MRSA Policy: Guidelines for
Control of Meticillin-Resistant
Staphylococcus aureus (MRSA)
Paper copies of this Document
If you are reading a printed copy of this document, you should check the Trust’s Policy
website (Intranet) to ensure that you are using the most current version.
Originator
Lead Director
Dr Manjula Meda (Consultant Medical
Microbiologist/IC Doctor) &
Amanda Walker (IPCN Consultant)
Ian Fry, Director of Infection Prevention &
Control
Version Number
13
Version/implementation date
November 2014
Ratified at
Hospital Infection Control Committee
November 2014
November 2015
Review date
NB: in this document ‘meticillin’ has been used in place of the established ‘methicillin’ in
accordance with the new International Pharmacopoeia guidelines.
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MRSA Policy: Guidelines for Control of Meticillin-Resistant
Staphylococcus aureus (MRSA)
Index
Page
3
4
7
9
10
12
13
14
17
18
20
21
22
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Introduction
MRSA Screening
MRSA Suppression Therapy and Treatment
MRSA ‘Incidents’
-MRSA Bacteraemia
-Outbreak
-New cases on Orthopaedic wards
Patient Care
-Isolation
-Environment and Equipment
-Visitors
-Antibiotic Stewardship
-Diagnostic testing and therapy
-Theatre guidelines
Discharge Planning
Monitoring
References
APPENDIX I – MRSA Screening Algorithm
APPENDIX II – MRSA Screening & Suppression Chart (with Integrated
Care Pathway)
APPENDIX III – Paediatric MRSA Screening Chart
APPENDIX IV – Inpatient placement of MRSA cases
Monitoring tool
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INTRODUCTION
Staphylococcus aureus is a bacterium that has been found on skin of 30% of the
population. It is a very common cause of surgical infections, boils and carbuncles.
Following the introduction of Penicillin in the 1940s, some strains of Staphylococcus
aureus were able to make an enzyme (penicillinase) that broke down the antibiotic and
protected the bacterium, and so by 1959, 90-95% of isolates were resistant to the
antibiotic (DH 2006).
There is not just one specific disease caused by Meticillin-resistant Staphylococcus
aureus (MRSA). A range of tissues and body systems can be affected.
MRSA is usually carried in the nose or skin folds (such as the groin).
So far 16 epidemic strains of MRSA have been discovered (clones EMRSA-15 and 16
are thought to be more transmissible than others (RCN 2005)).
MRSA is a problem in hospitals because it can affect vulnerable individuals who are
weaker, sicker or have reduced immunity when compared to the general population.
In order to reduce the spread of MRSA health care staff
should ensure that they clean their hands thoroughly
between patients (RCN 2005)
Symptoms
Symptoms can be ambiguous as they are general and are common to different
infections caused by other bacteria. They can range from colonisation (when the
bacteria is doing no damage but is still capable of causing clinical infection) to fatal
septicaemia.
MRSA may be found in:
 Wound infections
 Superficial ulcers
 IV line infections
 Abscesses
 Lung infections
 Bacteraemia/septicaemia
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MRSA SCREENING
The aim of screening is to identify all positive patients within the hospital to allow
targeting of isolation facilities. This can minimize the risk of onward transmission to
other patients (BSAC/HIS/ICNA 2006). The aim is to also ensure that antibiotic
therapy is appropriate to that patient.
From January 2015, at Frimley Park Hospital we will be following the guidance in the
Department of Health’s Implementation of modified admission MRSA screening
guidance for NHS (DH 2014).
In line with a risk assessment of MRSA infections identified at FPH in the past 5 years
staff need to screen:
1) Any Elective or Emergency in-patients admitted to/ or to be admitted for:
- Critical Care
- Neonatal Unit (NNU)
- Orthopaedics
- Cardiology
- Vascular Surgery
- Breast Surgery
- Urology
- Haematology.
(I.E. screen all patients admitted/transferred to Critical Care/MADU, NNU, F4, F5, F6,
F7/F7u, F8, SADU, Cath Lab, G9, CCU, G1).
