Theatre Protocol for Patients with Suspected or Known Infections

Publication: 16/06/2015  
Next review: 01/02/2022  
Clinical Protocol
INTERIM REVIEW DATE 
ID: 4232 
Approved By: Trust Clinical Guidelines Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2015  

 

This Clinical Protocol is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Theatre Protocol for Patients with Suspected or Known Infections

Background and indications for standard operating procedure/protocol

Many infections occur because micro–organisms colonising the patient are inadvertently transferred to a vulnerable site on the same patient or another patient. Practices to prevent patients acquiring infection and to minimise the risk of transmission should therefore be incorporated into routine practice (Wilson, 2006). This protocol intends to give general guidance to theatre and recovery practitioners.

This protocol applies to all staff (temporary or permanent) working in the Leeds Teaching Hospital Trust (LTHT).
This also includes volunteers, contractors, students and/or trainees.

This protocol is an appendix to the LTHT Isolation Guideline.

Refer to the Infection Prevention and Control Policy; managing the risks associated with infection prevention and control, for information on the criteria, responsibilities and systems required to prevent and control Healthcare Associated Infections (HCAIs.)

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Procedure method (step by step)

1. Introduction

This protocol relates to those patients who, prior to surgery, are suspected or known to be infected. In practice, it refers to anyone being managed with Source Isolation precautions on the ward. For patients with Creutzfeldt-Jakob disease (CJD) or similar prion diseases refer to the Transmissible Spongiform Encephalopathies (TSE) TSE guideline.

In addition to Standard Precautions that should be employed with all patients, the following must also be observed for these suspected or known infected patients.

  • The surgical team booking patients for theatre must notify theatres in advance of any organisms or infectious diseases the patient may have e.g. MRSA, Tuberculosis (TB), Carbapenemase Producing Enterobacteriaceae (CPE) or Chickenpox etc.
  • Ward nursing staff must also notify theatres in advance as to whether or not the patient is being nursed with Source Isolation precautions.
  • Appropriate antibiotic prophylaxis should be given, depending on the type of surgery and resistant bacteria/infection present. Refer to antimicrobial guideline available Leeds health pathways.
  • if a patient needs to be recovered in theatres due to their infectious status (see appendix 1), they should be placed last on the list to cause least disruption where possible.
  • Disposable gloves and yellow aprons must be worn by all staff when dealing with patients suspected or known to have an infection and when accessing equipment attached to such patients. Additional PPE may be required dependant on the infection (see appendix 1).

2. Anaesthetic Room

  • Patients with multi-drug resistant bacteria or infectious diseases may be anaesthetised in the anaesthetic room if all equipment used on them is decontaminated appropriately (see Decontamination of Reusable Medical Devices) before the next patient. If it is preferred that they go straight into theatre, then this is a satisfactory option.
  • Disposable anaesthetic machine circuits must be used and changed after an infectious case.

3. Theatre (operating room)

  • The minimum necessary number of people should be present.
  • In addition to the usual theatre clothing the circulating nurse, anaesthetist and anaesthetic nurse/ODP should wear disposable gloves, yellow aprons and any additional PPE as required (see appendix 1).
  • After the operation, all equipment, surfaces and the floor must be cleaned with Chlor–clean by theatre staff.
  • Surfaces contaminated with high risk body fluids must be cleaned with chlorine releasing agent at a concentration of 10, 000 ppm (see Standard Precautions).
  • Protective clothing i.e. gloves and aprons should be removed before leaving the operating room and disposed of in an orange clinical waste bag.
  • All linen must be put into red alginate bags and then into an outer white bag.
  • Clinical waste for incineration must be put into infectious waste bags.
  • Fluid waste must be put into a rigid container or treated with a solidifying gel.
  • Instruments must be returned to B Braun in the normal way (except instruments used on known and suspected CJD patients), refer to TSE guideline.
  • As soon as theatre cleaning is complete; it can be used again; no time period needs to elapse.

