Reviewing management of MRO’s in perioperative unit.

[Tina Muller]

Afternoon,

I’m a new member, and very excited to be able to network with such a diverse body of knowledge.

Question?
We are currently reviewing our management of MRO’s within the perioperative Unit.
Specifically focusing on decanting theatres prior to admitting the patient into theatre.
This includes the anaesthetic drugs trolley – which is kept close at hand outside the door.
Yes, we allocate an outside runner.

There are two components that we are keen to focus on.

1. Decanting the Theatre – we are discussing the Non-Contact vs Contact Zone
2. Recovering of patient – in the theatre ( VRE / ESBL/CRE ) vs PACU (MRSA)

These are the core issue that cause grief among the staff.
Ana Folk- not ready access to emergent equipment if required.
Loss of theatre time in recovering patient in Theatre.

As you are aware, this implicates theatre staff and activity time.
This is addressed with allocating the MRO patients to the end of the elective lists –
If we have a spare theatre – we will take the MRO patients there, so there is minimal lost time in their home theatre( while someone else cleans up or recovers the patient)
No so easy to negotiate if this is an emerg patient.

Earlier this year, I emailed across QHealth via SWAPNET, and thank-you to all who responded.
This has given us much to consider, drawing us to the Contact vs Non-Contact area within the actual theatre.

[cid:image001.jpg@01D48E36.7789BA40]

Before I totally re-write our Policy reflecting the changes, I would like the opinion of the ACIPC Network.
I thank-you for your time and consideration in this matter.

Regards,
Tina

Tina Muller
Clinical Nurse Consultant / Perioperative & CSD.
Mackay Hospital and Health Service
P: 07 4885 5387
E:tina.muller@health.qld.gov.au

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[Denise MacGregor Fraser]

Hi Tina

Refer to the ACORN Standards on Standard / Contact / Droplet / Airborne Precautions as these tables outline what to do in theatres for MRO management.
These are located in the Asepsis & Clinical Care section – Infection Control standard.

Removing items from theatre is for non-essential items only.
Recovering patients in the theatre should be for Airborne &/or Droplet transmission diseases only.

Regards Denise
MacGregor Fraser
IPC Consultant – NSW/National
HICMR Pty Ltd
Level 1, 123 Camberwell Road Hawthorn East VIC 3123
denise.mfraser@hicmr.com.au / support@hicmr.com.au
[cid:image004.png@01D10761.748A5520]
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Afternoon,

I’m a new member, and very excited to be able to network with such a diverse body of knowledge.

Question?
We are currently reviewing our management of MRO’s within the perioperative Unit.
Specifically focusing on decanting theatres prior to admitting the patient into theatre.
This includes the anaesthetic drugs trolley – which is kept close at hand outside the door.
Yes, we allocate an outside runner.

There are two components that we are keen to focus on.

1. Decanting the Theatre – we are discussing the Non-Contact vs Contact Zone
2. Recovering of patient – in the theatre ( VRE / ESBL/CRE ) vs PACU (MRSA)

These are the core issue that cause grief among the staff.
Ana Folk- not ready access to emergent equipment if required.
Loss of theatre time in recovering patient in Theatre.

As you are aware, this implicates theatre staff and activity time.
This is addressed with allocating the MRO patients to the end of the elective lists –
If we have a spare theatre – we will take the MRO patients there, so there is minimal lost time in their home theatre( while someone else cleans up or recovers the patient)
No so easy to negotiate if this is an emerg patient.

Earlier this year, I emailed across QHealth via SWAPNET, and thank-you to all who responded.
This has given us much to consider, drawing us to the Contact vs Non-Contact area within the actual theatre.

[cid:image001.jpg@01D48E36.7789BA40]

Before I totally re-write our Policy reflecting the changes, I would like the opinion of the ACIPC Network.
I thank-you for your time and consideration in this matter.

Regards,
Tina

Tina Muller
Clinical Nurse Consultant / Perioperative & CSD.
Mackay Hospital and Health Service
P: 07 4885 5387
E:tina.muller@health.qld.gov.au

[Email Signature]

********************************************************************************

This email, including any attachments sent with it, is confidential and for the sole use of the intended recipient(s). This confidentiality is not waived or lost, if you receive it and you are not the intended recipient(s), or if it is transmitted/received in error.

Any unauthorised use, alteration, disclosure, distribution or review of this email is strictly prohibited. The information contained in this email, including any attachment sent with it, may be subject to a statutory duty of confidentiality if it relates to health service matters.

If you are not the intended recipient(s), or if you have received this email in error, you are asked to immediately notify the sender by telephone collect on Australia +61 1800 198 175 or by return email. You should also delete this email, and any copies, from your computer system network and destroy any hard copies produced.

If not an intended recipient of this email, you must not copy, distribute or take any action(s) that relies on it; any form of disclosure, modification, distribution and/or publication of this email is also prohibited.

