AORN Blog - The Periop Life

Practical Ways to Keep Drug Resistant Bugs at Bay

A Conversation with AORN’s Amber Wood, MSN, RN, CNOR, CIC, FAPIC

Practical Ways to Keep Drug Resistant Bugs at Bay

March 8, 2018     

No OR is impervious to the dangers of multidrug-resistant organisms (MDROs).

With antibiotic resistance on the rise and more surgical site infections (SSIs) being caused by MDROs1, perioperative nurses play a critical role in keeping these deadly pathogens from finding refuge on surfaces in the OR, or worse, a patient’s surgical site.

One important way perioperative nurses prevent MDRO transmission is through contact precautions when a patient tests positive for being colonized or infected with a MDRO.

However, it’s not always clear what the best ways to maintain contact precautions are. It often comes down to split-second judgment calls that can make the difference in preventing patient exposure to a MDRO.

For example, the perioperative team typically moves the stretcher into the corridor after the patient is transferred to the OR bed. But, when a patient is in contact precautions for an MDRO, this practice is questioned. Should the stretcher go into the corridor or would that be a risk for transmission to other personnel who may inadvertently touch it? Should we leave the stretcher in the OR to contain the patient’s environment or would that be a risk for contamination of the sterile field? It’s this integration of contact precautions with everyday workflow that presents the biggest obstacle for preventing MDRO transmission in the surgical setting.

Based on observations of infection prevention techniques in the surgical setting, there are key steps that RNs in the periop suite should take to keep MDROs from their patients.

  1. The first step is to make sure you correctly don, use, and doff personal protective equipment, such as gowns, gloves, and masks.
  2. The second step is to perform hand hygiene when indicated, and remember that the use of gloves doesn’t replace the need for hand hygiene.
  3. The third step is to disinfect areas that could harbor MDROs. Remember that high-touch objects such as OR beds and patient monitors can serve as reservoirs for MDROs. That means that perioperative staff members who come in contact with these reservoirs and then touch the patient could be inadvertently transmitting an MDRO to a patient.

In the face of untreatable infections from MDROs, we must aim to prevent surgical site infections and transmission of MDROs to protect our patients.

Additional Resources

Wood will be demonstrating more of these practical ideas for preventing MDRO transmission with the implementation of contact precautions in a free half-day workshop in New Orleans on March 24.

The workshop will share the same location as the Global Surgical Conference & Expo 2018, making it easy for conference attendees to participate. However, separate registration is required. Learn more and register for this MDRO prevention workshop.

Read about antibiotic stewardship from the CDC.

1Read the 2017 study by Rubio-Perez et al. that investigated Specific Clinical Profile and Risk Factors for Mortality in General Surgery Patients with Infections by Multi-Drug–Resistant Gram-Negative Bacteria.