Prevention and Management of Multi-Resistant Organisms - Essay Example

?Infection Control Policy: Prevention and Management of Multi-resistant Organisms (MRO) NSW Department of Health Policy Directive PD2007_084 Brief Description of the Contents of the Policy Infection is one of the most common complications of surgical procedures and intervention (Hamlin, 2009: 105). This issue may result to increased morbidity and mortality among patients. It may also prolong hospital stay which adds to the patient’s medical expenses (NSW Health, 2007: 3). Multi-resistant organisms (MRO) are bacteria that are resistant to a number of antimicrobial drugs such as Methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant (VRE) (The Children’s Hospital at Westmead & Sydney Children’s Hospital. 2006: 1). Perioperative environment area is the sterile area that should be free of the infection-causing bacteria. Therefore preventing cross transmission of the MRO must be addressed in all perioperative settings including, day surgery, the surgical ward, the holding area, the surgery suite, and the PACU. It is the responsibility of all healthcare staff to protect themselves and their surgical patients from contracting MRO infections. The Infection Control Policy: Prevention and Management of Multi-Resistant Organisms (MRO), a policy directive of the NSW Department of Health, or PD2007_084 would guide all health workers in the prevention and management of MRO. The content of document, PD2007_084, the NSW Department of Health policy directive which is the Infection Control Policy: Prevention and Management of Multi-Resistant Organism (MRO) outlined the roles and responsibilities of healthcare staffs by highlighting the general and specific measures that should be observed as standard practices in all healthcare units. The general measures refer to infection control measures, use of antimicrobials, and environmental cleaning. Specific measures included surveillance of MRO, screening patients and healthcare workers for MRO, risk categorisation of patients and healthcare workers for MRSA, decolonisation and clearing a patient of MRSA, and risk categorisation of patient care area. Guidelines on specimen collection, decolonisation protocol for MRSA, and relevant readings are also included in this policy. Lee and Bishop (2002:273-274) stated that nosocomial infections are grouped into two categories: exogenous infections and endogenous infections. Exogenous infections refer to those infections from the hospital environment, staff, other patients and visitors. Endogenous infections are cause by microorganism in the patient’s own normal flora, including hospital strains. Lee and Bishop (2002: 274-275) also stated that the Australian survey showed a higher prevalence of nosocomial infections in large teaching hospitals because they usually have a large reservoir of infection in intensive care unit, specialised burns unit and in transplant operations facilities. In Australia, there has been an increasing awareness of the importance of controlling and managing infection control in the recent years. All staffs are responsible to control hospital infection by observing the infection control policies and guidelines (Lee and Bishops, 2002: 276). Purpose of the Policy The purpose of infection control policy is primarily the prevention and management of MRO in healthcare facilitates so as to ensure the safety of patients and healthcare workers through the implementation of routine and standard practices of preventing and controlling the risk of transmission and colonisation of infectious agents. This will prevent fatal illness or death from MRO infection, prolonged hospital stays, readmissions, and additional diagnostic and treatment cost associated with such infectious contamination. Implementation would thereby improve the delivery of healthcare services and protect the lives of both patients and healthcare workers. The purpose of infection control policy is not only for the prevention and management of multi-resistant organism in the perioperative environment but also in every aspect of the healthcare environment to control contamination and colonisation of MRO. Analysis of How the Policy Affect Perioperative Nursing Practice in the Workplace A common cause of nosocomial infection is the hospital strain of micro organisms such as Staphylococcus aureus, Klebsiella spp, Streptococcus spp., E. coli, Pseudomonas aeruginosa, Enterococcus spp and Enterobacter spp (Lee and Bishop, 2002: 270). Surgical wounds and burn wounds are frequently colonised by hospital strains that can cause serious infection. This infection can be life threatening because it is difficult to treat drug-resistant bacteria or microorganisms (Lee and Bishop, 2002: 271). There is also a high risk of contracting infection during surgical procedures because the patient’s external defences are breached during the surgery. Surgical patients maybe contaminated at the site of the wound resulting to postsurgical infection (Lee and Bishop, 2002: 283). The policy discussed in detail how to control and manage MRO