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Hi Michael,
Indeed a very interesting and often vexed topic for Infection Control! I also have ethical issues around providing second rate treatment to patients infected or colonised with an MRO by basing treatment decisions on their MRO status rather than their clinical need. How often do I hear the excuse that a patient had to be put last “because of infection control”?
We have been working with our theatre staff recently to research and review the approach to things such as relative placement on a theatre list when the patient has an MRO or other transmissible infectious condition. One of the issues that we clearly identified is not related to management of the MRO, rather it is poor compliance with standard precautions by medical staff (anaesthetic staff in particular it appears). This includes things such as diving a soiled hand/glove into the “Waterloo” trolley for intubation/anaesthesia, thus contaminating other items in this trolley. When you interrogate the decision to place patients with known MROs last on a list is more likely because staff are unable to consistently comply with basic infection control measures rather than a clear evidence base around the risk if basic controls can be implemented/adopted.
We considered these challenges and have really had to consider how to get consistent buy in from the medical staff and how to prevent breaches, the solution is not yet clear to me and really the major challenge is getting compliance with standard precautions within the operating suite. As I say, we have finally agreed that whilst the measures you put in place around the “known” risk might be relatively robust we are still left with questions about the risk associated with a patient whose MRO status is not known. Our protocol is not yet finalised but I would be happy to share the draft document with you or any other list subscriber. By the way, we expressly do not recommend that a patient with a known MRO colonisation/infection be placed last on the procedural list! I would welcome any comments or feedback from members if I make this available. Please let me know if you would like a copy of our draft protocol for the management of patients with MRO in theatre.
Cheers
Rachel
Rachel Thomson
Nurse Unit Manager
Infection Prevention & Control Unit
Royal Hobart Hospital
E: rachel.thomson@dhhs.tas.gov.au
—–Original Message—–
Hi all
Just trying to see what the current thoughts are in regard to management of patients with multi resistant organisms in procedural areas. Do most facilities still have ‘special cleaning’ after procedures on patients colonised or infected with MRSA, ESBL and MRGN’s? I would assume that most facilities would still have special cleaning following procedures on patients colonised or infected with VRE.
In my opinion, provided we have a good process for cleaning the immediate environment between cases, ‘special cleaning’ for MRSA / ESBL / MRGN is not necessary, and these organisms should be easily removed with normal cleaning techniques. The opportunities for widespread environmental colonisation from patients in procedural areas where patient movement is severely controlled is reasonably low, unlike in ward accommodation situations. VRE as an environmentally hardy organism requires a different approach, however. Does anyone else use this approach?
Also, should all MRO patients always be placed last on a list?
Any expert opinions out there?
Thanks
Michael
Michael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3326 3523
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
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