4. Recovery

  • Unless otherwise stated patients with suspected or known infections should be recovered using Source Isolation precautions in the Post Anaesthetic Care Unit (PACU). See appendix 1 for a list of patients who are required to be recovered in theatre.
  • If possible the patient should be nursed in a designated area using source isolation precautions away from other patients and near a clinical hand-wash basin. Wipe-able mobile screens can be used if available.
  • A sign should be displayed at the bedside/trolley to indicate source isolation precautions are required for this patient.
  • Gloves and yellow aprons must be worn by all staff when attending to the patient and the patient’s immediate environment and bed space.
  • Gloves and aprons must be changed between dirty and clean tasks and between patients and hands appropriately decontaminated (see Hand Hygiene Policy)
  • See appendix 1 for additional PPE requirements.
  • All equipment and bed space must be decontaminated using Chlor-clean between patients.
  • Curtains which have been used may need to be changed after suspected or known infected cases.Refer to RAG guidance for terminal bed space cleaning.

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Provenance

Record: 4232
Objective:

To standardise and optimise the placement and management of suspected, or known, infected patients in theatre.

Clinical condition:
Target patient group:
Target professional group(s): Secondary Care Doctors
Secondary Care Nurses
Allied Health Professionals
Adapted from:

Evidence base

G.A.J. Ayliffe et al, Control of Hospital Infection, a Practical Handbook, Fourth Edition, 2000, Arnold, London.
HPA, Guidelines for managing patients with suspected or confirmed H1N1 influenza virus, 2009
Wilson. J, Infection Control in Clinical Practice, Third Edition, 2006. Bailliere Tindall

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Approved By

Trust Clinical Guidelines Group

Document history

LHP version 1.0

Related information

 

Appendix 1

Additional PPE requirements for Patients with Suspected or Known Infections attending the Operating Theatre & PACU (Post Anaesthetic Care Unit).

This is not an exhaustive list, please contact Infection Prevention & Control Team on 22691 if you have any queries.

Suspected or Known Infection

Recovery Area

Additional PPE required

Comments

Multi Drug Resistant (MDR) TB

In Theatre

FFP 3 Masks

FFP3 mask be worn at all times

Open Pulmonary TB

In Theatre

Surgical Face Mask 

NOW FFP3 MASK 

FFP 3 masks to be worn for any Aerosol Generating Procedures
AT ALL TIMES 

Influenza

In Theatre

Surgical Face Mask

FFP 3 masks to be worn for any Aerosol Generating Procedures

RSV and other Respiratory Viruses (as per Respiratory Virus Guidelines)

In Theatre

Surgical Face Mask

Varicella Zoster (Chicken Pox/Exposed Shingles)

In Theatre

Surgical Face Mask

Dry covered Shingles can be recovered in PACU with Source Isolation precautions.

Measles

In Theatre

Surgical Face Mask

MRSA/VRE/ESBL’s (in Sputum)

In Theatre

Surgical Face Mask

CPO (Carbapenemase Producing Organism)/CPE (Carbapenemase Producing Enterobacteriaceae)

In Theatre

Blue long sleeved gowns (instead of yellow apron)

Invasive Group A Streptococcal Infection

Source Isolate In PACU

MRSA (other than in sputum)

Source Isolate In PACU

ESBL’s (Extended Spectrum Beta-Lactamases)

Source Isolate In PACU

VRE (Vancomycin Resistant Enterococci)

Source Isolate In PACU

Meningitis/Meningococcal septicaemia

Source Isolate In PACU

Clostridium difficile (toxin positive and toxigenic strain positive)

Source Isolate In PACU

Norovirus/Rotavirus

Source Isolate In PACU

Infectious Diarrhoea and/or Infectious Vomiting

Source Isolate In PACU

Including any asymptomatic patients from closed bays/wards

Any other suspected/known infection where a patient is being source isolated on the ward.

Source Isolate In PACU

Unless previously stated above.

Campylobacter

In PACU (Source Isolation not required)

Head lice/Scabies

In PACU (Source Isolation not required)

Malaria

In PACU (Source Isolation not required)

Legionellosis

In PACU (Source Isolation not required)

Viral Meningitis

In PACU (Source Isolation not required)

Any other non-transmissible infections not included in the above

In PACU (Source Isolation not required)

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Equity and Diversity

The Leeds Teaching Hospitals NHS Trust is committed to ensuring that the way that we provide services and the way we recruit and treat staff reflects individual needs, promotes equality and does not discriminate unfairly against any particular individual or group.