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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
MichaelMichael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside,Qld4032
t: (07) 3326 3068 | f: (07) 3326 3523
e:Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
Please consider the environment before printing this email—
WARNING : This email contains information, which is CONFIDENTIAL, and that maybe subject to LEGAL PRIVILEGE. This e-mail and any attachments to it (the “Communication”) is confidential and is for the use only of the intended recipient, and may not duplicated or used by any other party without the express consent of the sender. The Communication may contain copyright material of St Vincent’s Health & Aged Care(“SVHAC”), or any of its related entities or of third parties. If you are not the intended recipient of the Communication, please notify the sender immediately by return e-mail, delete the Communication, and do not read, copy, print, retransmit, store or act in reliance on the Communication. Any views expressed in the Communication are those of the individual sender only, unless expressly stated to be those of SVHAC. SVHAC does not guarantee the integrity of the Communication, or that it is free from errors, viruses or interference. Thank-you.Message protected by MailGuard: e-mail anti-virus, anti-spam and content filtering.http://www.mailguard.com.au/mg
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Hi Michael,
I find this interesting also.
I use a procedureal area for CVAD insertion, seeing up to 5-8 patients a day.
Quite often, these have an MRO (incl VRE) and I often see these patients towards the end of the day after the ‘non-infectious’ patients.
50% of my patients are immuno-compromised and so I triage my requests lists based around immune and infection status.
Between non-infectious patietns, we don’t get regular decontamination done, however do so after each MRO patient.
What I’d like to know is it necessary to decontaminate betwween patietns who have the same strain of MRO?
My procedureal bay is a large isolation room in our ICU that is NOT used for anythign except my procedures.
I get our after hours cleaner to do the room at the end of the day also.
Interested in hearing peoples thoughts on this also.
Regards,
Tim..
Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert.
Clinical Nurse Consultant | Central Venous Access & Parenteral Nutrition Service
Conjoint Lecturer, University of NSW
Dept of Intensive Care, Level 2, Clinical Building, Liverpool Hospital, Elizabeth Street, Liverpool, 2170, NSW, Australia
Tel 02 8738 3603 | Fax 02 8738 3551 | Mob 0409 463 428 | Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.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
MichaelMichael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside,Qld4032
t: (07) 3326 3068 | f: (07) 3326 3523
e:Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
Please consider the environment before printing this email—
WARNING : This email contains information, which is CONFIDENTIAL, and that maybe subject to LEGAL PRIVILEGE. This e-mail and any attachments to it (the “Communication”) is confidential and is for the use only of the intended recipient, and may not duplicated or used by any other party without the express consent of the sender. The Communication may contain copyright material of St Vincent’s Health & Aged Care(“SVHAC”), or any of its related entities or of third parties. If you are not the intended recipient of the Communication, please notify the sender immediately by return e-mail, delete the Communication, and do not read, copy, print, retransmit, store or act in reliance on the Communication. Any views expressed in the Communication are those of the individual sender only, unless expressly stated to be those of SVHAC. SVHAC does not guarantee the integrity of the Communication, or that it is free from errors, viruses or interference. Thank-you.Message protected by MailGuard: e-mail anti-virus, anti-spam and content filtering.http://www.mailguard.com.au/mg
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Hi Michael,
In my facility and some of those Ive previously worked in staff in procedural areas are instructed to do a ‘spot clean’ with the appropriate disinfectant post MRO patient. A terminal clean is only required if there is widespread contamination of the environment. The rationale is that the patient isn’t in the procedural area for very long and cleaning the surfaces with the appropriate solution is sufficient to break the chain of infection
However placing patients last on the list is something that causes much angst as far as Im concerned. I do not encourage this as patient’s are being discriminated against according to MRO status. Also there should be no need to place the patient last on the list as the work area should be cleaned in between each patient and the only difference with a MRO patient is the choice of cleaning product. Also there is risk to the patient placing them last on the list in that when procedural lists are running sometimes they are late and often patients get cancelled. Its been my previous experience that a MRSA patient was to go for a amputation of a MRSA infected foot and was placed last on the list in surgery and got cancelled 3 times. He developed a MRSA bacteremia and subsequently died. So I feel very strongly against placing patients last on the list as it has the potential to impact on patient outcomes, when there should be no difference in care of the patient in terms of cleaning the environment ie choose a disinfectant and ‘spot clean’.
