Preparing the room with MRSA patients

[Jane1988]

I work in a small rural hospital with a two bed OR. Our orthopedic and general surgeon frequently schedule cases with known or suspected MRSA organisms to I & D the wound.

For years the OR staff knows to clear the room of any unneccessary equipment in order to avoid any contamination by the infected organism. Recently we had a situation in which this was not done and the patient arrived, too late to clear the room. This brought up a discussion if clearing the room is necessary and recommended by AORN. Unfortunately we have been unable to find this information in our AORN standards book. Any ideas?

Also, related to these types of cases, when we leave the room we take off and throw away our hats, shoe covers, and masks before proceeding down the sterile hall. What is your policy?

[shodobe]

I don't know but this might sound crazy to some, but the only time we specially prepare a room is for Latex sensitive patients. We do try to avoid doing total joints in rooms that have had a recent MRSA patient. We do have one room for totals and generally we have enough empty rooms to do the infected patient. Our infection rate is very good and I can't see a change in the future.

[suzanne4, RN]

There is no special preparation in set-up for a known case of MRSA. If you think of it, many times you do cases and then find out that the patient had an infection after the case was completed. That is why you are not finding things specific to this.

All cases are treated in the same way if infected or not. Only changes are made if a known case of TB where you need to wear an N-95 mask instead of your routine OR mask.

The room should be cleaned the same way between cases, not dependent if the patient was infected or not. Even those that are unexpected, can come back with positive cultures.

[TravORNurse]

In most of the hospitals I've been to, we wear personal protective equipment while dealing with a MRSA pt. Most of the MRSA cases are scheduled for the end of the day so the rooms can be terminally cleaned following the procedure to be ready for the next days work.

[crackerjack]

I don't know where our super got it but she came up with a whole slew of preps for the OR with known MRSA...bane of our existence I tell ya. She claims it is new AORN standards. Aside from removing any unneeded items, we are to use plastic bags that are split and the end cut out to drape and tape in place over equipment, the computer, RN desk, glove racks on the wall, the anesthesia machine and cart (they sooo love that-NOT), missing equipment storage doors-old pyxis cabinets where some of the doors are missing, plus some old c-lockers that are missing the cover or it doesn't stay put when closed. Further, we were using our red biohazard bags for this as the trash bags we have are much to thin and fragile to stand up to being used in this manner and we were told OH NO DON'T USE THOSE---they cost us money, here, use the bags for soiled linens "because we get those free." WHAT?!?!?! I do believe that the linen service is going to catch onto that one eventually.

Additionally, no MRSA/VRE in total joint rooms. No MRSA/VRE ahead of 'non-MRSA/VRE' if can be helped...sorta like putting latex allergy as first case of day after the room was TC'd overnight then before exposed to latex cases. We have this saran-wrap with adhesive backing thing that we peel and adhere to the floor outside the OR room. I hate that film!!!! It is difficult to place without getting down and nearly wallering in the floor. It supposedly kills microbes that may have collected on shoes during a case. Then there's the PPE stuff, lovely yellow gowns on top fo all the extra running and hustling we've done to prep the room now we have to wear extra clothes on our already flushed and sweaty bodies. Last but not least, the non-existent, rarely to be found when one is actually assigned, but mandatory outside circulator so you don't track the evil bugs outside your now offensively contaminated OR when the doc calls for something that isn't in the room.

I hate known MRSA/VRE cases.

[ewattsjt]

we simply do the same thing as normal, like suzanne4 says. we change our caps etc… but our main difference is that the patient is recovered in the or room. once the patient is transported back to their room, our or room is terminally cleaned like at the end of the day.

[shodobe]

We have this saran-wrap with adhesive backing thing that we peel and adhere to the floor outside the OR room. I hate that film!!!! It is difficult to place without getting down and nearly wallering in the floor. It supposedly kills microbes that may have collected on shoes during a case.

I hate to tell you but the saran wrap junk goes back 20 years or more. We use to tape down a blanket and saturate it with something so when entering or leaving shoes would leave junk.. We DO NOT do anything special when we get patients with MRSA and we have a very good infection control issue. How many patients go through your OR weekly that you do not know anything about? Overkill can be a real problem and I think you super is overdoing it. Like posted above we do not schedule Totals in rooms that have had infected cases in them, that is the only exception.

[ewattsjt]

Oh, no totals or spines either. Sorry.

[boriquarn]

Honesty, every patient/case should be treated like it was potential MRSA/HIV/Hepatitis etc.--- Check with your infection control nurse for your facility policies and standards.

MRSA lives everywhere in the hospital and your standard precautions, appropriate cleaning techniques should cover it.

[Online660534]

Honesty, every patient/case should be treated like it was potential MRSA/HIV/Hepatitis etc.--- Check with your infection control nurse for your facility policies and standards.

MRSA lives everywhere in the hospital and your standard precautions, appropriate cleaning techniques should cover it.

I agree with this attitude. In South Africa, most of our rural hospitals have a 90% rate of HIV/AIDS or TB/XDR TB. The provincial hospitals - to a lesser degree - face much the same statistics. Abscesses due to HIV/AIDS are on the daily slate for incision and drainage. Our infection control departments are clued-up and can usually sort out any MRSA problems before they arise. We do however, have an OR that is only used for I & D's so that narrows it down to only one room being contaminated.

[umakemesmile]

I work in a small rural OR. We used to do the whole empty room thing too, last case of the day, terminal cleaning etc.

New thinking is that MRSA is treated as any other. Universal Percautions. All OR rooms cleaned after case and terminal cleaning at end of day. However, sacred cows die hard. I tend to pay special attention to area of affect. That is I take extra precautions depending on site i.e. urine,foot,respiratory. And let those helping with turn over know we need extra attention when cleaning.(i know we should ALWAYS clean the same way, but it's my way of calling attention to the problem)

[Chianastar]

In Uk we treat as per universal precautions. After each case the theatre is cleaned with whatever the 'in' agent is at the present time and also scrubbed thoroughly once per day.