Download Environmental Cleaning – RN or Team Member [Insert Facility Name]

[Insert Facility Name]
Competency Verification Tool—Perioperative Services
Practice: Environmental Cleaning – RN or Team Member
Name:
Date:
Competency Statement: The perioperative RN or team member has completed facility or health care organization-specific education and competency
verification activities related to practices that provide the patient with a clean, safe environment in the perioperative setting.1
1.
Guideline for environmental cleaning. Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2016.
Outcome Statement: Patient is free from signs and symptoms of infection.2
2.
Petersen C, ed. Infection. In: Perioperative Nursing Data Set. 3rd ed. Denver, CO: AORN, Inc; 2011:254-276.
Verification Method
[Select applicable code from legend at bottom of page]
DEM/
Competency Statements/Performance Criteria
DO/DA
S/SBT/
KAT
CS
RWM/
V
P&P
O
Not Met
(Explain why)
1. Visually inspects the procedure room for cleanliness before case
carts, supplies, equipment, and instruments are brought into the room.
2. Damp dusts all horizontal surfaces including furniture, lights, booms,
and equipment using a clean, lint-free cloth moistened with an
Environmental Protection Agency (EPA)-registered
detergent/disinfectant before the first scheduled procedure of the day.
3. Cleans and disinfects equipment brought from areas outside the
restricted area before bringing it into the procedure room.
4. Implements cleaning and disinfection procedures when needed, in
collaboration with other perioperative and environmental services
personnel.
5. Verifies that all reusable string and microfiber mops and cleaning
cloths are changed after each use.
6. Takes measures to prevent vermin infestation of the environment (eg,
not leaving food out in lounges, keeping doors and windows closed).
7. Cleans or oversees cleaning of procedure rooms after each surgical or
invasive procedure and monitors that properly prepared, EPAregistered disinfectants are used.
DEM/DO/DA
S/SBT/CS
RWM/P&P
=
=
=
Demonstration/Direct Observation/Documentation Audit
Skills Laboratory/Scenario-based Training/Controlled Simulation
Review of Written or Visual Materials/Policy/Procedure Review (Specify P&P #s _________________)
Copyright © 2016 AORN, Inc. All rights reserved. Used with permission.
KAT =
V
=
O
=
Knowledge Assessment Test
Verbalization
Other: ____________________________________________________
Page 1 of 3
[Insert Facility Name]
Competency Verification Tool—Perioperative Services
Practice: Environmental Cleaning – RN or Team Member
Verification Method
[Select applicable code from legend at bottom of page]
DEM/
Competency Statements/Performance Criteria
DO/DA
S/SBT/
KAT
CS
RWM/
V
P&P
O
Not Met
(Explain why)
8. Identifies all items to be cleaned between procedures (eg, all surfaces
of the OR procedure bed, mattresses, positioning devices, tourniquet
cuffs, blood pressure cuffs, transport vehicles, bins, kick buckets,
work surfaces).
9. Verifies that contaminated laundry is placed in designated leak-proof
containers or bags after the procedure is completed.
10. Handles contaminated disposable and reusable items according to
facility or health care organization policies and state and federal laws
and regulations.
11. Monitors that daily terminal cleaning in restricted and semi-restricted
areas includes cleaning of unused rooms, substerile areas, hallways
and floors, scrub and utility areas, and storage areas; wet-vacuuming
or single-use mopping of floors with disinfectant; and disassembly
and cleaning of the cleaning equipment.
12. Monitors weekly or monthly cleaning (eg, heating and air
conditioning vents, sterilizers and loading carts, clean and soiled
utility rooms, walls and ceilings, unrestricted areas, ventilation ducts,
refrigerators and ice machines, scrub sinks).
13. Adheres to standard precautions including the use of personal
protective equipment (eg, gloves, masks, eye protection, face shields)
when cleaning the room and equipment and when handling any
potentially infectious materials (eg, disposing of liquid waste).
14. Performs hand hygiene when gloves are removed and as soon as
possible when hands are soiled.
15. Implements effective cleaning and disinfection methods when caring
for patients infected or colonized with drug-resistant pathogens (eg,
methicillin-resistant Staphylococcus aureus, vancomycin-resistant
enterococci, Mycobacterium tuberculosis) or gram-negative bacteria.
DEM/DO/DA
S/SBT/CS
RWM/P&P
=
=
=
Demonstration/Direct Observation/Documentation Audit
Skills Laboratory/Scenario-based Training/Controlled Simulation
Review of Written or Visual Materials/Policy/Procedure Review (Specify P&P #s _________________)
Copyright © 2016 AORN, Inc. All rights reserved. Used with permission.
KAT =
V
=
O
=
Knowledge Assessment Test
Verbalization
Other: ____________________________________________________
Page 2 of 3
[Insert Facility Name]
Competency Verification Tool—Perioperative Services
Practice: Environmental Cleaning – RN or Team Member
16. Describes the extraordinary cleaning and decontamination processes
used after surgical procedures involving patients diagnosed with or
suspected of having a prion disease (eg, Creutzfeldt-Jakob disease).
17. Completes required documentation related to environmental cleaning
accurately, legibly, and completely according to the facility or health
care organization policies and procedures.
19. Verbalizes a review of facility or health care organization policies and
procedures related to environmental cleaning.
20. Participates in assigned quality improvement activities related to
environmental cleaning.



Concurrent competency verification of the following is recommended
Standard precautions,
 airborne precautions, and
contact precautions,
 droplet precautions,
additional competencies related to environmental cleaning as determined by the facility 
or health care organization.
DEM/DO/DA
S/SBT/CS
RWM/P&P
=
=
=
Demonstration/Direct Observation/Documentation Audit
Skills Laboratory/Scenario-based Training/Controlled Simulation
Review of Written or Visual Materials/Policy/Procedure Review (Specify P&P #s _________________)
Copyright © 2016 AORN, Inc. All rights reserved. Used with permission.
KAT =
V
=
O
=
Knowledge Assessment Test
Verbalization
Other: ____________________________________________________
Page 3 of 3