infection in healthcare settings. It is important that all staffs are well-trained on how to implement the policy in the workplace. Education and training on the infection control policy has benefited all perioperative healthcare workers where I worked. All staffs have recognised their responsibility of ensuring patient safety and reduce the transmission of MRO as per policy. For example, the nurse unit manager made sure that all staffs observe hand hygiene and use personal protective equipment when attending to patients (NSW Health, 2007: 7). Comparison and Contrast in the Policy and Theory in Theme 6 The infection control policy: Prevention & Management of Multi-Resistant Organisms (MRO) or PD2007_084 does not mention about stratification of contract precautions, therefore, staffs need to access the infection prevention and control precautions guideline for the specific instructions on how to effectively manage the MRO patients. This is more time consuming and hard for some staffs who are not proficient with searching the policy and guideline from computer. Furthermore, in day surgery where I work, only one room is available for patients with MRO infection or colonisation. As per the policy, patients infected or colonised with MRO must be isolated from other patients during treatment. It is truly a disadvantage that we can admit only one infected patient for the elective day surgery or maximum two if they can be accommodated together in the same room. In my work place, before transferring the MRO patient to the operating theatre or to other health care facility, the staffs notify area or facility receiving the patient prior to the transfer as per the policy (NSW Health, 2007: 8 of 36). Additional contact precaution is always in place with the infection patient at the end of the list. EMR isolation alert consultation is done for planning theatre lists and other documentation relevant to patient transfer directly to the operating room. The patient is not taken the anaesthetic bay or holding bay to protect the spread of infection (Northern Sydney Central coast NSW Health, 2010: 6). During transportation contract precautions are undertaken by wearing gloves, gown and mask to minimise the risk of transmission to other persons and contamination of environmental surfaces as per infection control policy on the prevention and management of multi-resistant organisms (NSW Health, 2007: 8 of 36). However, there are some occasions that we were not notified of an incoming infected patient from other health care facility for minor procedures such as the insertion of PICC line. This is against the infection control policy and should therefore be given attention by the nurse unit manager to prevent the risk of transmission and contamination. According to our lessons in theme 6, infection must also be controlled during traffic patterns. However these are not included in the infection control policy on the Prevention & Management of Multi-Resistant Organisms. There are three restricted areas clearly outlined in the traffic pattern that all staffs must be aware of. In my clinical workplace this is not strictly implemented. Staffs can just enter restricted areas wearing street clothes or surgical scrub in the day surgery area, change room, and the recovery room. Staffs wearing surgical scrubs enter semi restricted area and restricted areas like the storage area for sterile equipment and supplies, OR room, holding bay and the anaesthetic bay. Gardner (2002:1) stated that surgical scrub should not be worn in this area to prevent the spread of infection. Friedman and Petersen (2004: 62) also suggested that doors must always be close and that unnecessary movement must be avoided during clinical procedures. However this is not observed in my workplace. Doors were not always closed in the anaesthetic bay during the insertion of the IVC and during the anaesthetic assessment. Northern Sydney Central Coast NSW Health (2010: 6 of 12) suggested performing standard precaution by limiting the number of staffs in the operating room to minimise infection. This is another issue in the teaching hospital where I work because there was no control in the number of personnel that could enter into the operating room. According to NSW Health (2007: 7) hand hygiene is the most important measure for patient and healthcare safety in healthcare facilities. In my work unit, hand washing sinks and alcohol based hand rubs is always available for staffs, patients and visitors. Standard and additional safety precaution has been followed by all staffs in the unit. Regular infection education and refresher sessions should be mandatory for all levels of health care worker and staffs. Evaluation and recommendations to the infection control policy are considered during these education and refresher sessions (NSW Health, 2007: 8). In my work place, MRO room/areas are always double cleaned with neutral detergent followed by a chemical disinfectant. All furniture in the room such as bed side table and curtain are removed or changed after patient discharge, except wall surfaces as per