DOCUMENT CONTROL PAGE
Title
Title: MRSA Screening and Decontamination policy
Version: 2
Supersedes
Originator or
modifier
Originated By: Julie Cawthorne
Approval by: Infection Control Committee
Review
Circulation
Application
Supersedes: MRSA Policy January 2006
Approval
Reference Number: Infection Control Policy IC Org 03 MRSA
Designation: Nurse Consultant
Modified by: Jo Clubb
Designation: Infection Control Nurse
Sub Committee Approval Date: Expert Group Committee
All Staff
All Patients
Issue Date: December 2008
Circulated by: Jo Rothwell
Review Date: December 2010
Responsibility of: Jo Rothwell
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POLICY CONTROL PAGE (2) CIRCULATION DOCUMENT
Circulation List: See Infection Control Strategy 01
For Information
Central Manchester and Manchester University Hospitals NHS Trust is committed to
promoting equality and diversity in all areas of its activities. In particular, the Trust wants
to ensure that everyone has equal access to its services. Also that there are equal
opportunities in its employment and its procedural documents and decision making
supports the promotion of equality and diversity. Refer to section 8 for more detail on
undertaking equalities impact assessment.
This document must be disseminated to all relevant staff, refer to section 10:
Dissemination and Implementation
The Policy must be posted on the intranet: Date Posted:
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Section
1
Contents
Page
Introduction
5
2
Purpose
5
3
Roles and Responsibilities
5
Detail of Policy
4.1
MRSA Screening
4.1.1 MRSA screening statement of intent
4.1.2 Actions to be taken if the patient is MRSA
positive prior to elective admission
4.1.3 Actions to be taken following 3 Negative
MRSA screens for elective admissions
4.1.4 MRSA screening for high risk
admissions
4.1.5 MRSA screening and decolonisation
therapy regime for ALL patients with a
previous history of MRSA
colonisation/infection
4.1.6 MRSA screening procedure – sample
sites
4.2
MRSA Decolonisation Therapy
4.2.1 Adults and paediatric patients over 6
weeks of age – skin decolonisation
4.2.2 Adults and paediatric patients over 6
weeks of age – nasal decolonisation
4.2.3 Neonates and paediatric patients under 6
weeks of age – skin decolonisation
4.2.4 Neonates and paediatric patients under 6
weeks of age – nasal decolonisation
4.2.5 Pre-operative preparation for patients
known to have / with a history of MRSA
colonisation/infection
4.3
Source Isolation
4.3.1 Source Isolation – inpatients
4.3.2 Source Isolation – outpatients
4.3.3 Source Isolation – radiology, cardiology,
neurophysiology & nuclear medicine
4.6
Discharge of Patients Colonised / Infected with
MRSA
5
5
5
6
5
Equality Impact Assessment
20
6
Consultation, Approval and Ratification Process
20
7
Dissemination and Implementation
20
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6
7
7
9
10
11
12
13
13
14
18
19
20
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8
Review, Monitoring Compliance With and the
Effectiveness of Procedural Documents
21
9
References and Bibliography
21
10
Associated Trust Documents
21
11
Appendices
22
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1
Introduction
Meticillin-resistant Staphylococcus aureus (MRSA) remains endemic in many
UK hospitals. Specific guidelines for control and prevention are justified
because MRSA can cause serious illness and result in significant health care
costs.
MRSA can be transmitted via 2 main routes:
Contact transmission: via healthcare workers hands, or from the patient’s
immediate environment.
Airborne transmission: via droplets in patients who are sputum positive or
via skin scales when large quantities are released into the air e.g. during bed
making.
2
Purpose
This document provides a framework for all members of trust staff involved in
clinical care. It provides information on MRSA screening and management of
patients known to have been either colonised / infected with MRSA.
3
Roles and Responsibilities
The roles and responsibilities of named individuals within the organisation,
with regard to their duty to comply with this policy and protect patients from the
risks of acquiring healthcare associated infection, are identified in the Trust
Infection Control Strategy 01 in accordance with The Health Act, Code of
Practice, 2006 section2.
4
Detail of Policy.
The Policy is described below under the following sections:
4.1 MRSA SCREENING
4.2 MRSA DECOLONISATION
4.3 MRSA SOURCE ISOLATION
4.1 MRSA SCREENING
4.1.1 MRSA Screening Statement of Intent
All relevant elective admissions to Central Manchester University Hospitals
NHS Foundation Trust are screened for MRSA prior to admission.
All high risk emergency admissions are also screened for MRSA on
admission. This will be extended to include all remaining emergency
admissions by March 2011.
All patients who test positive for MRSA on screening, prior to admission or on
admission or those who have had a previous history of MRSA (including those
who have had three negative screens) will be commenced on decolonisation
therapy.
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4.1.2 Action to be taken if the patient is MRSA positive prior to ELECTIVE
admission
A list of patients who should be screened prior to elective admission can be
found in appendix 1.
An attempt should be made to eradicate MRSA from patients listed for elective
admission. They should be screened at least every week whilst receiving
decolonisation therapy. If the patient has three consecutive negative screens,
the decolonisation therapy may be discontinued until admission. If however,
after two courses of Mupirocin nasal ointment and three weeks continuous
treatment with Octenisan /Oilatum Plus body wash, the patient still remains
positive a risk assessment should be undertaken for the individual patient
concerned. Please contact a member of the Infection control Team for further
advice in such circumstances.
For elective admissions or transfers where a delay in admission may be
seriously detrimental to the patient outcome, such patients should be admitted
following a risk assessment by the Consultant in-charge of the case. These
patients must be isolated and treated in accordance with this Policy (see
section 4.3).
4.1. 3 Action to be taken following three negative MRSA screens from
ELECTIVE admissions
Action
Rationale
Patients listed for elective admission who
have a previous history of MRSA
colonisation / infection despite three
negative screens must be screened on
admission and commenced on skin
decolonisation therapy. (They do not need
to be isolated unless found to be MRSA
positive.
MRSA decolonisation therapy may reduce
the risk of endogenous infection and
reduce the risk of cross transmission
especially if three consecutive negative
screens have been established. Three
consecutive negative screens however, is
not a definitive indicator of the patients
MRSA status.
Patients who are elective admissions for
surgery should commence nasal
decolonisation therapy as well as skin
decolonisation therapy during the pre and
post operative period.
Furthermore local evidence indicates that
a previous history of MRSA
colonisation/infection is a common factor in
incidents of MRSA bacteraemia.
All patients who are known to be MRSA
positive / have a history of being MRSA
positive, that are to undergo procedures that
would usually require the use of prophylactic
antibiotics must receive antibiotic therapy
that has activity against MRSA, for example,
Vancomycin or Teicoplanin (see adult antiinfective prescribing guidelines section 4,
antibiotic prescribing guidelines for paediatric
and neonatal patients, section 4).
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4.1.4 MRSA screening for high risk admissions
See Appendix 1
All patients who match the criteria below are considered to be high risk of
MRSA infection and must be screened for MRSA within 24 hours of
admission. They do not require isolation unless found to be MRSA positive

Transfers from other hospitals / healthcare facilities

History of admission to hospital / healthcare facility within the previous 6
months

Admission from a long-term residential facility e.g. nursing home /
residential home for elderly or chronically sick / respite care

Patient’s with exfoliating skin conditions e.g. extensive eczema or
psoriasis

Previous history of being MRSA positive (despite three or more
negative screens).

Healthcare workers.
4.1.5 MRSA screening and decolonisation therapy regime for ALL
patients with a previous history of MRSA colonisation / Infection
Action
Rationale
Patients being admitted for an
overnight stay (or longer), who have
had a previous history of MRSA
colonisation / infection, must be rescreened within 24 hours of
admission.
Local evidence from analysis of
incidents demonstrates a previous
history of MRSA as being a potential
risk factor for MRSA bacteraemia
This applies to all patients with a
previous history of MRSA
colonisation or infection regardless
of whether or not they have had
three or more negative screens for
MRSA.
Local evidence from analysis of
incidents demonstrates a previous
history of MRSA as being a potential
risk factor for MRSA bacteraemia.
Patients who have not had 3
negative screens should be isolated
until the results of the screen are
known. If necessary, seek advice
from a member of the Infection
Control Team regarding risk
assessment.
Isolation of patients with a known
history of MRSA colonisation or
infection will reduce the risk of cross
infection
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Contd.
Action
Rationale
Patients must be commenced on
This reduces the risks of
topical decolonisation therapy from

The patient developing an
admission using either: Octenisan
MRSA infection with their own
body washes (unless contraindicated)
MRSA during medical
or Oilatum Plus.
interventions

Transmission of MRSA to
Mupirocin or Naseptin nasal cream
another patient
should only be given on the advice of
the Infection Control Team.
See Appendix 2 and 3
Where the patient has had 3 negative
screens, Octenisan or Oilatum Plus
should be commenced and used
continually every day during the inpatient stay.
3 negative screens indicate that the
patient may have undetectable levels
of MRSA and therefore the risk of
transmission to others is minimal.
Isolation is not required unless the
patient has a positive result .
Patients who have had 3 negative
screens must be screened weekly
throughout their hospital stay, or in
line with any additional screening
program already in place.
Early detection of recolonisation
reduces the risk of infection and
transmission to others.
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4.1.6 MRSA screening procedure – sample sites
Action
Rationale
The following sites are recommended
for sampling for MRSA in adults and
children over 6 weeks of age
The nose and perineum are the main
carriage sites for MRSA. The groin is
often preferred but may be less
sensitive.
Nose, perineum or groin, skin lesions
(including pressure sores) and any
manipulated clinical sites e.g. wounds
/ intravenous and stoma sites / urine
from catheterised patients /
tracheotomies and sputum if
applicable.
N.B Swabs taken from Clinical
Sites will only be cultured for
MRSA. A further sample will be
necessary if further Culture and
Sensitivity is required.
In neonates and children under 6
weeks of age, axilla, groin, umbilicus
and any manipulated clinical sites
e.g. cannula, stomas, skin lesions
etc.
The ability to detect MRSA carriage
depends on many factors including
the number and patient sites
sampled.
Where moisture is not evident at the
site to be swabbed, swabs should be
dampened by dipping them in
transport media or sterile saline prior
to swabbing.
To increase amount of bacteria
picked up.
Use the same swab to sample
symmetrical sites e.g. Single swab for
right and left nostril, single swab for
right and left groin.
Both sites would be treated if carriage
is detected therefore it is an
unnecessary expense to use
separate swabs.
Request screen using Clinical Work
Will reduce time of ordering cards,
Station (CWS). One request card can and bulk of screen.
be used for multiple swabs (maximum
of 8 per card) as long as each swab
is clearly identified with patient details
and site from which taken.
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Action
Rationale
Additional sites i.e. the throat may be
sampled if clearance of the carrier
status is difficult. (This should only
be done after discussion with a
member of the infection control
team)
The role of throat carriage in the
spread of infection is uncertain.
If the in patient has widespread
eczema or psoriasis (a heavy skin
shedder) please inform the infection
control team as soon as possible.
A person with dry / flaky skin will shed
more skin scales into the environment
and will increase the risk of infection.
4.2.MRSA Decolonisation Therapy
4.2.1 Adults and paediatric patients over 6 weeks of age – skin
decolonisation
Action
Rationale
NB This is a medical treatment, it is not optional. Please ensure patient
is given help in receiving the body wash as it should be applied all over
the body and left on for 3 minutes.
Treatment with a topical
Continuous treatment for skin
antibacterial lotion should
colonisation reduces the amount of
commence as soon as possible after MRSA on the skin and therefore
the patient has been identified as
reduces the risk of endogenous
MRSA positive / has had a previous
infection and cross infection
history of MRSA colonisation /
infection and should continue without
interruption (unless contraindicated),
during the in-patient stay
If a screen for MRSA is required, it
should be taken before the patient
has a daily wash with
Octenisan/Oilatum Plus. Screens
should be taken at weekly intervals
until 3 negative screens have been
achieved or until advised by the
infection control team.
Once the patient has had 3 negative
screens they no longer need to be
isolated. However, they should
continue to be screened every week.
3 negative screens indicate that the
MRSA is at undetectable levels and
isolation may be discontinued.
Local evidence suggests that
previous colonisation / infection with
MRSA maybe a significant
contributing factor to MRSA
bacteraemia.
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Contd.
Action
Patients should have a shower using
Octenisan or bath with Oilatum Plus
every day. Where this is not possible
they should either strip wash or be
bed bathed.
Rationale
This will reduce the level of MRSA
colonisation on the patient’s skin and
therefore reduce the risk of
endogenous / exogenous infection.
4.2.2 Adults and paediatric patients over 6 weeks of age - nasal
decolonisation
Action
Rationale
NB This is a medical treatment, it is not optional.
Patients who are treated with
Mupirocin nasal ointment:

A course of Mupiricin lasts 5
days (3 times per day). Once
completed a further 2 days
must pass before the patient
can be re -screened.
An indication of nasal carriage is only
possible once the Mupirocin has
been discontinued.

A maximum of 2 courses of
Mupirocin is recommended
To reduce the risk of Mupirocin
resistance.
Naseptin Nasal Ointment may be
used if further treatment is required.
Used on the advice of the infection
control team if nasal carriage
clearance is preferable.
Good oral hygiene of teeth or
dentures is recommended in patients
who are screen positive.
To reduce the level / risk / spread of
throat colonisation.
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4.2.3 Neonates and paediatric patients under 6 weeks of age – skin
decolonisation
Action
Rationale
Infants > 1.8kg should have a bath or
wash all over daily using disposable
wipes and cleaning solution as per
Neonatal Medical Unit (NNMU) skin
care guidelines.
Neonatal Medical Unit (NNMU)
guidelines support the use of neutral
pH cleansing solutions in neonates
Infants < 1.8kg are washed with water The skin of premature babies is more
only
permeable and there is risk of
absorption of cleaning solutions.
Infants skin creases e.g. axilla, groin
and umbilicus are dusted with
Chlorhexidine acetate (CX powder) 3
times per day for 5 days.
These areas are more susceptible to
MRSA colonisation.
Once completed a further 2 days
must pass before the infant can be
rescreened.
It is not appropriate to continue CX
powder indefinitely in neonates and
clearance of MRSA can only be
determined once treatment has
stopped.
Eradication of carriage may not be
achievable.
If a negative screen has not been
achieved after 3 cycles of treatment
the infection control team will advise
on further management of
colonisation.
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4.2.4 Neonates and paediatric patients under 6 weeks of age –
- nasal decolonisation
Action
Rationale
Naseptin nasal ointment applied to
each nostril 4 times per day for 5
days
To treat for suspected nasal carriage
Once completed a further 2 days
must pass before the infant can be
rescreened.
An indication of nasal carriage is only
possible once the Naseptin has been
discontinued.
If a negative screen has not been
achieved after 3 cycles of treatment
the infection control team will advise
on further management of
colonisation.
Eradication of carriage may not be
achievable.
4.2.5 Pre- operative preparation for patients known to have / with a
history of MRSA colonisation/infection
Action
Rationale
Patients who are going to theatre for
a procedure must be showered /
washed (including hair wash) as
close to the time of the procedure as
is practical using either Octenisan or
Oilatum Plus .
This will reduce the level of MRSA
colonisation on the patient’s skin and
therefore reduce the risk of
endogenous / exogenous infection.
If the Patient has already had 2
courses of Mupirocin a course of
Naseptin may be given over the pre
and post operative period please
consult with a member of the
Infection Control Team.
Over use of Mupirocin may cause
Mupirocin resistance
See adult anti-infective prescribing
guidelines section 4, antibiotic
prescribing guidelines for paediatric
and neonatal patients, section 4.
Patients with a history of MRSA must
be given Vancomycin/Teicoplanin if
antibiotic prophylaxis is required
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4.3 MRSA SOURCE ISOLATION
4.3.1 Source isolation – inpatients
Objective:
To minimise the risk of transmission of MRSA, directly from patient to patient,
or indirectly via health care workers or patient care equipment, whilst
maintaining patient safety and comfort.
Equipment
1. Single room with clinical handwash basin, appropriate handwash solution
and paper towels.
NB. If a single room is unavailable, and following a risk assessment, a
patient with MRSA colonisation / infection may be nursed on the ward
next to a sink. Full contact precautions must still be applied.
2. Toilet facilities, if appropriate, preferably en suite.
3. Isolation notice for outside of door or at bed space.
4. Disposable aprons and gloves (kept outside of room by the entrance,
preferably in Danicentres).
5. Alcohol hand rub (inside the room and easily accessible and outside the
room by entrance, preferably in wall mounted dispensers)
6. Pedal bin lined with clinical waste bag (kept by handwash basin).
7. Separate patient’s wash bowl stored dry and inverted when not in use.
8. Patients chart/records should be kept outside the room.
Action
Rationale
Commence MRSA ICP
documentation (available in preprinted format from the printing
department – order code J378).
Allows "step by step" approach to the
management and care of MRSA
positive patients.
Prepare and equip single room / bed
space for isolation.
Allows isolation procedures to be
carried out in an organised manner.
Keep equipment to a minimum
To facilitate cleaning of the room /
bed space and equipment. All
disposable equipment must be
discarded following patient discharge.
Ensure an Isolation notice is fixed to
bed space or outside the door,
advising ‘Please See Nurse in
Charge before Entering’.
Will ensure that all staff / visitors seek
proper advice before entering the
room / bed space, thus avoiding
confusion and unnecessary anxiety.
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Contd.
Action
Rationale
Inform infection control nurse of
MRSA result.
Infection control nurse can be used
as a resource to facilitate patients’
care whilst isolated.
Explain the need for isolation to
patient and relatives, and allow him /
her to express any anxieties she / he
may have. Give patient appropriate
information leaflets.
Reduces anxiety and fulfils legal
requirements. Gains patients’ and
relatives’ trust and co-operation and
involves them in their care.
Commence treatment for eradication
of MRSA colonisation (see section 5
and 6 above)
Prompt and effective treatment will
reduce the risk of cross infection and
may reduce the risk of patient
becoming infected with MRSA.
Disposable apron and gloves should
The use of protective clothing will
be worn by all staff when handling the reduce the risk of contaminating
patient or their immediate
uniform and hands.
environment, contact with their
secretions and handling of
contaminated dressings or linen.
Meticulous attention to hand hygiene HAND HYGIENE IS THE SINGLE
before leaving the room / bed space
MOST IMPORTANT MEANS OF
by all personnel. (Ensure there is
PREVENTING CROSS INFECTION
appropriate facilities i.e. soap /
alcohol gel in dispensers and paper
towels).
The patient must have a wash all
This will reduce skin carriage of
over / bath / shower using a topical
MRSA.
antibacterial lotion, disposable wipe
and clean towel daily. (See ICP for
neonates for variations in care).
Meticulous attention to oral / dental
hygiene is required.
To reduce the level / risk / spread of
throat colonisation.
Patient’s night-clothes and bed linen
(sheets and pillow cases) should be
changed daily.
To reduce recontamination of
patient’s skin with MRSA.
Wash patient’s wash bowl after each
use with soap and water, dry and
store inverted after use.
To remove grease, skin debris etc
from washbowl
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Contd.
Action
Rationale
Check mattress and pillow covers are
intact. Dispose of bed linen
immediately into pink alginate watersoluble infected linen bag. The
alginate bag may then be taken out of
room and put into a red linen bag in
the linen skip. Store spare alginate
bags outside patient’s room.
MRSA may be shed on skin scales
into the bed linen. Prompt disposal
of used bed linen into the alginate
bag by the bedside will reduce the
risk of environmental and uniform
contamination. The alginate bag
dissolves in the washing machine in
the laundry releasing the linen.
If the single room does not have
ensuite facilities and there is a toilet
nearby it may be appropriate for the
patient to use it rather than keep a
commode in the room. If the patient
has a commode it is advisable that it
is kept for his / her use only during
the period of isolation.
The least amount of cleaning and
handling of equipment the less likely
MRSA can be indirectly transmitted
to another patient. Also, a mobile
patient may be reluctant to use a
commode.
Patient should use ordinary crockery
and cutlery. This should be returned
to the kitchen after each meal and
washed in a dishwasher.
The indirect transmission of MRSA
from crockery and cutlery is very
unlikely providing it is washed
thoroughly.
Visitors do not have to wear
protective clothing, unless assisting
with the patient’s bodily care, but
should be encouraged to clean their
hands before leaving the room.
Visitors do not have the same
contact with other patients as health
care workers, and therefore will not
transmit MRSA from one patient to
another.
Door to the room to be kept closed,
particularly during procedures which
may generate staphylococcal
aerosols e.g. physiotherapy, bed
making, wound dressing
To minimise the risk of spread of
MRSA to adjacent areas.
Patient to avoid social contact with
other patients.
To minimise the risk of spread of
MRSA.
In some cases it may be appropriate
for patients to walk in hospital
corridors or in the garden.
To try and enhance the psychological
well being of the patient.
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Contd.
Action
Instruments or equipment e.g.
dinamap cuffs, lifting slings etc.
should be single patient use where
possible.
Rationale
To prevent spread of MRSA to other
patients.
If not single patient use such items
must be cleaned thoroughly before
use on another patient. See
Procedures and Principles for
decontamination of equipment on
Trust Infection Control intranet site
If the patient is to be transferred to
other wards / departments / hospitals,
please inform the receiving area that
this patient has been nursed in a
single room and to contact the
infection control nurse or doctor for
further advice.
To avoid confusion and anxiety to
both staff and patient and to
minimise the risk of transmission of
MRSA.
It is not necessary for clinical or
portering staff to wear PPE during
transfer but staff must take the
following precautions:
 Cover chair / trolley with clean
sheet.
 Wear disposable gloves and
aprons if handling the patient
 Remove gloves and apron and
clean hands before leaving the
ward
 When transfer is complete,
place sheet in alginate bag and
place in infected laundry bag. If
there is any leakage of fluids
onto the chair / trolley surface,
it must be cleaned by staff at
the receiving area as per Trust
guidelines found on the
Intranet.
 Clean hands before next
activity / job.
Patients may feel stigmatised if staff
involved with the transfer are wearing
PPE.
There is a risk of contaminating
during manual handling of patient so
PPE is advised.
HAND HYGIENE IS THE SINGLE
MOST IMPORTANT MEANS OF
PREVENTING CROSS INFECTION
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Contd.
Action
Rationale
If the patient requires physiotherapy
or occupational therapy within the
department, please discuss each
individual case with a member of the
infection control team.
Once 3 negative screens have been
obtained then isolation precautions
may be discontinued.
Every effort should be made to
ensure all patients receive therapy
regardless of their MRSA status.
With the exception of neonates,
treatment with a topical antibacterial
lotion should continue until the
patient’s discharge home.
Continuous treatment with a topical
antibacterial lotion reduces the
amount of MRSA on the skin and
therefore reduces the risk of recolonisation.
MRSA is no longer present in
sufficient amounts to be detected
and the risk of transmission is
significantly reduced.
4.3.2 Source isolation – outpatients
Objective:
To minimise the risk of transmission of MRSA, directly from patient to patient,
or indirectly via health care workers or patient care equipment, whilst
maintaining patient safety and comfort.
Equipment
1.
Patient should be seen in a single room with clinical handwash basin,
appropriate handwash solution and paper towels.
2.
Disposable aprons and gloves should be available in the room
3.
Alcohol hand rub should be inside every room and be easily accessible.
4.
Pedal bin lined with clinical waste bag (kept by handwash basin).
5.
Suitable disinfection solution for decontamination of equipment and
immediate environment.
Action
Rationale
Patients visiting outpatient clinics do
not need to be isolated from others in
clinic.
Patients colonised with MRSA pose
minimal risk to other patients in the
outpatient setting
During consultation, disposable apron
and gloves should be worn by all staff
when handling the patient or their
immediate environment, contact with
their secretions and handling of
contaminated dressings or linen.
The use of protective clothing will
reduce the risk of contaminating
uniform and hands.
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Contd.
Action
Rationale
Ensure meticulous attention to hand
hygiene following removal of gloves.
(Ensure there is appropriate facilities
i.e. soap / alcohol gel in dispensers
and paper towels).
HAND HYGIENE IS THE SINGLE
MOST IMPORTANT MEANS OF
PREVENTING CROSS INFECTION
Protective clothing should be
disposed of in a clinical waste bin as
per Trust waste guidelines.
To reduce the risk of spread of MRSA
to the environment and other patients.
The chair / couch and any equipment
that has been in contact with the
patient should be cleaned with
Chlorclean as per Trust
decontamination guidelines, found on
the intranet.
Linen should be disposed of as per
Trust guidelines.
To reduce the risk of spread of MRSA
to other patients
4.3.3 Source isolation – radiology, cardiology, neurophysiology and
nuclear medicine
Action
Rationale
For outpatients visiting these
departments who are colonised with
MRSA please follow section 4.3.2
above.
Patients colonised with MRSA pose
minimal risk to other patients in the
outpatient setting
Outpatients known to be colonised
Inpatients are potentially more
with MRSA should not be seated near vulnerable to infection due to length of
to inpatients / tertiary referrals
stay and the presence of invasive
devices.
Inpatients / tertiary referrals known to
be colonised or infected with MRSA
should be seen at the end of the clinic
/ list where possible
This will allow for efficient
decontamination at the end of the
clinic / list to take place and to reduce
the risk of transmission to other
patients.
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4.6
Discharge of Patients Colonised / Infected with MRSA
Colonisation or infection with MRSA should not delay patient discharge home
or to other healthcare or residential facilities. All those responsible for the
clinical and social care of the patient should be kept informed of screen results
and any treatment or decolonisation therapy required
Action
Rationale
Inform the receiving health facility /
residential home of MRSA status and
current treatment.
Appropriate infection control measures
can be put in place prior to patient
transfer to prevent transmission of
MRSA to others
This will allow for continuation of care
in the Primary care setting if
appropriate.
When discharging patients home, the
GP must be informed of the patient’s
MRSA status and treatment in the
Trust standard discharge letter
5.0
Discharge lounge Ambulant patients
waiting for transfer home who are
MRSA positive can be managed as
per section 4.3.2 above
The risk of transmission to other
patients in this setting is minimal.
Patients awaiting discharge / transfer
who are MRSA positive and who still
require a bed should be nursed next
to a sink and an isolation sign
displayed at the bedside. Infection
control procedures should be followed
as outlined in section 4.5.2 above
There is an increased risk of
contamination of the immediate
environment and transmission of
MRSA to others in patients still
requiring hospital care.
Equality Impact Assessment
5.1
This policy has been equality impact assessed by the author using the
Trust’s Equality Impact Assessment (EqIA) framework.
5.2
The completed Equality Impact Assessment has been completed and
submitted to the Equality and Diversity Department for ‘Service Equality
Team Sign Off’
5.3
There are no significant issues in relation to equality, diversity, gender,
colour, race or religion are identified as raising a concern.
6.0
Consultation, Approval and Ratification Process
See the Trust Infection Control Strategy 01.
7.0
Dissemination and Implementation
See the Trust Infection Control Strategy 01. In addition, the policy will be
disseminated and implemented through the Trust Mandatory training.
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8.0
Review, Monitoring Compliance With and the Effectiveness of Procedural
Documents
See the Trust Infection Control Strategy 01. In addition, the policy will be
audited monthly (using the guidelines within this document, appendix 3) in
every clinical area and clinical department by a chosen lead (usually the
Infection Control Link Practitioner). The results will be submitted online and
will be disseminated to all Divisions.
9.0
References and Bibliography
Guidelines for the control of epidemic meticillin-resistant Staphylococcus aureus
(MRSA) in healthcare facilities by the Joint BSAC/HIS/ICNA Working Party on MRSA
(2006) in Journal of Hospital Infection 63S, S1 - S44
Ayliffe GAJ, Babb, JR, Taylor LJ (2001). Hospital Acquired Infection: Principles and
Prevention. Third edition. Arnold, London.
Ayliffe, GAJ, Fraise, AP, Geddes, AM and Mitchell, K (2000). Control of
Hospital Infection: a Practical Handbook. Fourth edition. Arnold,
Royal College of Nursing (2000). Methicillin Resistant Staphylococcus aureus
(MRSA) guidance for nurses
10.0
Associated Trust Documents
See the Trust Infection Control Strategy 01.
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Appendix 1
Division Of Medicine
Elective Admission Screening
Programme
Elective High Risk admissions (see
section 4.1)
Additional Screening Programme
All elective Cardiothoracic
Emergency Cardiothoracic
On admission
High Risk Emergency admissions
(see section 4.1)
CHDU / CSU / CCU
Al patients every week
All renal patients on admission
Patients attending the programmed
Investigation Unit (PIU) who are
undergoing a high risk invasive
procedure (e.g. ERCP) will be
screened.
All admissions to haematology ward
Urgent admissions to ward 34
Renal medicine
On admission and every 2 weeks
during in-patient stay
Screen prior to creation of
vascular/peritoneal access
Haematology
Screen new referrals to day case unit
(DCU)
Ward 27 screen every 2 weeks during
in-patient stay
Division of Clinical Scientific Support
Elective Admission Screening
Programme
Additional Screening Programme
All admissions to General Intensive
Care Unit
ICU/HDU
All patients every week
All admissions to General High
Dependency Unit
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Division Of Surgery
Elective Admission Screening
Programme
Additional Screening Programme
Elective High Risk admissions (see
section 4.1)
Elective:

