SAMPLE
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Department & Location
Protocol
Number
Surgical Services Department
Management of the Surgical
Patient with a Multi-Resistant Organism
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POLICY:
All Operating Room personnel will follow Contact Precautions based on GHC
Management of the Patient with Multi-resistant Organisms (MRO) to prevent the
transmission of these organisms between patients and employees.
PURPOSE:
To protect surgical patients from multi-resistant organisms (MRO) such as Methicillin
Resistant Staphylococcus aureus (MRSA) and Vancomycin Resistant Enterococcus
(VRE).
REFERENCES:
AORN “Standards,Recommended Practices, and Guidelines” 2008
CDC Guideline for Hand Hygiene in Health-Care Settings. MMWR. October 25,
2002/Vol.51/no.RR-16.
Muto, c., et al. SHEA Guideline for Preventing Nosocomial Transmission of Multidrug-Resistant Strains of Staphylococcus aureus and Enterococcus. Infection Control
and Hospital Epidemiology 2003; 24:362-385.
CDC Guideline for Isolation Precautions 2007
ADDENDUM:
Anesthesia Department Management of the Surgical Patient with a MRO
SPECIAL INSTRUCTIONS:
Surgeon:
1. Identify patients with MRO or history of MRO.
2. Notify Preoperative Anesthesia Clinic or surgery scheduler if patient has a MRO.
3. Follow MRO protocol and contact precautions in the surgical setting.

Wear Personal Protective Equipment (PPE) gloves and yellow gowns when
positioning patient.

Use consistent hand hygiene after removal of gloves with either antimicrobial agents
or alcohol based preparations.
Scheduler/Charge Nurse:
1. Enters MRO onto surgery schedule in comment section.
2. Writes MRO on surgery white board day of surgery.
3. Notifies preop nurse.
Surgical Services
MRO Surgery Protocol
Number:
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Preoperative Anesthesia Clinic if available:
1. Notifies surgery scheduler for instructions:
2. Staff may initiate, in collaboration with PCP or surgeon, screening cultures of patients
who have a history of MRO.
Preoperative Area:
1. Admit patient to private room when feasible.
2. If do not have separate admitting areas, follow routine admitting procedure by performing
hand hygiene after preoperative admit.
3. Patient specific equipment (i.e., BP cuffs, oximeters) may follow patient throughout
perioperative day.
4. Follow “All Perioperative Personnel” instructions.
All Perioperative Personnel:
1. Follow protocol for Contact Precautions to prevent transmission to other patients.
2. Use consistent hand hygiene (antimicrobial agents or alcohol based preparations).
3. Instruct patients to perform hand hygiene (hand sanitizer or soap and water) prior to
transport.
4. Use PPE for direct body to body contact. Precautions include gloves and yellow gowns.
5. Clean and disinfect equipment and surfaces with an approved disinfectant before reuse.
6. Dedicate, when feasible, patient specific equipment (i.e., BP cuffs, oximeters) that may
follow patient throughout perioperative day.
Patient Care Technician / Transporter:
1. Follows protocol for Contact Precautions when transporting patients and cleaning rooms.
2. Checks for “Special Precaution Stop” sign outside of patient’s room.
3. Wears PPE, yellow gown and gloves when transporting and delivering patient.
4. Staff will walk patient to OR room if feasible.
5. Uses consistent hand hygiene after removal of PPE.
6. Cleans and disinfects OR surfaces, equipment, and gurney per routine protocol.
Circulator:
1. Confirms that “Special Precaution Stop” signs are on the doors of the operating room.
2. Wears yellow gowns and gloves when caring for and positioning patient.
3. Enforces use of yellow gowns and gloves for all staff having direct contact with patient.
4. Removes gloves and sanitizes hands before touching clean supplies or equipment.
5. Disinfects all reusable items (gel pads, tourniquets) and disposes of items that cannot be
disinfected (egg crates, safety straps).
6. Removes yellow gown and gloves and sanitize hands when direct patient contact is no
longer occurring.