Hope this helps
Louisa
Regards
Louisa
CNC Infection Control
Ph 985 87664
M 0434323266
Pager 54581>>> Michael Wishart 23/08/2012 8:32 am >>>
Hi allJust 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
MichaelMichael 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
Please consider the environment before printing this email—
WARNING : This email contains information, which is CONFIDENTIAL, and that maybe subject to LEGAL PRIVILEGE. This e-mail and any attachments to it (the “Communication”) is confidential and is for the use only of the intended recipient, and may not duplicated or used by any other party without the express consent of the sender. The Communication may contain copyright material of St Vincent’s Health & Aged Care(“SVHAC”), or any of its related entities or of third parties. If you are not the intended recipient of the Communication, please notify the sender immediately by return e-mail, delete the Communication, and do not read, copy, print, retransmit, store or act in reliance on the Communication. Any views expressed in the Communication are those of the individual sender only, unless expressly stated to be those of SVHAC. SVHAC does not guarantee the integrity of the Communication, or that it is free from errors, viruses or interference. Thank-you.Message protected by MailGuard: e-mail anti-virus, anti-spam and content filtering.http://www.mailguard.com.au/mg
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Hi Tim,
In reply to your message, Ive already posted a message through the AICA list.
All environmental surfaces that come into direct contact or indirect contact with the patient should be cleaned in between each patient. So with non-MRO patients this should be a neutral detergent and with MRO’s an appropriate disinfectant.
Yes you should clean appropriately in between each patient with the same MRO strain and the reason for this is the patient will have other flora that is unknown to the HCW. They could have other MRO’s. So the environment/equipment must be cleaned with the appropriate solution.
Regards
Louisa
>>> Tim Spencer 23/08/2012 8:49 am >>>
Hi Michael,
I find this interesting also.
I use a procedureal area for CVAD insertion, seeing up to 5-8 patients a day.
Quite often, these have an MRO (incl VRE) and I often see these patients towards the end of the day after the ‘non-infectious’ patients.
50% of my patients are immuno-compromised and so I triage my requests lists based around immune and infection status.
Between non-infectious patietns, we don’t get regular decontamination done, however do so after each MRO patient.
What I’d like to know is it necessary to decontaminate betwween patietns who have the same strain of MRO?
My procedureal bay is a large isolation room in our ICU that is NOT used for anythign except my procedures.
I get our after hours cleaner to do the room at the end of the day also.
Interested in hearing peoples thoughts on this also.
Regards,
Tim..
Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert.
Clinical Nurse Consultant | Central Venous Access & Parenteral Nutrition Service
Conjoint Lecturer, University of NSW
Dept of Intensive Care, Level 2, Clinical Building, Liverpool Hospital, Elizabeth Street, Liverpool, 2170, NSW, Australia
Tel 02 8738 3603 | Fax 02 8738 3551 | Mob 0409 463 428 | Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.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
MichaelMichael 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
Please consider the environment before printing this email—
WARNING : This email contains information, which is CONFIDENTIAL, and that maybe subject to LEGAL PRIVILEGE. This e-mail and any attachments to it (the “Communication”) is confidential and is for the use only of the intended recipient, and may not duplicated or used by any other party without the express consent of the sender. The Communication may contain copyright material of St Vincent’s Health & Aged Care(“SVHAC”), or any of its related entities or of third parties. If you are not the intended recipient of the Communication, please notify the sender immediately by return e-mail, delete the Communication, and do not read, copy, print, retransmit, store or act in reliance on the Communication. Any views expressed in the Communication are those of the individual sender only, unless expressly stated to be those of SVHAC. SVHAC does not guarantee the integrity of the Communication, or that it is free from errors, viruses or interference. Thank-you.Message protected by MailGuard: e-mail anti-virus, anti-spam and content filtering.http://www.mailguard.com.au/mg
Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
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_____________________________________________________________________
This email has been scanned for the Sydney & South Western Sydney Local Health Districts by the MessageLabs Email Security System.
Sydney & South Western Sydney Local Health Districts regularly monitor email and attachments to ensure compliance with the NSW Ministry of Health’s Electronic Messaging Policy.Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.
