Mrsa???

RN4NICU, LPN, LVN · Aug 5, 2004

MRSA is Methicillin Resistant Staph Aureus and in surgery YES it absolutely does have to be cleaned in a particular way by housekeeping rather than turned over by the OR staff.

Ideally, MRSA rooms are not used again that day. They are terminally cleaned and the room opens again the next day. MRSA is a very serious infection and could enter the surgical wound of the next patient, causing extensive complications for the patient - as well as a lawsuit for the hospital. It is general procedure everywhere I have worked that an MRSA case closes the room for the day - even if it is the first case of the day (we try to avoid that, of course, but it happened sometimes). We used to tape the door so personnel would not enter the room to borrow supplies.

Terminal cleaning is a complete different procedure than the regular turnover wipe-down. Different cleaning agents are used by housekeeping than are just kept around the OR for room turnover cleaning.

karenG · Aug 5, 2004

now I have a question.........over here we dont operate on a patient with MRSA- surgery is delayed until the infection has been cleared. Are you saying that you do surgery on patients with MRSA? I take by room you are meaning operating theatre??? sorry but your terminology is different to mine at times!

Karen

RN4NICU, LPN, LVN · Aug 5, 2004

now I have a question.........over here we dont operate on a patient with MRSA- surgery is delayed until the infection has been cleared. Are you saying that you do surgery on patients with MRSA? I take by room you are meaning operating theatre??? sorry but your terminology is different to mine at times!
Karen

Yes our rooms (or ORs) are like your operating theatres.

Although we do like to postpone surgery if we can, we do perform surgery on MRSA patients. This is usually a wound debridement type of thing, where the wound will not heal due to the damage from the infection. The surgeries are done in two parts - the dirty part and the clean part. Two sets of instruments are used and the surgeon and scrub team rescrub, regown, reglove, etc - like starting a new case, between the dirty and clean parts as an added precaution.

The wound is debrided during the dirty part. The "dirty" stuff is removed from the field, the wound is covered, everyone breaks and scrubs and the clean part is started, in which the wound is flushed with antibiotic solution, drains are placed, suturing is done, etc.

Willardguy1 · Aug 6, 2004

Well all personnel (set-up crew and "total" crew) know how to clean a room. I guess what I am trying to figure out is should a MRSA room that is done at 1130am (last case) sit there closed for 10 hours or more until the total team comes in and cleans them. Imagine a most discusting surgery room, and how it would be after sitting 10 hours.

Thanks for your advice and opions

**canoehead, BSN, RN** · Aug 6, 2004

We had a similar debate at our hospital about cleaning up after deliveries at night. With no night housekeeping staff the nurses did the clean up and got the room ready for the next patient. If the delivery occured late enough we would just leave it for housekeeping, who would be fairly perturbed that it had been left 4 hours.

Sure it would be ideal for the room to be cleaned right away, but patient care staff have an obligation to take care of the patients first, and cleaning comes in at last or next to last place on a list of about 100 priorities. I imagine the same situation exists at your hospital, that staffing for patient care is tight, and if the room can possibly be left it will be.

If you are talking about other housekeeping staff leaving it for you, then the story is different-I don't see why they can't be trained. Perhaps on the day shift they are looking for high volume turnover. So if someone can do 3 regular rooms in the time it takes to do a terminal clean it would make sense to save the MRSA room for later.

RN4NICU, LPN, LVN · Aug 6, 2004

Also a good point, canoehead

Turnover time is the be-all-end-all of every Surgery department I have ever worked in. MRSA cases are indicated on the surgery schedule and it is planned ahead of time for the room to be down. Nurses do not have time to clean any of the rooms - we have to stay with the patients from holding to recovery. Surgical techs help the OR techs turn the rooms over, but they have to get ready to start their next cases, and the OR techs have all the work they can handle turning the regular rooms over and helping to transport patients between surgery and the outpatient surgery unit.