7. Wears yellow gown and gloves at end of case or any time during the case when direct
patient care reoccurs.
Surgical Services
MRO Surgery Protocol
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8. Performs hand hygiene after removal of PPE.
All Other Assisting Personnel:
1. Wear yellow gown and gloves for positioning and transferring patient.
2. Perform hand hygiene after removing PPE.
Scrub Personnel:
1. Wear yellow gown and gloves if positioning or transferring patient.
2. Do routine processing of instruments, linen, and trash.
3. Perform hand hygiene after removing PPE.
PACU:
1.
2.
3.
4.
4.
Patient assignment will be one RN to one patient in PACU, as staffing allows.
Wears a yellow gown and gloves when caring for MRO patient.
Removes PPE and sanitizes hands prior to caring for another patient.
Performs hand hygiene after removing PPE.
Place in private room or spatially separate (6 feet) the MRO patient from other PACU
patients, if feasible, position patients at end of PACU.
Addendum
Anesthesia Department Management of the Surgical Patient with a MRO
I.
Identification:
All MRO patients will be identified during morning report by the Charge Anesthesiologist.
II. Anesthetic Plan:
On the day of surgery, the Charge Anesthesiologist and, CRNA will review the Anesthetic Plan
for appropriateness regarding open wounds or active infection, or colonization.
III. Patient Transport Preop:
A. Patients will follow normal flow or be spatially separated depending on need, or admitted to a
private room if available on admit.
B. A surgical mask on the patient at transport is required for droplet based modes of transmission
(i.e., MRSA pneumonia, MRSA in tracheostomy).
IV. Preop:
A. Whenever possible, dedicated monitoring equipment (a single set of monitoring cables and BP
cuff, oximeter, stethoscope) will be used on the MRO patient throughout the hospitalization,
until discharge from Phase II, at which time they will be removed and cleaned.
B. Wear gloves and gown when providing care for (physically touching, examining, transferring,
or suctioning) a patient who has a MRO.
Surgical Services
MRO Surgery Protocol
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C. Protective eyewear and surgical mask is to be worn during suctioning, intubation, or when
within three feet of patients who cannot control their cough, and at all times during the
operative procedure.
D. Use hand sanitizer when removing personal protective equipment.
V. Intra-operative Care:
A. “Dirty” and “clean” areas will be designated as follows:
1.
The top of the anesthesia MACHINE will be considered “dirty”.
a.
All syringes and materials in use for the MRO patient will be placed on top of the
anesthesia machine.
b.
DO NOT use the surface of the machine for your charting.
The top of the anesthesia CART will be considered “clean”.
2.
a.
Hand sanitizer shall be available within reach of the Anesthesia Care provider at all
times.
b.
Use hand sanitizer after removing gloves (PPE), when working between the dirty and
clean areas, and before charting.
c.
Minimize the amount of equipment and supplies on top of the cart to avoid crosscontamination.
d.
Multi-dose vials stored on the “clean area” that are used on MRO patients are to be
discarded at the end of the case if contaminated during the procedure (handled prior
to degloving and hand sanitization).
e.
At the end of the case, Patient Care Techs, anesthesia techs or designated staff will
discard all of the disposable items on the dirty surface, and clean and disinfect
equipment and all surfaces touched by patient and staff with an approved disinfectant
before reuse. If there is any question regarding possible contamination of an item, it
should be treated as contaminated and either discarded or disinfected.
VI. Recovery:
A. The anesthesia provider will communicate with the PACU during the operative procedure to
coordinate the disposition of the patient for post-operative care.
B. MRO patients will be admitted to PACU unless they are intubated or have uncontained
draining wounds.
C. Patients who are intubated or have uncontained wounds will be recovered in a private room or
area, or will be spatially separated from other patients.
D. Patient assignment will be one RN to one patient in PACU, as staffing allows.
Responsibility:
Original date:
Reviewed By:
Reviewed/Revised date(s):
Revised by: