Fluorescent Marker Monitoring and Nurse-Led Feedback for Operating Room Environmental Cleaning: A Quasi-Experimental...

Background: Environmental hygiene in operating rooms is essential for infection prevention, but visual inspection alone may not reliably identify missed cleaning. Aim: To assess the feasibility of fluorescent gel marker monitoring with ultraviolet light, combined with a nurse-led educational and feedback intervention, on the cleaning of high-touch operating room surfaces. Methods: A quasi-experimental, nonrandomized, single-group pre-post study was conducted in five operating rooms of a district general hospital in southern Portugal. Forty-two cleaning episodes and 420 surface assessments were evaluated across three sequential phases: blinded baseline monitoring, post-training monitoring after a 45-min nurse-led workshop, and feedback-based monitoring using an ultraviolet walk-through. The primary outcome was the proportion of surface assessments classified as completely clean. Exploratory Mann-Whitney U tests compared ordinal cleaning outcomes between phases; p-values were nominal and not adjusted for multiple comparisons. Results: Complete cleanliness increased from 44.7% at baseline to 69.3% after training and 89.2% during feedback-based monitoring. The largest observed increases occurred among surfaces with poor baseline performance, particularly anesthesia machine rebreathing bags, IV stands, computer keyboards, and computer mice. Visual inspection identified dust on keyboards and occasional medication residue but missed several surfaces detected by fluorescent marker assessment. Conclusions: Fluorescent marker monitoring with ultraviolet feedback was feasible within the study setting and was accompanied by progressive improvements in the proportion of surfaces classified as completely clean. However, the absence of a concurrent control group precludes attributing these changes exclusively to the intervention. The approach may support nurse-led quality improvement in operating room environmental hygiene.