Authors (including presenting author) :
Mak WF(1), Chan TY(2), Kwan JST(1), Kwok HY(1), Yan LS(1), Lai FY(1), Tsang PY(1), Lai WK(1), Tsung PPK(1), Siu KY(2), Lee CK(1)
Affiliation :
(1) Operating Theatre, Department of Anaesthesia, Pain and Peprioperative Medicine, Prince of Wales Hospital, (2) Department of Obstetrics & Gynaecology, Prince of Wales Hospital
Introduction :
Environmental cleanliness in PWH's Operating Theatre (OT) faces critical challenges, including inconsistent cleaning procedures, ineffective cleaning, and extended overhaul periods due to high microbial counts. The COVID-19 pandemic has emphasized the necessity for effective cleaning workflows. Issues stem from inexperienced staff (12.8% newly hired Operation Assistants (OpAs)), inadequate training, inefficient manpower allocation with 4+ OpAs cleaning a single theatre, and insufficient nursing supervision, highlighting the urgent need for revised cleaning workflows and better workforce management.
Objectives :
This program aims to enhance OpAs' and nurses' knowledge of revised cleaning protocols through structured training, while establishing efficient workflows validated by adenosine tri-phosphate (ATP) swab measurements within specified timeframes.
Methodology :
A PDCA framework guided this project. The Plan phase included baseline assessments of OpAs' knowledge and environmental cleanliness using assessments and ATP measurements. The Do phase implemented evidence-based cleaning workflow changes, assigning two OpAs specific clean/dirty roles, introducing accountable record system, and providing comprehensive training. The Check phase involved continuous monitoring, while the Act phase evaluated program effectiveness through qualitative and quantitative metrics and implemented revised workflows.
Result & Outcome :
Pre-implementation findings identified significant challenges in cleaning workflows, with poor compliance (below 50%) observed in 7 out of 9 target items. Post-implementation data demonstrated substantial improvements, particularly with compliance rates increasing across multiple metrics. Notably, the adoption of 2-OpAs cleaning workflow resulted in compliance rising from 10% to 70%, while understanding of correct cleaning principles improved from 40% to 90%. Additionally, the correct cleaning sequence compliance increased from 40% to 80%, and the classification of clean versus dirty roles improved from 0% to 70%. ATP measurements reflected a reduction in dissatisfactory results from 70-90% to 30% in selected areas, with overall cleaning effectiveness enhancing from 30% to 70%. These outcomes underscore the intervention's success in elevating cleaning standards and staff performance.
Despite these advancements, challenges remained, such as inadequate nursing supervision attributed to time constraints (20% to 50%), unsatisfactory compliance with proper personal protective equipment usage and hand hygiene (20% to 40%), occasional ATP test failures, and extended cleaning time (>15minutes) needed for certain complex operations.
The program improved staff knowledge and compliance through training, establishing efficient cleaning workflows that maintained cleaning times while enhancing performance and standards. Future plans include ongoing education, monitoring, and expanding ATP measurement to other cleaning procedure. These outcomes demonstrate the effectiveness of the intervention in improving both staff performance and environmental cleaning standards.