2) In addition, any patients flagged as previous MRSA positive (as highlighted by
PAS, Patient Centre, Realtime ADT, Winpath, or by the patient themselves)
3) Patients admitted electively or as emergencies with chronic ulcers/wounds or
medical devices (such as long term catheters, PEGs, CVCs etc in situ)
4) Paediatrics in a high risk group (previous MRSA-positive or admission from
another hospital or care facility) or in SCBU/NNU.
5) All patients (adult and paediatric) admitted to FPH from another hospital in the
UK or from a hospital overseas.
Roles & Responsibilities
 It is the ward/ department nurses’ responsibility for ensuring all pertinent patients
are screened for MRSA.
 The healthcare worker providing the specimen for testing is responsible for the
appropriate collection of the specimen following Trust protocol, and the timely
delivery of the specimen to the laboratory.
 The pathology laboratory and Consultant Microbiologist are responsible for the
accurate and timely processing of the specimen.
 It is the ward/ department nurses’ responsibility for checking for MRSA screening
results and documenting the results.
 It is the ward/ department nurses’ responsibility for communicating a positive result
to both the patient and the patient’s clinician.
 It is the clinician’s responsibility to act on receipt of a positive result, and for
prescribing MRSA suppression therapy and review of any antibiotic treatment.
 It is the clinician’s responsibility to inform the patient’s GP of an MRSA positive
result, via the summary on the patient’s discharge letter.
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Requesting an MRSA screen
Follow the ‘MRSA Screening Algorithm’ found in Appendix I.
A trained and competent healthcare worker (HCW) must take the specimens for the
MRSA screen in a timely manner (at pre-admission assessment for Elective patients;
within 48 hours of admission for Emergency patients; at any time during admission if
repeat screen is required or infection is suspected).
The HCW must ensure the paper pathology request form is completed appropriately,
and ensure the specimen arrives at Specimen Reception in a timely manner.
Screening and results should be checked by the ward/department nursing staff and be
recorded on the yellow ‘MRSA Screening and Suppression Therapy chart’.
Ideally transfers from other hospitals (including transfers to F1 and SCBU) should be
isolated in a single room until negative admission screening results are available.
How to Screen
The reason for the MRSA screen being carried out must be explained to the patient
prior to specimens being taken. An MRSA information leaflet (available on the hospital
intranet) can be provided to the patient to aid explanation.
To determine the extent of MRSA carriage swabs must be taken from the following
sites:






Nose - 1 swab used for both nostrils (anterior nares).
Groin – 1 swab used in the moist skin folds.
Umbilicus – in neonates.
Wound - Any breech in the integrity of the skin (such as IV/CVC devices, any
wounds, suprapubic catheters, drain sites). State the site that was swabbed on
the Microbiology request form. Do not remove Central or IV dressings if intact –
swab when dressing next changed.
Catheter urine (if patient catheterised). Do not send this in the same bag as the
wound swabs.
Sputum (if patient has a productive cough).
Patients who have screened negative in pre-op assessment do not require admission
screening.
If a patient has been screened negative for MRSA at FPH in the 12 weeks prior to their
present admission to hospital, and have not been admitted to another care facility in
the interim, please contact the IPCT for MRSA screening advice on an individual basis.
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Identification & Sharing Information
Patients known by Frimley Park Hospital to have MRSA (or have previously had
positive MRSA at his Trust) are identified as “MRSA” on the PAS/ Patient Centre
system and on Realtime. Patients with positive results after July 2009, will also have
‘Known Positive MRSA’ written at the top of all Micro results on Winpath. Having
reviewed the patient’s results, the IPCNs record the date that the positive swab was
taken on PAS/Patient Centre.
Any identified MRSA patients admitted must have an ‘MRSA Care Pathway’ in place
(Appendix II). Completing this pathway ensures that communication of the MRSA
colonisation with the patient, next of kin and clinician is recorded, as is MRSA
suppression treatment.
