’s schedule each OR)
 Terminal cleaning and disinfection of the OR and
procedural areas should be performed at the end of
the day every day when the area is in use
 HOW TO PERFORM?

Clean and disinfect all exposed surfaces

including wheels and casters
all equipment in the room
Move the equipment around the room to
clean the floor underneath
SCHEDULED CLEANING
 Not all areas in the OR and procedural areas are
cleaned daily
 Each facility will decide how frequently these
areas should be cleaned
 A weekly or monthly cleaning routine is set up, in
addition to the daily cleaning schedule, by the
director of environmental/housekeeping services
and Operating room manager.
PREPARATION
USE RIGHT DILUTION OF
DISINFECTANT.
MOP WITH RIGHT COLOR CODE.
STERISORB POWDER.
OPERATING ROOM PERSONNELS USE
PPE.
PROCEDURE/STEPS
 Decontaminating clinical waste first, after that change gloves
 Cleaning start from clean area to dirty area as the following
sequences:-
1. WALL/CEILING/ OUTLET CHANNEL
2. GA MACHINE
3. ALL INSTRUMENT/EQUIPMENT INSIDE OPERTAING
ROOM.
4. OT LIGHT
5. OT TABLE
6. FLOOR
 STEPS OF TERMINAL CLEANING

4.GA MACHINE
2. WALL
1. CEILING
3. OUTLET

7. OT TABLE

6. OT LIGHT
5. OTHERS
8. FLOOR
 DILUTION OF DICHLOSEP
 DISCHLOSEP/PRISEPT DILUTION
DISCHLOSEP/PRISEPT WATER (LITRE)
1 ½ TABLET 15L
1 TABLET 10L
½ TABLET 5L
 BLOOD SPILLAGE
DISCHLOSEP/PRISEPT WATER
7 TABLET 1 LITRE
 BIOHAZARD

DISCHLOSEP/PRISEPT WATER (LITRE)

4 TABLET 5L
2 TABLET 2.5L
 COLOUR CODE OF MOP
 TOILET , DIRTY ULITY,SLUICE ROOM

 GENERAL AREA
 LOBBY, CORRIDOR, STAIR, OFFICE, STORE,
BALCONY

 ALL WARD, CLINIC (MEDICALS WARD)

 OPERATION THEATRE/ROOM, PHARMACY,BLOOD

BANK, BURN UNIT, LABOUR ROOM, ALL ICU,
A&E, DENTAL DEPARTMENT, IODINE ROOM,
ISOLATION ROOM.

 MOP FLOOR ONLY

DECONTAMINATION
OF SPILLAGE
DECONTAMINATION OF
SPILLAGE
Types of spillage
a) Small Spillage
b) Large Spillage
DECONTAMINATION OF
SPILLAGE
TYPE OF SPILLAGE:
A. BLOOD
B. BODY FLUID EG; URINE, BODY
SECRECTION , MUCOUS
C. CHEMICAL EG; MERCURY

STANDARD PRECAUTION APPLIED INCLUDING USE

OF PPE WHEN HANDLING WITH THE SPILLAGE.
 Cleaning Spills of Blood and Body Fluid
Procedures for dealing with small spillages example splashes and droplets.

Gloves and a plastic apron must be worn

while procedures.
 The area should be wiped thoroughly using
disposable paper roll / towels.
 The areas should be cleaned using a neutral
detergent and warm water.
Cleaning Spills of Blood and Body Fluid
Procedures for dealing with small spillages example splashes and
droplets
Recommended concentration of Precept (1 tab
in 2.5 water liters) to decontaminate surfaces.
Used gloves, apron / towels should be
disposed in yellow waste bag.
 Wash hands after procedures.
 Cleaning Spills of Blood and Body Fluids
Large blood spills in 'dry' areas (such as clinical areas)

 If possible , isolate the spill area

The area must be vacated for at least 30 minutes.
 Wear protective equipment like disposable
cleaning gloves, eyewear, mask and plastic apron
Cover the spill area with paper towels / powder.
Cleaning Spills of Blood and Body Fluids
Large blood spills in 'dry' areas (such as clinical areas)

Place all contaminated items into yellow plastic

bag or in sharp container for disposal
Pour (3.5 tab Presept in 1 water liter)solution and
allow 10 minutes to react then wipe up
Decontaminated areas should be cleaned
thoroughly with warm water and neutral
detergent .
Cleaning Spills of Blood and Body Fluids
Large blood spills in 'dry' areas (such as clinical areas)

