Communicate and Isolate to Prevent CRE Transmission

CRE is deadly, with a mortality rate of up to 50% if carbapenem-resistant enterobacteriaceae cause serious infections such as bloodstream infections in your patient.

Contamination of health care professionals’ hands and the equipment used to care for patients are two of the leading causes for CRE transmission.

“This means perioperative nurses have the power to protect their patients by reducing the risk for CRE transmission, but only if they act on that power by implementing evidence-based infection prevention practices,” stresses Terri Link, MSN, RN, CNOR, CIC, FAPIC, an infection preventionist and AORN education specialist.

Communicating CRE Risk

Because there is no clearing protocol at this time, there is not enough evidence to make a firm recommendation about when to discontinue use of contact precautions for patients infected or colonized with CRE, Link explains. “Always consult an infection preventionist in managing these patients and their isolation,” she suggests.

“Transitions of care must include thorough, documented communication about a patient having CRE, whether the patient is being transferred within the perioperative unit or between the perioperative unit and other health care settings,” she says, noting that infection preventionists are working to improve communication regarding the risk of transmitting CRE  in health care settings. “A patient cannot be placed in contact isolation if no one is aware of their infection. Early isolation is imperative in preventing transmission.”

Following Contact Precautions in the OR

Contact precautions in perioperative units require several actions that are unique to the perioperative setting. Here are a few actions Link notes:

• Isolate the patient upon arrival
  After arrival in the perioperative area, the perioperative nurse should immediately transfer the patient to a private room with doors or curtains that close or segregate the patient in a private area away from other patients in the waiting room to reduce the risk of CRE exposure.


• Follow standard and contact precautions (including hand hygiene and wearing appropriate PPE)
  Standard precautions should be in place for all patients and in addition contact precautions for CRE patients who have an active infection or are colonized. PPE includes an isolation gown and gloves. Scrubbed personnel in the OR should wear a surgical gown in accordance with sterile technique. Take care to discard isolation gown and gloves in a receptacle within the patient's room or holding area to reduce risk for contamination and follow with hand hygiene.


• Handle equipment without causing personal and environmental contamination
  For reusable noncritical equipment, this means allowing the equipment to be disinfected between patient uses. Single use or disposable stethoscopes, blood pressure cuffs, and electrocardiogram leads can be used and should be disposed of appropriately to reduce contamination risk.


• Perform Enhanced environmental cleaning
  Personnel performing environmental cleaning and disinfection should wear an isolation gown and gloves. After the patient leaves the room enhanced environmental cleaning should be done with special care for high touch surfaces.

Practicing Correct Hand Hygiene—ALWAYS!

CRE occurs primarily among patients with health care exposure, but there is the potential for CRE to spread outside a health care facility because enterobacteriaceae are a common cause of community-associated infections—this is part of the reason CRE has become more prevalent, Link explains.

“Because we are never sure of a patient’s infectious status, adhering to hand hygiene practices in every case is our best way to prevent transmission of infectious disease, including CRE transmission,” she stresses.

Link reminds nurses to practice hand hygiene as recommended, including during specific moments of care, such as:

• before and after patient contact;
• before performing a clean or sterile task;
• after risk for blood or body fluid exposure;
• after contact with patient surroundings, such as patient bed and linens, OR bed controls, the floor, or items that have come in contact with the floor;
• before and after assembling items for sterilization; and
• when hands are visibly dirty or soiled.

Learn more about CRE transmission prevention with this CDC tool kit.

Read more about contact precautions in the perioperative setting in this AORN Journal Clinical Issues.

FREE RESOURCES FOR MEMBERS

Guideline Essentials: Prevent the transmission of infectious disease in your OR with access to implementation tools for hand hygiene, high-level disinfection, surgical attire, environmental cleaning, and much more.

• Quick views: Photos, illustrations, videos and an overview of the guideline.
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AORN Journal CNE Articles

Guideline Implementation: Hand Hygiene (1.1 CHs)

Back to Basics: Patient Care Transitions (.8 CHS)

Back to Basics: Sterile Technique (1.2 CHs)

Tool Kits

Environmental Cleaning