Although Queensland Health takes all reasonable steps to ensure this email does not contain malicious software, Queensland Health does not accept responsibility for the consequences if any person’s computer inadvertently suffers any disruption to services, loss of information, harm or is infected with a virus, other malicious computer programme or code that may occur as a consequence of receiving this email.

Unless stated otherwise, this email represents only the views of the sender and not the views of the Queensland Government.

**********************************************************************************
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

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MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

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[Joanna Harris]

Hello Tina, and welcome.
The important thing is to thoroughly look at the risks associated with MROs in theatre balanced with the risks associated with managing patients known to be colonised. Also recognise that you do not probably know the MRO colonisation status in real time for every single patient.
Here in the Illawarra Shoalhaven in NSW we have adopted a much more horizontal approach to our infection prevention and control policies. Essentially this can be described as doing the right thing for everyone. By doing this we make things simpler for staff, prevent discriminatory practices for those patients with a history of MRO colonisation, and avoid problems such as the ones you have described with wasted theatre time and equipment issues.
I would be very happy to discuss off line, and share policies etc. if you are interested.

JoannaHarris
Nurse Manager, Infection Management and Control Service,
Illawarra Shoalhaven LHD, NSW.
Joanna.Harris@health.nsw.gov.au

Sent from my iPhone

> On 7 Dec 2018, at 15:09, Tina Muller wrote:
>
> Afternoon,
>
> Im a new member, and very excited to be able to network with such a diverse body of knowledge.
>
> Question?
> We are currently reviewing our management of MROs within the perioperative Unit.
> Specifically focusing on decanting theatres prior to admitting the patient into theatre.
> This includes the anaesthetic drugs trolley which is kept close at hand outside the door.
> Yes, we allocate an outside runner.
>
> There are two components that we are keen to focus on.
> Decanting the Theatre we are discussing the Non-Contact vs Contact Zone
> Recovering of patient in the theatre ( VRE / ESBL/CRE ) vs PACU (MRSA)
>
> These are the core issue that cause grief among the staff.
> Ana Folk- not ready access to emergent equipment if required.
> Loss of theatre time in recovering patient in Theatre.
>
> As you are aware, this implicates theatre staff and activity time.
> This is addressed with allocating the MRO patients to the end of the elective lists
> If we have a spare theatre – we will take the MRO patients there, so there is minimal lost time in their home theatre( while someone else cleans up or recovers the patient)
> No so easy to negotiate if this is an emerg patient.
>
> Earlier this year, I emailed across QHealth via SWAPNET, and thank-you to all who responded.
> This has given us much to consider, drawing us to the Contact vs Non-Contact area within the actual theatre.
>
>
>
> Before I totally re-write our Policy reflecting the changes, I would like the opinion of the ACIPC Network.
> I thank-you for your time and consideration in this matter.
>
> Regards,
> Tina
>
>
>
> Tina Muller
> Clinical Nurse Consultant / Perioperative & CSD.
> Mackay Hospital and Health Service
> P: 07 4885 5387
> E:tina.muller@health.qld.gov.au
>
>
>
>
>
>
>
> ********************************************************************************
>
> This email, including any attachments sent with it, is confidential and for the sole use of the intended recipient(s). This confidentiality is not waived or lost, if you receive it and you are not the intended recipient(s), or if it is transmitted/received in error.
>
> Any unauthorised use, alteration, disclosure, distribution or review of this email is strictly prohibited. The information contained in this email, including any attachment sent with it, may be subject to a statutory duty of confidentiality if it relates to health service matters.
>
> If you are not the intended recipient(s), or if you have received this email in error, you are asked to immediately notify the sender by telephone collect on Australia +61 1800 198 175 or by return email. You should also delete this email, and any copies, from your computer system network and destroy any hard copies produced.
>
> If not an intended recipient of this email, you must not copy, distribute or take any action(s) that relies on it; any form of disclosure, modification, distribution and/or publication of this email is also prohibited.
>
> Although Queensland Health takes all reasonable steps to ensure this email does not contain malicious software, Queensland Health does not accept responsibility for the consequences if any person’s computer inadvertently suffers any disruption to services, loss of information, harm or is infected with a virus, other malicious computer programme or code that may occur as a consequence of receiving this email.
>
> Unless stated otherwise, this email represents only the views of the sender and not the views of the Queensland Government.
>
> **********************************************************************************
>
> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
> The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
>
> Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
>
> Replies to this message will be directed back to the list. To create a new message send an email to acipclist@acipc.org.au
>
> To send a message to the list administrator send an email to admin@acipc.org.au
>
> You can unsubscribe manually from this list by sending ‘signoff acipclist’ (without the quotes) to listserv@aicalist.org.au

MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

Replies to this message will be directed back to the list. To create a new message send an email to acipclist@acipc.org.au

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[Michael Wishart]

Hi Tina

Our approach is similar to that described by Joanna Harris. I did a presentation to some per-operative nurses here about this. The key was investigating current practices between patients and plugging the holes (ie who cleans what make sure everyone knows their role).

