Orthopaedic surgery and infections

[Wishart, Michael]

Hi all

Just some quick questions about orthopaedic patients with infections.

1. Do you accommodate orthopaedic patients with active wound infection
on your post-op orthopaedic wards?
2. In particular, do you accommodate orthopaedic joint surgery patients
with active wound infections on the same ward as post-op orthopaedic
joint surgery patients?
3. Do you allow patients colonised with MRSA or ESBL’s to be
accommodated on the same ward as post-op orthopaedic joint surgery
patients?
4. If yes to any of the above, are patients on orthopaedic wards with
colonisation or infections always placed in single rooms?

These are contentious issues for orthopaedic surgeons in our facility
(and probably many other facilities!), so any comments or thoughts on
risks and risk management strategies to prevent joint infections
post-operatively would be appreciated.

Does any one know of any useful published guidelines about this?

Thanks
Michael

Michael Wishart | GPH – Infection Control Coordinator

GPH – Quality & Safety Unit (Infection Control) | Greenslopes Private
Hospital
Newdegate Street, Greenslopes QLD 4120
t: 07 3394 7919 | f: 07 3394 7985
e: WishartM@ramsayhealth.com.au | w: http://www.ramsayhealth.com.au

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[Grimes, Andrea]

Hi Michael,

All our orthopaedic patients are accommodated in the ortho unit unless they are requiring care in HDU.
Any ortho patients that are colonised or have an active infection are always allocated a single room.
I agree this is sometimes a very contentious issue with some ortho surgeons but we always try to influence them with policy! 🙂

Cheers, Andrea

Andrea Grimes | ICC | WHS | RRTWC
Cairns Private Hospital
t: 07) 4052 5274 f: 07) 4052 5188 m: 0417 714 374
e: grimesa1@ramsayhealth.com.au

Ramsay Health Care is an environmentally responsible corporation, please consider the environment before printing this email.
Save lives – Clean your Hands

—–Original Message—–

Hi all

Just some quick questions about orthopaedic patients with infections.

1. Do you accommodate orthopaedic patients with active wound infection
on your post-op orthopaedic wards?
2. In particular, do you accommodate orthopaedic joint surgery patients
with active wound infections on the same ward as post-op orthopaedic
joint surgery patients?
3. Do you allow patients colonised with MRSA or ESBL’s to be
accommodated on the same ward as post-op orthopaedic joint surgery
patients?
4. If yes to any of the above, are patients on orthopaedic wards with
colonisation or infections always placed in single rooms?

These are contentious issues for orthopaedic surgeons in our facility
(and probably many other facilities!), so any comments or thoughts on
risks and risk management strategies to prevent joint infections
post-operatively would be appreciated.

Does any one know of any useful published guidelines about this?

Thanks
Michael

Michael Wishart | GPH – Infection Control Coordinator

GPH – Quality & Safety Unit (Infection Control) | Greenslopes Private
Hospital
Newdegate Street, Greenslopes QLD 4120
t: 07 3394 7919 | f: 07 3394 7985
e: WishartM@ramsayhealth.com.au | w: http://www.ramsayhealth.com.au

Ramsay Health Care is an environmentally responsible corporation, please
consider the environment before printing this email.

This e-mail message and any accompanying files may contain
information that is confidential and subject to privilege. If you
are not the intended recipient, and have received the e-mail
in error, you are notified that any use, dissemination,
distribution, forwarding, printing or copying of the message
and any attached files is strictly prohibited. If you have
received this e-mail message in error please immediately
advise the sender by return e-mail, or telephone 1800 243 903.
You must destroy the original transmission and its contents.
Any views expressed within this communication are those of
the individual sender, except where the sender specifically
states them to be the views of Ramsay Health Care.
This communication should not be copied or disseminated
without permission.
————————————————————————

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[Fiona de Sousa]

Hi Michael,

At our facility we have one Orthopaedic ward and a second surgical ward
that takes the MRO positive orthopaedic patients as well as other types
of surgery.

Our surgeons generally complain when their MRO positive patient does not
get accommodated on the orthopaedic ward however the same surgeons get
quite upset if anyone else’s MRO positive patient makes it onto the
orthopaedic ward ! We keep reminding them of this and they are
generally ok about it.