infection control policy on the prevention and management of multi-resistant organisms. After cleaning the room the cleaner will give the inspection form for the perioperative staff to inspect and sign. In general cleaning and routine housekeeping, liquid disinfectant or wipe products can be use to clean the computer set, table, bed, furniture and so on. Grota (2007: 364) stated that disinfectant in liquid form and wipe products have been approved by the Environmental protection agency. All health care workers can therefore use these to supplement routine housekeeping in their clinical area. Grota (2007:1) also reported that surgical patients are at very high risk of contracting MDRO and MRSA infection. These types of infection are difficult and expensive to treat, and would result to increase morbidity and mortality rate. Therefore, screening surgical patient pre operatively before a major surgery is highly recommended (NSW Health, 2007:15). The purpose of MRO screening is to prevent the transmission and colonisation from the source of infection (NSW Health, 2007: 14). In my work place, a patient for elective joint surgery is scheduled to the preadmission clinic for MRSA swab and other pathology test at least four weeks prior to surgery. The result would be reviewed by the surgical team, when the result is positive, the patient would be contacted for treatment and decolonisation before admission for elective surgery. NSW Health (2007: 16) suggested that previous MRO patients who have been cleared of carriage treatment are required to undergo screening and isolation for contract precaution on admission. In my workplace, if the MRSA result still show on the system and is still unclear, the patient will be isolated and reswab. It is also recommended that clearing a patient of MRSA should be done in consultation with clinical Microbiology specialist or with an infectious disease specialist. The patient needed to have two sets of screening swabs at least 3 days apart, until there is no sign and symptom of infection. (NSW Health, 2007: 22). NSW Health (2006: 4) suggested patient for elective joint replacement should be screened for MRSA in accordance with the MRO policy. NSW Health (2007: 18) also required that HCW screening programs should not be pursued until basic infection control efforts have been maximised and any infection or source of outbreak have been investigated. The policy also required for the screening of health workers with MRO and MRSA patient under their care. However, in my work place this policy is not complied with. Suggestions/Recommendations The infection control policy should include the aseptic technique of controlling and managing MRO in the perioperative environment. The purpose of aseptic technique is to ensure sanitation and prevent the spread of pathogens through contamination. It would also help health workers implement closely the infection control policy by providing a link in the policy all the perioperative unit guidelines for convenience and quick access of staffs that needed to read or review policies on specific infection control precaution. Also the link of Infection Prevention and Control Precautions (Standard and Additional) should be included in the policy because the MRO policy did not mention about contract precaution and related guidelines that should be followed by healthcare professionals. As has been observed in my workplace, particularly in the perioperative unit, the infection policy and the implementing guidelines are not strictly adhered to by some healthcare workers. This could also be the case in other healthcare facilities. Therefore it is recommended that strict monitoring should be done by the Department of Health. Those that are proven guilty of non-compliance must be sanctioned or penalized to promote strict implementation of the infection control policy at all levels in the healthcare unit and ensure the health safety of all stakeholders, the patients and the health workers as well. References Grota, P. G. 2007 Perioperative Management of Multidrug-Resistant Organisms in Health Care Setting. AORN Journal 86, 3, 361-368. Gardner, M. 2002. Surgical Attire Lends Reliability to infection Prevention. Available URL: http://www.infectioncontroltoday.com/articles/2002/09/surgical-attire-lends-reliability-to-infection-pr.aspx Friedman, C. and Peterson, K. H. 2004 Infection control in ambulatory care. Jones and Barlett Publishers, Canada. [Google books Version] Available URL: http://books.google.com.au/books?id=fAQbla86fzkC&pg=PA62&lpg=PA62&dq=traffic+patterns+in+operating+theater&source=bl&ots=SCJUKr4l-E&sig=sd4QG_sh7ILawwTwS-Hfj02yAaI&hl=en&ei=3JjXTfmtLY6YvAPfrMyxBw&sa=X&oi=book_result&ct=result&resnum=3&ved=0CCQQ6AEwAjgU#v=onepage&q&f=false The Children’s Hospital at Westmead & Sydney Children’s Hospital, Randwick. 2006 Multi-resistant organisms. Available URL: http://www.chw.edu.au/parents/factsheets/pdf/mro.pdf. NSW Health. 2006 Reducing the burden of multiple resistant organisms (MROs). Available URL: http://www.health.nsw.gov.au/resources/quality/hai/pdf/tools_mros1.pdf Read More