Negative results
Routine MRSA screen results will not normally be phoned, and is the responsibility of
the ward/ department nurse caring for the patient, to check the WINPATH system and
document negative results on the yellow ‘MRSA Screening and Suppression Therapy
chart’. Doctors can presume the result of the screen is negative unless informed by
the nursing team of a positive result.
Negative results should be available to view on WINPATH within 48 hours of the
specimen being sent, but positive results may take longer (possibly up to 5 days).
Positive results
MRSA positive results are available to clinicians by accessing the WINPATH system.
It is the responsibility of the ward/ department nursing staff caring for the patient, to
check the WINPATH system and document positive results on the yellow ‘MRSA
Screening and Suppression Therapy chart’.
It is the nursing staff responsibility to ensure the patient is informed of a positive MRSA
result (within 24 hours of receipt of the result), and document the communication on
the ‘MRSA Care Pathway’. The patient should be provided an MRSA information
leaflet, and the IPCNs can be contacted for further advice for the patient.
It is the nursing staff responsibility to inform the patient’s clinician (within 24 hours of
receipt of a positive result) and to ensure any antibiotic therapy is reviewed and MRSA
suppression therapy is prescribed. Ensure also, that MRSA status information is
shared with any clinical staff involved in that patient’s care.
As a minimum requirement for documentation of MRSA positive results, the ‘MRSA
Care Pathway’ and yellow ‘MRSA Screening and Suppression Therapy chart’ must be
completed.
Patients who have been found to be MRSA positive since July 2009 will also be
flagged up to clinicians on the Microbiology section of the hospital pathology system.
The previous MRSA status should be recorded in all medical clerking records
(electronic and/or paper).
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MRSA SUPPRESSION THERAPY and TREATMENT
Treatment of MRSA-positive in-patients (ADULT)
MRSA suppression treatment must be prescribed without delay by the patient’s
clinician, and should be commenced for adult in-patients (within 24 hours of receipt of
a positive result) and pre-op elective patients found to be MRSA-positive from any site
(ideally pre-op patients should receive suppression therapy that completes on their day
of admission).
If there is a record of previous complete MRSA suppression therapy (i.e. completed
the 5-day course of treatment detailed below) in the past 3-6 months, please contact
the Infection Prevention & Control Team for advice. Suppression therapy should not
be repeated more than twice, as resistance may be encouraged (BSAC/HIS/ICNA
2006).
The MRSA screening results and suppression treatment should be recorded on the
yellow ‘MRSA Screening and Suppression Therapy chart’.
Patient MRSA suppression therapy packs are provided by the Pharmacy Department,
and the packs contain an ‘MRSA Suppression Therapy Information Leaflet’, for
instructions on how to complete the treatment.
1. Mupirocin 2% nasal ointment
 apply to the inner surface of each nostril (do not “poke” tube into nostril)
 rub side of nose until patient able to taste ointment
 apply three times daily for 5 days and then stop treatment (as resistance may
be encouraged by prolonged use). Do not repeat once course of treatment has
finished.
(NB. MRSA screening results showing resistance of the organism to mupirocin, will
require treatment with Naseptin instead of mupirocin).
2. Hibiscrub body wash/shampoo (4% chlorhexidine)
 Wet skin and then apply body wash thoroughly to all areas (using it like soap)
before rinsing
 Pay special attention to axillae, groin and perineal area.
 Use for hair washing also
 Use daily in bath or shower for 5 days only (then dispose of any remaining
product)
 Use when bed bathing for 5 days (and then dispose of any remaining product)
 Moisturising cream and hair conditioner may be applied after use.
After each bath and hair wash freshly laundered clean clothing, bedding and towels
should be used.
If patient has eczema, dermatitis or other skin condition – treat the underlying skin
condition (on advice of dermatologist).
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Treatment of MRSA-positive Children/ Babies
Please contact the on-call medical microbiologist for advice.
1. Mupirocin 2% nasal ointment
 Apply to inner surface of each nostril (do not “poke” tube into nostril)
 Rub side of nose until patient able to taste ointment
 Apply three times daily for 5 days and then stop treatment (as resistance
may be encouraged by prolonged use). Do not repeat once course of
treatment has finished.