I think you need to work out what will work in your setting, though. I do not believe a one-size-fits-all approach will work.

Cheers
Michael

Michael Wishart | Infection Control Coordinator, CICP-E

St Vincents Private Hospital Northside | 627 Rode Road CHERMSIDE QLD 4032
T +61 7 3326 3068 | F +61 7 3607 2226
E michael.wishart@svha.org.au |
W http://www.hsnph.org.au

[cid:image001.jpg@01D46C86.4CDB6090]

From: ACIPC Infexion Connexion On Behalf Of The Harrises
Sent: Thursday, 13 December 2018 4:31 AM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: Reviewing management of MRO’s in perioperative unit.

Hello Tina, and welcome.
The important thing is to thoroughly look at the risks associated with MROs in theatre balanced with the risks associated with managing patients known to be colonised. Also recognise that you do not probably know the MRO colonisation status in real time for every single patient.
Here in the Illawarra Shoalhaven in NSW we have adopted a much more horizontal approach to our infection prevention and control policies. Essentially this can be described as doing the right thing for everyone. By doing this we make things simpler for staff, prevent discriminatory practices for those patients with a history of MRO colonisation, and avoid problems such as the ones you have described with wasted theatre time and equipment issues.
I would be very happy to discuss off line, and share policies etc. if you are interested.

JoannaHarris
Nurse Manager, Infection Management and Control Service,
Illawarra Shoalhaven LHD, NSW.
Joanna.Harris@health.nsw.gov.au

Sent from my iPhone

On 7 Dec 2018, at 15:09, Tina Muller <Tina.Muller@HEALTH.QLD.GOV.AU> wrote:
Afternoon,

Im a new member, and very excited to be able to network with such a diverse body of knowledge.

Question?
We are currently reviewing our management of MROs within the perioperative Unit.
Specifically focusing on decanting theatres prior to admitting the patient into theatre.
This includes the anaesthetic drugs trolley which is kept close at hand outside the door.
Yes, we allocate an outside runner.

There are two components that we are keen to focus on.

1. Decanting the Theatre we are discussing the Non-Contact vs Contact Zone
2. Recovering of patient in the theatre ( VRE / ESBL/CRE ) vs PACU (MRSA)

These are the core issue that cause grief among the staff.
Ana Folk- not ready access to emergent equipment if required.
Loss of theatre time in recovering patient in Theatre.

As you are aware, this implicates theatre staff and activity time.
This is addressed with allocating the MRO patients to the end of the elective lists
If we have a spare theatre – we will take the MRO patients there, so there is minimal lost time in their home theatre( while someone else cleans up or recovers the patient)
No so easy to negotiate if this is an emerg patient.

Earlier this year, I emailed across QHealth via SWAPNET, and thank-you to all who responded.
This has given us much to consider, drawing us to the Contact vs Non-Contact area within the actual theatre.

[cid:image001.jpg@01D48E36.7789BA40]

Before I totally re-write our Policy reflecting the changes, I would like the opinion of the ACIPC Network.
I thank-you for your time and consideration in this matter.

Regards,
Tina

Tina Muller
Clinical Nurse Consultant / Perioperative & CSD.
Mackay Hospital and Health Service
P: 07 4885 5387
E:tina.muller@health.qld.gov.au

[Email Signature]

********************************************************************************

This email, including any attachments sent with it, is confidential and for the sole use of the intended recipient(s). This confidentiality is not waived or lost, if you receive it and you are not the intended recipient(s), or if it is transmitted/received in error.

Any unauthorised use, alteration, disclosure, distribution or review of this email is strictly prohibited. The information contained in this email, including any attachment sent with it, may be subject to a statutory duty of confidentiality if it relates to health service matters.

If you are not the intended recipient(s), or if you have received this email in error, you are asked to immediately notify the sender by telephone collect on Australia +61 1800 198 175 or by return email. You should also delete this email, and any copies, from your computer system network and destroy any hard copies produced.

If not an intended recipient of this email, you must not copy, distribute or take any action(s) that relies on it; any form of disclosure, modification, distribution and/or publication of this email is also prohibited.

Although Queensland Health takes all reasonable steps to ensure this email does not contain malicious software, Queensland Health does not accept responsibility for the consequences if any person’s computer inadvertently suffers any disruption to services, loss of information, harm or is infected with a virus, other malicious computer programme or code that may occur as a consequence of receiving this email.

Unless stated otherwise, this email represents only the views of the sender and not the views of the Queensland Government.

**********************************************************************************
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

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MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

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______________________________________________________________________
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