Patient isolation tips for outpatient surgery

Gowns, gloves, and staff awareness are key

Hospital inpatients with methicillin-resistant Staphylococcus aureus (MRSA) are isolated from other patients to reduce the risk of colonizing other patients or visitors, but how does an outpatient surgery program isolate a patient when there often is a shortage of space and a need to move many patients through a single area in a short time?

The first step is to ensure that staff members in all areas of the surgery program know the patient is positive for MRSA or has a high likelihood of having MRSA, says Toni B. Hughes, RN, BSN, MA, CNOR, perioperative education specialist at Baltimore Washington Medical Center in Glen Burnie, MD. Because her facility doesn't culture all patients, if a patient indicates that he or she has had MRSA in the past or if a family member has it, the patient is considered positive, she says. "MRSA appears in the face sheet of the chart to alert all staff members to take precautions against the spread of MRSA."

They're fortunate that their outpatient surgery center has all private rooms in pre-op and recovery, so there is little risk of cross-contamination while the patient is in those rooms, says Hughes. "We do clean the rooms, including bedrails and all hard surfaces, before the next patient is moved into the room," she says.

The staff at Ruby Day Surgery Center in Morgantown, WV, follow isolation guidelines set for the entire hospital for MRSA patients within the context of surgery, says Mary Wilson, RN, BSN, CNOR, clinical preceptor for the operating room and endoscopy at the center. [A copy of the isolation guidelines are available.]

"We wear gowns and gloves at all times and we make sure the wound is covered during transport," Wilson says. Staff members also seem to wash their hands more frequently when the patient is known to have MRSA, she adds. "We also have isolation carts that contain supplies and equipment necessary for isolation so that nurses can easily access gowns and gloves as they approach the patient's bedside," says Wilson. The isolation carts used in Wilson's facility include the following items:

  • oral and rectal thermometers;
  • one box of alcohol wipes;
  • a package of about 25 plastic bags with zipper-type closures;
  • five small plastic garbage bags that can be attached to bedrail with tape for patient's personal trash;
  • boxes of three types of masks: masks with splash guards, regular masks, and N95 respirator masks;
  • one box each of different sizes of exam gloves;
  • a bag for dirty linen;
  • two to three disposable goggles;
  • two disposable stethoscopes;
  • 10 yellow isolation gowns.

Also, if a patient is known to have MRSA, you can decrease the risk of transmission to another patient by scheduling the procedure at the end of the day, says Robert G. Sawyer, MD, professor of surgery and public health sciences at the University of Virginia Medical School in Charlottesville. An end-of-the-day procedure means that the operating room will be terminally cleaned following the procedure, and patient care areas occupied by the patient can be thoroughly cleaned before the next morning, Sawyer says.