Willardguy1 · Aug 6, 2004

Well I know that nurses don't have time and neither do the scrubs, but we have 6 aides during the day, and they have plenty of time to clean the MRSA room, so that I am not scraping dried up blood, and who knows what else trying to total the room. I guess it is hard to explain from my end. Having to do it, makes me upset, because that room takes quite a while to clean and clean right. Since I am the only one who totals 7 rooms a night, in an 8 hour period, MRSA's take up a lot more time, especially if they have 2 or more. I love my job, makes me feel important, I guess I just want other people to pitch in when it comes to that, not to make my job easier, but to help out. It is sad that my co-workers (other housekeepers on 1st and 2nd shift cant lend a hand-by the way we are all housekeepers/aides/turnover). I just thought MRSA rooms were more important than other rooms, and I also thought they had to sit for 24 hours after they were cleaned. I guess I need to do more research on this. By the way I would be interested in knowing what your housekeepers use to clean your OR's, and are there betadine stains on your floors? If so, what is used to get them up? We use A-33 for floors and furniture, and bleach on the stains, but the bleach is really bad on me, and I would like to get away from it. I hope I am not bothering you or anyone else with all this babble. I just have questions, and who better to ask then a nurse:nurse:

RN4NICU, LPN, LVN · Aug 6, 2004

well i know that nurses don't have time and neither do the scrubs, but we have 6 aides during the day, and they have plenty of time to clean the mrsa room, so that i am not scraping dried up blood, and who knows what else trying to total the room. i guess it is hard to explain from my end. having to do it, makes me upset, because that room takes quite a while to clean and clean right. since i am the only one who totals 7 rooms a night, in an 8 hour period, mrsa's take up a lot more time, especially if they have 2 or more. i love my job, makes me feel important, i guess i just want other people to pitch in when it comes to that, not to make my job easier, but to help out. it is sad that my co-workers (other housekeepers on 1st and 2nd shift cant lend a hand-by the way we are all housekeepers/aides/turnover). i just thought mrsa rooms were more important than other rooms, and i also thought they had to sit for 24 hours after they were cleaned. i guess i need to do more research on this. by the way i would be interested in knowing what your housekeepers use to clean your or's, and are there betadine stains on your floors? if so, what is used to get them up? we use a-33 for floors and furniture, and bleach on the stains, but the bleach is really bad on me, and i would like to get away from it. i hope i am not bothering you or anyone else with all this babble. i just have questions, and who better to ask then a nurse:nurse:

questions don't bother me a bit :) course i don't always know the answers.

we didn't have any housekeepers in the surgery department on 1st or early 2nd shift. that's why the or techs (like orderlies, but for surgery) would turn over the regular rooms, but housekeeping came in for the mrsa rooms and the terminal cleans. i don't know what it is that they use, our infection control people just told us that they had their own "magic stuff" that is stronger than what we use. we would only have, at most, 1 mrsa room - we couldn't afford to let more than one room go down. we had to keep the open heart rooms open - no mrsa in there, ever! - we had to keep at least one room open for other emergency cases, and then we had our late cases.

we were also told that mrsa rooms had to sit after they were cleaned. housekeeping usually came in around 9pm i think, and the rooms sat overnight - i don't recall offhand, but it seems like those were the rooms that were started late the next day, as well. i've forgotten many of the specifics because i have long since deserted the or for the nicu. nicu sends all its equipment down for equipment techs to clean so the "infected" stuff, when we get it, is treated the same as the regular stuff.

i don't know what was used on our betadine stains, but in some rooms, they were worse than others. you can put cleaner on betadine immediately and it still will not come up without special treatment. it's no surprise that, if left on a patient's skin, betadine will actually cause burns. that is some potent stuff.

wish i could remember more, but i've put much of that info in storage areas of my brain that are now collecting dust, lol. your job is very important, btw, as is that of our nicu equipment techs. it has to be done for the protection of the patients, but without you guys - if the nurses had to do it - we would be taken away from our patients (and the job probably would not get done nearly as well, because we would be so eager to get back to our patients - it's easy to forget about the importance of thorough disinfection when your background is more clinical). i wish all housekeeping personnel were as dedicated as you seem to be. every job is necessary for the hospital to function and it throws a wrench in the works when administration tries to play "musical staff members". each of us is more knowledgeable about our specific function than any other department could ever be - to take us out of our "homes" and pretend that labor is labor actually hurts patient care. that has been the topic of much discussion here on the board, as you've probably seen. it would probably seem pretty petty to someone outside of health care, but when dealing with people's health and well being, not much of anything is petty. ok, i'm rambling now, so i'll stop here.

thanks for all you do! :)