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Second Opinions > Patients with MRSA

Patients with MRSA

Can everyone tell me how you care for pts. with MRSA? These are pts. who have a history of MRSA with no verification of clear cultures and no obvious wound.
Do you do them in your ASC? Are they the last case of the day? Do you isolate them? Do you close the room down for the day after they are done for terminal cleaning?

Started by: Claire Moffa (OR Manager / Supervisor) at November 10, 2010 (8:05 am)

Comments and Responses

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We screen out patients through PAT process. if they have a Hx of MRSA and or MRSa we donot admitt to our center unless the cultures come back negative. They must be Hospital cases because we do not have isolation rooms


I. POLICY
A. The purpose of Standard Precautions is to prevent or minimize exposure to bloodborne pathogens. It is the responsibility of each employee to read, understand and implement The Basic Rules of Standard Precautions.

1. Methicillin-Resistant Staphylococcus Aureus (MRSA)
a. Cultures will be obtained no sooner than 48 hours after all antibiotics have been discontinued.
b. Two (2) consecutive negative nares cultures at least 5 days apart, and
c. Two (2) consecutive negative cultures from previously positive site(s) at least 5 days apart.

Dawn Dormitorio (OR Manager/Supervisor) at November 10, 2010 (2:51 pm)

What is the primary cause of turn over time during the "terminal cleaning" process. It it the need to wipe off residue from the use of sanitizers? For example, ozone gas in a sealed room would completely elimimate pathogens but is highly toxic. Liquified Ozone however can be sprayed on all surfaces eliminating pathogens with no need to wipe or presenting concerns for residue. Liquified Ozone would save a tremendous amount of time and sanitize immediately without the need to isolate the room. It then return to O2 or tap water. Any comment would be appreciated. Art Pichierri

Art Pichierri (Other) at November 10, 2010 (2:51 pm)

In our ASCs, we have 3, we place patients with a MRSA, VRE, or ESBL history (current or past) into contact precautions on admit. Gowns and gloves are used by staff when doing direct care for the patient. We dedicate the BP cuff to the patient during the visit. Then clean it with disinfectant or send it to CSR for cleaning.

We also instruct all patients (not just MRSA)at time of admit to either wash their hands with soap and water or use an alcohol based hand sanitizer.

We have a protocol for each OR/PACU/Techs/surgeon/anesthesia so they know what they are supposed to do.

MRO patients can be scheduled anytime during the day because the room turnaround should be the same for any patient-all surfaces that are touched should be wiped with disinfectant. We never close the room down after the patient exits because this is not an airborne disease. If someone came in with MRSA pneumonia and needed a bronch or a patient with a trach, we would implement droplet precautions (mask with eye shield) to prevent exposure to the droplets generated by cough. So staff would wear surgical masks with eye shields when within 6 feet of the patient to prevent breathing the droplets generated by coughing or the procedure.

In PACU we either place in a designated room or spatially separate (6 feet apart) from other PACU patients. We like to have one nurse assigned to the patient but depending on staffing they may need to care for more than the isolation patient. They discard their gown/gloves and sanitize their hands before moving to the next patient.

Gwen Felizardo.g@ghc.org

Gwenda Felizardo (Other) at November 10, 2010 (2:21 pm)

In patients with known history of MRSA, and no open wound, the most appropriate screening tool is culture of nares to identify the colonized patient. Our guidelines/recommendations include Mupirocin nasal ointment, chlorhexidine shower/prep evening prior, and consideration of prophylactic antibiotic.
Dr. John Murphy
Medical Director Corvallis Clinic Surgery Center

John Murphy (Medical Director/Chief Surgeon) at November 10, 2010 (2:18 pm)

At my facility we try to make them last; this is not always possible. We do isolate them and we give them educational material on how to get rid of the "MRSA title". We use Clorox to clean rooms between patients so we do not close the room after but continue on with the next case.

Dawn V. (OR Manager/Supervisor) at November 10, 2010 (2:17 pm)

We use standard precautions as we do with all patients. I have read where there is no reason to do them as the last case.

Michelle Fundshon (Administrator/Director/Manager/Owner/Exec. Officer) at November 10, 2010 (2:14 pm)

We use standard precautions as we do with all patients. I have read where there is no reason to do them as the last case.

Michelle Fundshon (Administrator/Director/Manager/Owner/Exec. Officer) at November 10, 2010 (2:14 pm)

We do a number of pain cases and occassionally we will see a patient with MRSA or a history of MRSA. We generally use contact precautions and move their case to the end of the day. Once, the case is done we terminally clean the procedure room. We have done them in the middle of the schedule but the time to terminally clean and turn over the room for the next patient is prohibitive. We have only had one patient that had a history of MRSA and finally came to us with clear culture reports.

Sharon Foster (Administrator/Director/Manager/Owner/Exec. Officer) at November 10, 2010 (2:13 pm)

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