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Regards
Louisa
CNC Infection Control
Ph 985 87664
M 0434323266
Pager 54581Views expressed in this message are those of the individual sender, and are not necessarily the views of the Local Health District or associated entities.
Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
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Well said Louisa – I agree with your comments.
No need to place patients last on the list. Clean between every patient, the appropriate disinfectant product for all MRO’s.
Regards Denise
Infection Control Consultant (NSW)
HICMR Pty Ltd
(Healthcare Infection Control Management Resources)
Level 1, 123 Camberwell Road Hawthorn East VIC 3123
Ph: (03) 9811 9923 Fax: (03) 9882 4534
Pager: 1300 657 359 http://www.hicmr.com.au
denise.mfraser@hicmr.com.au
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From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Louisa Sasko
Sent: Thursday, 23 August 2012 8:52 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: MROs in procedural areasHi Michael,
In my facility and some of those Ive previously worked in staff in procedural areas are instructed to do a ‘spot clean’ with the appropriate disinfectant post MRO patient. A terminal clean is only required if there is widespread contamination of the environment. The rationale is that the patient isn’t in the procedural area for very long and cleaning the surfaces with the appropriate solution is sufficient to break the chain of infection
However placing patients last on the list is something that causes much angst as far as Im concerned. I do not encourage this as patient’s are being discriminated against according to MRO status. Also there should be no need to place the patient last on the list as the work area should be cleaned in between each patient and the only difference with a MRO patient is the choice of cleaning product. Also there is risk to the patient placing them last on the list in that when procedural lists are running sometimes they are late and often patients get cancelled. Its been my previous experience that a MRSA patient was to go for a amputation of a MRSA infected foot and was placed last on the list in surgery and got cancelled 3 times. He developed a MRSA bacteremia and subsequently died. So I feel very strongly against placing patients last on the list as it has the potential to impact on patient outcomes, when there should be no difference in care of the patient in terms of cleaning the environment ie choose a disinfectant and ‘spot clean’.
Hope this helps
Louisa
Regards
LouisaCNC Infection Control
Ph 985 87664
M 0434323266
Pager 54581>>> Michael Wishart 23/08/2012 8:32 am >>>
Hi allJust 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
MichaelMichael 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
Please consider the environment before printing this email—
WARNING : This email contains information, which is CONFIDENTIAL, and that maybe subject to LEGAL PRIVILEGE. This e-mail and any attachments to it (the “Communication”) is confidential and is for the use only of the intended recipient, and may not duplicated or used by any other party without the express consent of the sender. The Communication may contain copyright material of St Vincent’s Health & Aged Care(“SVHAC”), or any of its related entities or of third parties. If you are not the intended recipient of the Communication, please notify the sender immediately by return e-mail, delete the Communication, and do not read, copy, print, retransmit, store or act in reliance on the Communication. Any views expressed in the Communication are those of the individual sender only, unless expressly stated to be those of SVHAC. SVHAC does not guarantee the integrity of the Communication, or that it is free from errors, viruses or interference. Thank-you.Message protected by MailGuard: e-mail anti-virus, anti-spam and content filtering.http://www.mailguard.com.au/mg
Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.
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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
RachelRachel 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
MichaelMichael 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
Please consider the environment before printing this email—
WARNING : This email contains information, which is CONFIDENTIAL, and that maybe subject to LEGAL PRIVILEGE. This e-mail and any attachments to it (the “Communication”) is confidential and is for the use only of the intended recipient, and may not duplicated or used by any other party without the express consent of the sender. The Communication may contain copyright material of St Vincent’s Health & Aged Care(“SVHAC”), or any of its related entities or of third parties. If you are not the intended recipient of the Communication, please notify the sender immediately by return e-mail, delete the Communication, and do not read, copy, print, retransmit, store or act in reliance on the Communication. Any views expressed in the Communication are those of the individual sender only, unless expressly stated to be those of SVHAC. SVHAC does not guarantee the integrity of the Communication, or that it is free from errors, viruses or interference. Thank-you.Message protected by MailGuard: e-mail anti-virus, anti-spam and content filtering.http://www.mailguard.com.au/mg
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