Orthopaedic

Vascular

Urology

Renal Transplant

ENT

Max Fax

General Surgery

GI Surgery

Patients attending ETC for
procedure under LA
Emergency Trauma &
Orthopaedics
Screen on admission and then every
2 weeks
Emergency Vascular
On admission
High Risk Emergency admissions
(see section 4.1)
Saint Mary’s Hospital
Elective Admission Screening
Programme
Additional Screening Programme
Elective High Risk admissions (see
section 4.1)
Neonatal Medical and Surgery
every week
All admissions to medical / surgical
neonatal units
High Risk Emergency admissions
(see section 4.1)
Elective Caesareans
All elective gynaecological
admissions
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Royal Eye Hospital
Elective Admission Screening
Programme
Additional Screening Programme
Elective High Risk admissions (see
section 4.1)
High Risk Emergency admissions
(see section 4.1)
Children’s Division
Elective Admission Screening
Programme
Elective High Risk admissions (see
section 4.1)
Elective admissions to Intensive Care
Unit / High Dependency Unit / Burns
unit and BMTU
All Cystic Fibrosis patients.
Neuro / Spinal surgery
Additional Screening Programme
PICU/HDU
All patients weekly
Burns Unit / BMTU
All patients weekly
Oncology admissions and inpatients with CVC line - monthly
Renal medicine
On admission and every 2 weeks
during in-patient stay
Dialysis patients - monthly
Prior to creation of vascular/
peritoneal access
High Risk Emergency admissions
(see section 4.1)
Manchester Dental Hospital
Elective Admission Screening
Programme
Not applicable to day Cases
Additional Screening Programme
Not applicable to day Cases
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APPENDIX 2
Octenisan Body Wash
Octenisan body wash should be used every day as a liquid soap, for a shower,
bath or wash. It is easier to use Octenisan in a shower but, it is perfectly
acceptable to use the lotion for a strip wash each day.
Shampoo hair with Octenisan body wash on alternate days.
If the skin becomes dry and or irritated stop using Octenisan and inform the
Infection Control team.
1.
2.
3.
Use 30
ml of
solution
Leave the
lotion on the
skin for 3
minute
before
rinsing
Ensure that hair and
body are wet
Apply all over hair and
body paying special
attention to the areas
indicated in red
Put the lotion onto a damp
washcloth
4.
5.
Rinse off thoroughly
Dry with clean, dry towel
6.
Put on clean
underclothes/nightwear
every day
Continued on next page-
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APPENDIX 3
Oilatum Plus
How to use Oilatum Plus
Always use Oilatum Plus diluted in water.
Add 2 capfuls of Oilatum Plus to a 20cm (8 inch) deep bath or 1 capful to a 10 cm
(4 inch) deep bath.
Add a quarter of a capful to a bowl of water for washing.
Take care: Oilatum Plus makes the skin and bath surfaces slippery.
BACTROBAN NASAL OINTMENT (Mupirocin 2%)
Bactroban Nasal Ointment (Mupirocin 2%) should be used for the first 2 cycles
following MRSA screen positive result. Use it three times each day for 5 days.
A small amount of ointment, about the size of a match head, should be placed on a
cotton bud or on a gloved finger and applied to the inside of each nostril (apply to the
front part of the nostril). The nostrils should be closed by pressing the sides of the
nose together; this will spread the ointment through the nostrils.
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