Minimising the risk of Mycobacterium chimaera infection during cardiopulmonary bypass by the removal of heater-cooler units from the operating room.

INTRODUCTION: Mycobacterium chimaera ( M. chimaera) is a recently characterised bacterium that can cause life-threatening infections in small numbers of patients who undergo cardiopulmonary bypass during cardiac surgery. The likely mode of transmission is thought to occur through aerosolisation from contaminated water reservoirs. The airborne bacteria then contaminate the surgical field, leading to an infection months or even years later. The preferred practical solution to disrupt the transmission of these airborne bacteria to the patient is to remove the heater-cooler units (HCUs) from the operating room (OR). We describe a process of achieving this in order to provide information to guide other institutions who wish to do a similar thing. METHODS: A multidisciplinary team was assembled to work on the project. The planning phase involved trialling different OR layouts and simulating the alterations in the HCU circuit function. The changes to the OR were made over a weekend to minimise disruption to the operating schedule. RESULTS: The HCU was moved to the dirty utility room adjacent to the OR. Standard operating procedures (SOP) and risk assessments were made to enable this to be used for a dual purpose. One of the ORs was reconfigured to allow the cardiopulmonary bypass machine to be located close to the HCU in the dirty utility room. The total cost of the alterations was £6,158. Although we have provided a physical barrier to interrupt patient exposure to aerosolised M. chimaera from HCUs, we continue to perform cultures and decontamination as per the national recommendations. The SOP was designed to be auditable to ensure compliance with the protocols. CONCLUSIONS: We show a method by which the HCU can be removed from the OR in a relatively low-cost, straightforward and practical manner.

Investing in the future a cross-organisational approach.

THE NHS CANCER PLAN ( Department of Health 2000a ) identifies the need to develop staff in order to deliver the highest quality cancer care and meet the complex needs of patients with cancer. Nurses make up the single largest professional group in this workforce.

Palliative care nursing. Part 1. Building the foundations for primary nursing.

Primary nursing offers a structure that can facilitate the development of patient-centred care and promote the role and status of the nurse. Successful introduction of primary nursing depends on a careful analysis of the current situation, a shared vision for the future, and a consensus on strengths, weaknesses, opportunities and threats. This article explores the experience of four senior nurses who set out to introduce primary nursing to a palliative care setting.