TheatrePracticeStandardsGeneric1

Generic Theatre Standard No 06D Management of Patients with
Glycopeptide Resistant Enterococci (GRE) in the Operating Theatre
Department
Standard Statement: All Theatre staff will have knowledge of the requirements for caring for
patients with GRE into operating department to protect self, colleagues and patients from the risk
of health care acquired infection.
Enterococci are Gram positive bacteria that are commonly found in the bowel of humans and
animals. They rarely cause infection. They are occasionally responsible for urinary tract infections
(UTIs), often related to the use of indwelling catheters, and more rarely cholangitis, endocarditis
and gut-related sepsis. Two main types are associated with human diseases: Enterococcus
faecalis and Enterococcus faecium. Enterococcus faecium is more common to cause bacteremic
infections.
Glycopeptide resistant enterococci (GRE) are resistant to vancomycin, usually teicoplanin and
often other antibiotics. During mid 1980s enterococci resistant to vancomycin emerged and
therefore often termed as Vancomycin Resistant Enterococci (VRE). GRE usually tend to cause
colonisation rather than infection but when they cause serious infection, they are difficult to treat
because of less therapeutic option.
Hospital outbreaks of GRE have been reported mainly from renal dialysis, transplant, haematology
and intensive care units. Risk factors for colonisation and infection with GRE include previous
antibiotic therapy (especially with glycopeptides, cephalosporins, or carbapenems),
immunosuppression, prolonged hospital stay, and admission to intensive care, renal, haematology
or liver units. Once gut colonisation has occurred, carriage can be prolonged and there is no
effective means of eradication.
General Considerations
Please see the Glycopeptide Resistant Enterococci (GRE) Policy
Generic Theatre Standard 04 - Infection control in the Operating Department
• Staff risk Effective hand decontamination is the most important measure to prevent
and control the spread of GRE. Portering staff do not need to wear protective clothing
whilst transporting patients. They only need to wear protective clothing if there is any
possibility of having close contact with the patient and they must decontaminate their
hands after removal.
• Patient position on list schedule DO NOT NEED to be last on list, however, to
ensure robust cleaning, adequate, non-pressured time be allowed to the staff to clean
effectively.
• Hand Hygiene Effective hand decontamination is the most important measure to
prevent and control the spread of GRE. Alcohol gel is effective on GRE, so should be
used in all potential situations as recommended in the Standard Precautions policy.
Hands must be decontaminated between each patient contact whether or not the
patient is known to be colonised with GRE.
• Personal Protective Equipment (PPE) Staff should use standard precautions after
contact with urine or faeces to prevent spread. Staff must put on gloves when entering
the theatre and wear a plastic apron if substantial contact with the patient or
environmental surfaces is anticipated. PPE must be removed followed by hand
washing before coming out of the patient zone
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