Follow this decontamination process with a

terminal disinfection.
Discard contaminated materials (absorbent
toweling, cleaning cloths, disposable gloves
and plastic apron).
 Wash hand after procedure.
Management of
Used Instruments
 5. MANAGEMENT OF USED
SURGICAL INSTRUMENTS
1. PRE SOAKING AND PRE RINSING
2. CLEANING
3. LUBRICANT
4. INSPECTING AND TESTING
5. INSTRUMENT MARKING
 USINGSOLUTION (PROTEOLYTIC ENZYME) TO
MANAGEMENT OF USED SURGICAL INSTRUMENTS
PREVENT BLOOD AND DEBRIS FROM DRYING
1. PRE SOAKING/ PRE RINSING

ON INSTRUMENT.
MANAGEMENT OF USED SURGICAL INSTRUMENTS

2. CLEANING

 A) MANUAL CLEANING
INSTRUMENTS ARE WASHED BY HAND IN THE PROCESSING
AREA TO REMOVE RESIDUAL, BLOOD AND DEBRIS
 B)WASHER DECONTAMINATOR

CLEANS WITH A SPRAY FORCE ACTION.

 C) ULTRASONIC CLEANING

USING HIGH FREQUENCY SOUND WAVES, ULTRASONIC

ENERGY THOROUGHLY CLEANS BY A PROCESS OF
CAVITATION
 MANAGEMENT OF USED SURGICAL INSTRUMENTS

3. LUBRICATION

 INSTRUMENTS SHOULD BE LUBRICATED WITH NON

SILICONE, WATER SOLUBLE LUBRICANT TO CREATE
A THIN FILM ON THE INSTRUMENTS SURFACE.
 MANAGEMENT OF USED SURGICAL INSTRUMENTS

4. INSPECTING AND TESTING

 INSPECT
INSTRUMENT FOR ALIGNMENT AND TEST
FOR SECURITY AND PRECISION
 MANAGEMENT OF USED SURGICAL INSTRUMENTS

5. INSTRUMENT MARKING

 TAPEIS WRAPPED AROUND THE CIRCUMFERENCE

OF INSTRUMENTS HANDLE AS MARKING FOR
IDENTIFICATION
Management of Used Instruments.
All instruments used during
surgical procedures will be
returned to CSSU for
reprocessing in a manner that
minimizes risk to all staff
handling the contaminated items.
 METHOD
 All instrumentation used will be accounted for and
returned to its original tray at the end of each operative
procedure.
  All disposable items will be removed and safely
disposed off.
  It is the scrub person’s responsibility to ensure that all
sharps are removed and discarded.
  Instruments which may potentially cause injury will be
closed if possible e.g. ratcheted items, or placed within a
receptacle e.g. diathermy point should be placed inside
CONT..
 If sets are required to be
reprocessed quickly, the theatre
team will telephone TSSU/SSD as
soon as the sets is available to
request urgent turn around.
MANAGEMENT OF
USED DRAPES
6. MANAGEMENT OF USED
DRAPES
SURGICAL DRAPING

 The procedure of covering patient with a sterile barrier to

create and maintain a sterile field during a surgical procedure
is called draping.

 The purpose of draping is to eliminate the passage of

microorganisms between sterile and non-sterile areas.

 Draping materials may be disposable or non-disposable.

Cont….
*Disposable drapes are
generally paper or plastic or a
combination and may or may
not be absorbent.
Cont…
Non disposable drapes
are usually double
thickness muslin.
DRAPING MATERIAL
CHARACTERISTIC
Are selected to create and maintain an effective barrier that
minimizes the passage of microorganisms between sterile and non-
sterile areas.
To be effective, a barrier material is resistance to blood, aqueous
fluid, and abrasion as lint free as possible.
Maintain isothermic environment that is appropriate to body
temperature.
Meet the requirement of the current National Fire Protection
Association Standards so that no risk from a static charge exists.
Fabric draping materials must be penetrable by steam under
pressure or by gas to achieve sterilization within hospital facilities.
 TYPES OF DRAPE
1. Towels
 They must be used to outline the operation site. The folded edge of each
towel is placed on the line of incision.
2. Laparotomy sheets
 Often called a lap sheet, operating room sheet. Has a longitudinal opening at
the center that is placed over the operative site on the abdomen, the back or
a comparable area. Long enough to cover anesthesia screen at the head and
extend down over the foot of the table.
3. Medium sheet/small sheet
 Use to drape under legs as an added protection above or below the operative
area or for draping area in which a fenestrated sheet cannot be used.
4. Perianeal sheet
 A sheet use to be an adequate sterile field with the patient in lithotomy

position.
CONCERNING DRAPES
 Whenever packaged for sterilization,
drapes must properly folded and
arranged.
  Drapes should be sufficiently thick
to prevent from soaking through them.
  The entire team should be familiar
with the draping procedures.
 ADVANTAGE DISADVANTAGE

