Perioperative management of multidrug-resistant organisms in health care settings

AORN Journal,  Sept, 2007  by Patti G. Grota

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* maintaining good hand hygiene practice,

* wearing gloves and gowns when appropriate,

* maintaining a clean hospital environment,

* isolating patients who are colonized or infected with MRSA, and

* providing reassurance with a positive attitude to isolated patients and their family members to help relieve anxiety and to instill confidence. (11)

Infection control professionals should be available to respond to requests for MDRO consults immediately and must provide accurate and appropriate clinical answers. A multidisciplinary process should be established to monitor and improve health care personnel adherence to hand hygiene and standard and contact precautions. Communication systems must be designed to designate patients known to be colonized or infected with an MDRO and used to relay this status between transferring and receiving personnel in different sections of the health care facility. These systems may be implemented with verbal reports and/or through computerized alerts that flag the medical records of patients with MDRO infections. The HICPAC MDRO guidelines also address the responsibility of providing updated feedback to health care providers and administrators regarding facility and unit trends in MDRO infections as a measure of program effectiveness.

A perioperative nurse should be a member of the multidisciplinary team assigned to champion, monitor, and improve adherence to hand hygiene and standard and contact precautions. It is essential that the entire process of providing care to a patient who is colonized or infected with an MDRO be addressed in multidisciplinary meetings. Patients with MDROs frequently are sent to surgery with infections such as a draining wound or infected hardware. The process of preventing cross transmission of the MDRO must be addressed in all perioperative settings including the surgical ward, the holding area, the surgery suite, and the PACU. As a member of the infection control interdisciplinary team, the perioperative nurse can advocate for the importance of communicating the presence of an MDRO between sending and receiving units during hand-off communications. (12) The perioperative nurse is instrumental in designing an effective mechanism for communicating with transferring units regarding infection status of a patient. Another role that the perioperative nurse can assume is champion of prevention programs that are designed to decrease the prevalence or incidence of MDRO infections.

Infection control programs are strengthened by expert liaisons in clinical areas who can educate staff members on clinical strategies targeted to decrease the incidence of MDRO infections. As a part of this communication, it is useful to share the trends in surgical site infections, catheter-related blood-stream infections, and ventilator-acquired pneumonias, particularly those caused by MDROs. Giving feedback to staff members by displaying quality improvement graphs and sharing of performance findings has been shown to be highly effective in performance improvement. Having a perioperative nurse participate in this multidisciplinary endeavor is invaluable in meeting the administrative and education components of the HICPAC MDRO guideline.