Infection control nurses, we OR nurses need your expertise!

[stevierae]

I wonder if some kind soul from this discussion area would drop into the operating room nursing area and tune in to the MRSA discussion? This issue comes up all the time, and, especially in the operating room, I am wondering if what we are told to do is little more than voodoo.

Thanks. Below appears the original question and my own response; there are more. We look forward to your input.

Originally posted by carcha

In our or when we have an MRSA, patient, we clear the room or non essential furniture, have two clean nurses in the or and one to circulate outside. when we finish we recover the patient in the or and then we shower and change while the or is cleaned and the walls are washed down. Is our practice up to date, over the top, rubbish or what. What do u do?

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Carcha, I have worked in ORs where they do as you described with MRSA and VRE patients--even one where they had engineering come in and do something weird to the ventilation system, so that the air in the room was exhausted to the outside (literally, OUTDOORS, or so they said) but I don't know that any of that was necessary. or if they were following any infection control guidelines by doing so.

They also made a big point of telling housekeeping, "This patient had MRSA (or VRE)" whether houskeeping did anything different, I don't know. Maybe they cleaned everthing with bleach. I always thought, with universal precautions we treat every case as an infectious case, so why do we have to do anything different with MRSA or VRE?

Also, they used to change the soda lime canisters on the anesthesia machines after any MRSA or VRE patient, and did not use the room for the rest of the day; even after terminal cleaning and even if it caused the schedule to get behind (letting a perfectly good room go to waste.)

Somehow, I think the overkill is similar to what we saw in the early '80s with AIDS patients--people tend to freak out when they are uninformed or underinformed about a disease process--with AIDS, however, we really WERE uninformed, as HIV had not yet been pinpointed as the cause.

One thing I do agree with is recovering these patients in an isolation room in PACU--I figure it can't hurt if one is available--but it may not be at all necessary, as long as universal precautions are followed.

I don't know--I've never seen any written infection control guidelines, at least hospital or unit based ones, that say one way or another if isolation is necessary--I think they are in isolation rooms in ICU (these patients are usually pretty sick, and immunocompromised for other reasons, so I think the rationale for isolation is to protect THEM from the many bugs in an ICU setting--not because of paranoia on the part of the staff surrounding MRSA or VRE.)

I wish an infection control nurse would drop in to this discussion area and give us her thoughts.

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[ecugirl]

To determine what you need to do to prevent the transmission of MRSA or VRE, you must understand WHAT it is. MRSA is transmitted no differently that Staph aureus would be...that is, on your unwashed hands or contaminated equipment or clothing. It is a skin organism that sets up house in the patient's nose, armpits, groin, and skin/hair....just like Staph aureus does. VRE lives in the GI tract; just like Enterococcus does.....we just are limited now with what drugs will kill MRSA/VRE. Both are transmitted by contact...you pick it up and hand it over to the next patient....if you don't wash your hands or clean your equipment.

The same staff can work with a MRSA/VRE patient as with any patient in the OR; if contact precautions are maintained during the procedure...meaning, you wear gloves and a isolation or cover gown to protect your clothing. MRSA/VRE will not go thru your cover gown worn in a case, so you don't need to wear the isolation gown over it (like the scrub). As with any patient, you would change gloves and wash hands when going from a "dirty" area to a "clean" area on the same patient. The circulator and CRNA or anesthesiologist would also need to wear gloves and an isolation gown also because they will be touching the patient or what the patient has touched. Basically, if you are going to touch the patient or any equipment (I'm talking more about the OR table and linens that are in direct contact with the patient that you might brush up against) used on the patient, you need to wear a "barrier" like gown or gloves.

We do recommend that MRSA or VRE patients be scheduled as the last case of the day; if possible and terminally clean the room. It does not have to sit empty for any time because the organism is not airborne. We recommend terminal cleaning because we know that we may not remember all areas/equipment in the OR that we may have touched with our contaminated gloved hands.....but we dont' go so far as washing the walls down....who's touching the walls during a case???

Hope this helps and sorry if I got too "basic" with you....but I've found that most people understand how to prevent the transmission once they understand the organism....from an Infection Control Practitioner

[pettyfoot]

I only have one comment about your discussion. I agree with most of what was said, but, MRSA and VRE can be isolated to the respiratory tract and then it can be airborne. Universal precautions must be used and waiting till the end of the day can help prevent you from losing that surgery room all day.

[MRhodes]

I have another comment about VRE. just keep in mind VRE can survive up to two weeks on enviromental surfaces for 2 weeks or longer, so good terminal cleaning is esential after these cases. Please contact me if further info is needed.

An IC Nurse

[email protected]

[buggal1989]

I have another comment about VRE. just keep in mind VRE can survive up to two weeks on enviromental surfaces for 2 weeks or longer, so good terminal cleaning is esential after these cases. Please contact me if further info is needed.

An IC Nurse

[email protected]

My e-mail is now [email protected]