 Cut cost  Flammable

 Washable  Worn out & faded
 Usually for bio hazard cases
NON DISPOSABLE  Maintain normal body temperature
DRAPES /  Reducing waste from OR
REUSABLE
DRAPES

 Save time  High costing

 Inflammable  Non friendly users
 Reducing contamination

DISPOSABLE DRAPES
PROCESS DISPOSAL USED
DRAPES/LINEN
1-Segregation of Linen:
 It is the responsibility of the person disposing of the linen to ensure that it
is segregated appropriately. All linen may be segregated into the following
three categories:
i) Clean / Unused Linen
ii) Dirty / Used Linen
iii) Soiled / Infected Linen
Clean / Unused Linen:
 Clean linen must be in a state of good repair, as tearing or roughness can
damage the patient’s skin. The condition of the linen in use should be
monitored by Operating room personnel. Linen should also be free from
stains and excessive creasing and should be acceptable to both patients
and staff.
Cont…

Dirty / Used Linen:

 Linen which is used but dry: Dirty / Used linen must
not have been:
i) visibly soiled with blood or bodily fluids
ii) used on source-isolated patients.
 Dirty / Used linen should be placed directly into a
clear plastic laundry bag.
i) Linen bags should be no more than 2/3
full.
Cont…
Soiled / Infected Linen:
 Any used linen that is soiled with blood or any other body
fluid or any linen used by a patient with a known infection
(whether soiled or not).
 Soiled / Infected linen should be placed directly into a RED
water-soluble alginate bag and secured, then placed into a
WHITE (hire items), BLUE (hospital owned items), GREEN
(Surgical gowns/drapes) or BROWN (curtains) outer bag.
i) Linen bags should be no more than 2/3 full
ii) Never rinse or sluice contaminated laundry
iii) Dirty or soiled linen bags should be stored in
‘dirty’ linen cages and not on floors
Cont…
This includes patients with or suspected:
i) MRSA
ii) Extended Spectrum beta-lactamase (ESBL) or Carbapenemase producing
organisms
iii)Human Immunodeficiency Virus (HIV)
iv)Hepatitis A, B or C
v) Draining Tuberculosis (TB) lesions and open pulmonary TB
vi) Enteric Fever
vii) Dysentry (Shigella spp)
viii)Salmonella
viiii)Norovirus
x) Clostridium difficile
xi) Chickenpox
xii) Head or body lice, scabies
xiii) Other notifiable diseases
Handling Linen
 Do not place used linen on the floor or any other surfaces e.g. a
locker/table top
 When beds or curtains are changed all open wounds/drains etc need
to be temporarily covered during linen changes.
 Do not shake linen into the environment
 Do not change linen during wound dressings in the same area
 Use PPE when handling dirty linen.

 Care must be taken to ensure that no sharps or non-laundry

items are included with dirty linen before it is placed ready for
laundering. Such items are potentially dangerous to staff
handling the laundry.
7. MANAGEMENT OF
CLINICAL WASTE
Definitions of clinical waste :
MANAGEMENT OF CLINICAL WASTE

• Any waste which consists wholly or partly of

human or animal tissue, blood or other body fluids,
excretions, drugs or other pharmaceutical products,
swabs or dressings, syringes, needles or other sharp
instruments, being waste which unless rendered safe
may prove hazardous to any person coming into
contact with it.
 Handling of Waste
1. Personal protection equipment – (Gloves,
goggles, face shield etc)
2. Procedures/Precautions in handling,
packaging transporting and storage
3. Appropriate label - Labels for the
containers
4. Recommended Method of Disposal
Major classification of clinical waste
and its recommended management
guidance in
Malaysia
 1. Blood and body fluid waste
(i) Soiled surgical dressings, e.g. cottonwool, gloves,
swabs. All contaminated waste from treatment area.
Plasters, bandages which have come into contact with
blood or wounds, cloths and wiping materials used to
clear up body fluids and spills of blood.
(ii) Material other than reusable linen, from cases of
infectious diseases (e.g. human biopsy materials, blood,
urine, stools)
CONT..
 iii. Pathological waste including all human tissues
(whether infected or not), organs, limbs, body
parts, placenta and human fetuses and all related.
.
 2. Waste posing the risk of injury
("sharps"),
 All objects and materials which are closely linked with
healthcare activities and pose a potential risk of injury and/
infection, e.g. needles, scalpel blades, blades and saw, any
other instruments that could cause a cut or puncture.
Management
 Collected and managed separately from other waste. The
collection container; must be puncture resistant and leak
tight. This category of waste has to be disposed/ destroyed
completely as to prevent potential risk of injury / infection.
Figure 2.2 : Flow Chart Disposal Of Infectious Clinical Wastes Start

Infectious Clinical Waste Non-

Sharp
sharps

Sharp Yellow waste bag

Central Collection Area

Incineration

End
THE END