Perioperative management of multidrug-resistant organisms in health care settings

AORN Journal,  Sept, 2007  by Patti G. Grota

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* improving current safe infection practices in all settings;

* donning gowns, gloves, and masks upon entry into the room of a patient who is subject to contact and/or droplet precautions; and

* developing a new definition of epidemiologically important organisms. (6)

ACCESSIBILITY AND AVAILABILITY OF PPE. Appropriate PPE (eg, gowns, gloves, barrier masks with face shields, aprons) should be readily available in all clinical settings at all times--for instance, in case a patient develops explosive diarrhea of an unknown etiology. Gowns and gloves should be immediately available and worn to protect the health care workers' clothing from becoming contaminated and to decrease cross transmission. Many facilities are moving toward replacing or enhancing the isolation cart system with the installation of PPE cabinets mounted next to patient rooms so that health care workers will have immediate access to appropriate PPE.

CLEANING AND DISINFECTION PROGRAM, Finally, an effective prevention program addresses the effective cleaning and disinfection of patient care equipment and the environment. The facility infection control committee should select Environmental Protection Agency (EPA)-approved hospital disinfectants based on identified need at the facility. Disinfectants in liquid form as well as disposable disinfectant wipes should be available to all health care workers and used as a supplement to routine housekeeping. Disposable disinfectant wipes have improved the efficiency of cleaning hospital equipment and furniture. They are particularly useful for disinfecting computer keyboards and other technological equipment used in clinical areas. In addition to being an EPA-approved, disinfectant product, the selected product should be used according to the manufacturer's recommendations.

INTENSIFIED INFECTION CONTROL MEASURES

The HICPAC guideline also presents an elevated level or second tier of contact precautions called "intensified interventions," which may be used in facilities that have endemic levels of MDRO colonization or outbreaks of MDRO infections. (4) Optimal strategies for the control of MDROs remain under debate and should be based on assessments of appropriate local facility personnel such as members of the infection control program. The HICPAC recommends, therefore, that individual facilities adopt effective measures that fit their circumstances and needs.

It is important for perioperative nurses to understand the prevalence of targeted MDROs that are causing infections in their facility and the reason for the level of infection control measures adopted. If the prevalence of MRSA or any other targeted MDRO increases, the HICPAC recommends that intensified interventions be implemented. These measures include

* increasing the frequency of education for health care workers that is adapted specifically to the prevalence of the targeted MDRO unique to that unit and type of infection,

* implementing molecular typing,

* implementing protocols to obtain active surveillance cultures from patients at risk and to isolate colonized as well as infected patients, and