We do have one exception to this rule and that is in the case where
extremely specialist orthopaedic nursing care is required. In this
situation we would isolate the patient on the orthopaedic ward with
contact precautions and either 1 to 1 nursing care or a very select
patient load for the nurse caring for them. This is extremely rare
though (less than 1 patient per year).

In relation to wound infections if it is caused by an MRO then the
patient will be accommodated in the second ward. However if it is an
infection caused by another organism they have a single room in the
orthopaedic ward and the staff use standard precautions.

I do not have a specific guideline about this but it is based on advice
form our ID physician and the Orthopaedic section.

Fiona De Sousa
Infection Prevention & Control Coordinator, SAH

—–Original Message—–
Behalf Of Wishart, Michael

Hi all

Just some quick questions about orthopaedic patients with infections.

1. Do you accommodate orthopaedic patients with active wound infection
on your post-op orthopaedic wards?
2. In particular, do you accommodate orthopaedic joint surgery patients
with active wound infections on the same ward as post-op orthopaedic
joint surgery patients?
3. Do you allow patients colonised with MRSA or ESBL’s to be
accommodated on the same ward as post-op orthopaedic joint surgery
patients?
4. If yes to any of the above, are patients on orthopaedic wards with
colonisation or infections always placed in single rooms?

These are contentious issues for orthopaedic surgeons in our facility
(and probably many other facilities!), so any comments or thoughts on
risks and risk management strategies to prevent joint infections
post-operatively would be appreciated.

Does any one know of any useful published guidelines about this?

Thanks
Michael

Michael Wishart | GPH – Infection Control Coordinator

GPH – Quality & Safety Unit (Infection Control) | Greenslopes Private
Hospital
Newdegate Street, Greenslopes QLD 4120
t: 07 3394 7919 | f: 07 3394 7985
e: WishartM@ramsayhealth.com.au | w: http://www.ramsayhealth.com.au

Ramsay Health Care is an environmentally responsible corporation, please
consider the environment before printing this email.

This e-mail message and any accompanying files may contain
information that is confidential and subject to privilege. If you
are not the intended recipient, and have received the e-mail
in error, you are notified that any use, dissemination,
distribution, forwarding, printing or copying of the message
and any attached files is strictly prohibited. If you have
received this e-mail message in error please immediately
advise the sender by return e-mail, or telephone 1800 243 903.
You must destroy the original transmission and its contents.
Any views expressed within this communication are those of
the individual sender, except where the sender specifically
states them to be the views of Ramsay Health Care.
This communication should not be copied or disseminated
without permission.
————————————————————————

Messages posted to this list are solely the opinion of the authors, and
do not represent the opinion of AICA.
Archive of all messages are available at http://aicalist.org.au/archives
– registration and login required.
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[Wendy Grey]

The main issue with this is, do you then screen in all your patients to Orthopaedics? Unless you screen every single patient on arrival and regularly (if they stay for long periods of time) You can of course isolate those identified with an MRO but unless you screen everyone you may be admitting patients who you are not aware are already colonised.
In the UK some areas do have a designated Ortho clean ward where such screening takes place and where they do not take any colonised patients. It is only used for elective, planned and pre assessed patients
regards
Wendy
Wendy Grey
Nursing Director of Infection, Prevention and Control
IMB 64
PO Box 670
Townsville Hospital 4810
Fax : 4796

>>> “Grimes, Andrea” 6/07/2010 10:42 am >>>
Hi Michael,

All our orthopaedic patients are accommodated in the ortho unit unless they are requiring care in HDU.
Any ortho patients that are colonised or have an active infection are always allocated a single room.
I agree this is sometimes a very contentious issue with some ortho surgeons but we always try to influence them with policy! 🙂

Cheers, Andrea

Andrea Grimes | ICC | WHS | RRTWC
Cairns Private Hospital
t: 07) 4052 5274 f: 07) 4052 5188 m: 0417 714 374
e: grimesa1@ramsayhealth.com.au

Ramsay Health Care is an environmentally responsible corporation, please consider the environment before printing this email.
Save lives – Clean your Hands

—–Original Message—–

Hi all

Just some quick questions about orthopaedic patients with infections.

1. Do you accommodate orthopaedic patients with active wound infection
on your post-op orthopaedic wards?
2. In particular, do you accommodate orthopaedic joint surgery patients
with active wound infections on the same ward as post-op orthopaedic
joint surgery patients?
3. Do you allow patients colonised with MRSA or ESBL’s to be
accommodated on the same ward as post-op orthopaedic joint surgery
patients?
4. If yes to any of the above, are patients on orthopaedic wards with
colonisation or infections always placed in single rooms?

These are contentious issues for orthopaedic surgeons in our facility
(and probably many other facilities!), so any comments or thoughts on
risks and risk management strategies to prevent joint infections
post-operatively would be appreciated.

Does any one know of any useful published guidelines about this?

Thanks
Michael

Michael Wishart | GPH – Infection Control Coordinator

GPH – Quality & Safety Unit (Infection Control) | Greenslopes Private
Hospital
Newdegate Street, Greenslopes QLD 4120
t: 07 3394 7919 | f: 07 3394 7985
e: WishartM@ramsayhealth.com.au | w: http://www.ramsayhealth.com.au

Ramsay Health Care is an environmentally responsible corporation, please
consider the environment before printing this email.

This e-mail message and any accompanying files may contain
information that is confidential and subject to privilege. If you
are not the intended recipient, and have received the e-mail
in error, you are notified that any use, dissemination,
distribution, forwarding, printing or copying of the message
and any attached files is strictly prohibited. If you have
received this e-mail message in error please immediately
advise the sender by return e-mail, or telephone 1800 243 903.
You must destroy the original transmission and its contents.
Any views expressed within this communication are those of
the individual sender, except where the sender specifically
states them to be the views of Ramsay Health Care.
This communication should not be copied or disseminated
without permission.
————————————————————————

Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of AICA.
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[Toni Schouten]

We have a designated elective ward where patients are screened
pre-admission. If a patient needs to be admitted immediately due to
their medical condition to this ‘ring fenced’ ward they are placed in a
single room and swabs collected for MRSA. “Released” once proven
negative.
We have another ortho ward in our main hospital where known MROs can go
and trauma cases. In this ortho ward the patient would not necessarily
be placed in a single room unless the organism was significant.

Regards,
Toni Schouten CICP
Clinical Nurse Consultant
Infection Control
Royal Prince Alfred Hospital
Level 7, KGV Building
Missenden Road
Camperdown NSW 2050
Australia
toni.schouten@sswahs.nsw.gov.au

—–Original Message—–
Behalf Of Wishart, Michael

Hi all

Just some quick questions about orthopaedic patients with infections.

1. Do you accommodate orthopaedic patients with active wound infection
on your post-op orthopaedic wards?
2. In particular, do you accommodate orthopaedic joint surgery patients
with active wound infections on the same ward as post-op orthopaedic
joint surgery patients?
3. Do you allow patients colonised with MRSA or ESBL’s to be
accommodated on the same ward as post-op orthopaedic joint surgery
patients?
4. If yes to any of the above, are patients on orthopaedic wards with
colonisation or infections always placed in single rooms?

These are contentious issues for orthopaedic surgeons in our facility
(and probably many other facilities!), so any comments or thoughts on
risks and risk management strategies to prevent joint infections
post-operatively would be appreciated.

Does any one know of any useful published guidelines about this?

Thanks
Michael

Michael Wishart | GPH – Infection Control Coordinator

GPH – Quality & Safety Unit (Infection Control) | Greenslopes Private
Hospital
Newdegate Street, Greenslopes QLD 4120
t: 07 3394 7919 | f: 07 3394 7985
e: WishartM@ramsayhealth.com.au | w: http://www.ramsayhealth.com.au

Ramsay Health Care is an environmentally responsible corporation, please
consider the environment before printing this email.

This e-mail message and any accompanying files may contain
information that is confidential and subject to privilege. If you
are not the intended recipient, and have received the e-mail
in error, you are notified that any use, dissemination,
distribution, forwarding, printing or copying of the message
and any attached files is strictly prohibited. If you have
received this e-mail message in error please immediately
advise the sender by return e-mail, or telephone 1800 243 903.
You must destroy the original transmission and its contents.
Any views expressed within this communication are those of
the individual sender, except where the sender specifically
states them to be the views of Ramsay Health Care.
This communication should not be copied or disseminated
without permission.
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