2. Body wash/ shampoo
Please contact the on-call medical microbiologist for advice.
Treatment of MRSA-positive pre-admission patients (ADULT)
A positive screen should not delay surgery for elective patients. It is preferable for the
elective surgery to take place on the last day of topical suppression therapy to ensure
the maximum reduction of MRSA present on the patient’s skin.
Maternity cases screening positive for MRSA should commence suppression therapy
at 37 weeks.
Clearance screening is not recommended prior to admission, and these patients
should be isolated in single rooms on admission.
When prescribing anti-microbial treatments (such as peri-operative antimicrobial
prophylaxis) for known MRSA-positive patients, the MRSA-positive protocol must be
followed.
“Re-screening”
Re-screening after MRSA suppression therapy is not required, unless the patient is in
Critical Care or SCBU/NNU (where admission and weekly screens are carried out), or
unless the tests are required to check for successful treatment of infection (e.g. blood
cultures, tissue samples).
If patient is colonised with MRSA the clinical team must keep MRSA cover in mind
while starting empirical antibiotic therapy.
Guidance to empirical therapy is available from the trust antibiotic guidelines.
Treatment for MRSA patients is highlighted under individual sections.
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MRSA ‘INCIDENTS’
MRSA Bacteraemia
If a patient is found to have a positive blood culture with MRSA as the causative agent,
a root cause analysis (RCA) will be undertaken.
A Consultant Medical Microbiologist must undertake a root cause analysis using the
Strategic Health Authority’s document (based on the NPSA document) within 5-days of
the positive result. The Microbiologist will discuss the blood culture result with the
pertinent Consultant team and advise on treatment measures.
The IPC nursing team in conjunction with the pertinent Head of Nursing and the
Infectious Diseases pharmacist will also undertake a RCA using the Trust form.
A RCA meeting will take place to discuss the findings. This meeting will involve the
Chief Executive, Director of Infection Prevention and Control, Director of Nursing,
Consultant Microbiologist, IPC team, the patient’s Consultant, Patient Safety Manager
and pertinent Head of Nursing.
MRSA bacteraemia results will be reported onto the Health Protection Agency MESS
(mandatory enhanced surveillance scheme) web-site as per DH guidance and the
completed RCA document will be sent to the NHS South Cluster (previously known as
‘South East Coast Strategic Health Authority’).
Outbreak
An outbreak is defined as two or more related cases of MRSA infection (with the same
sensitivity/ typing pattern) in one clinical area.
The Outbreak Control Team will be established as per the Outbreak Plan.
If patients with MRSA are unable to be nursed in single rooms, the Infection Prevention
& Control Team must be informed so they can then advise on placement of patients.
The reason for not isolating the patient must be recorded on their MRSA care pathway.
If an MRSA-positive patient’s clinical condition allows, they should be discharged from
hospital.
New cases on Orthopaedic wards
If a patient has a positive MRSA result (who is currently nursed in a ring-fenced
orthopaedic ward bay):
 Inform on-call Medical Microbiologist (via hospital switchboard)
 Isolate patient in side room
 Close the bay to admissions and re-screen all other patients in the bay.
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PATIENT CARE
Good infection control practices, which should be in place for all patients, should
reduce the risk of cross-infection. A standard approach must be used to care for
MRSA patients in accordance with the general principles of infection control, rather
than introducing differing standards (BSAC/HIS/ICNA 2006).
Patient care
Patients identified with MRSA infection or colonization should be informed of their
condition (BSAC/HIS/ICNA 2006). Please provide patient with Frimley Park Hospital
“MRSA information leaflet” (available on the hospital intranet under “Patient
information”/ “Infection Control”).
It is desirable that all patients who are infected or colonised with MRSA are nursed in a
single room (Appendix II – Inpatient Placement of MRSA Cases). If no single rooms
are available, due to higher priority infections, the Infection Prevention & Control Team
should be contacted for advice. MRSA-positive patients should not be admitted to
bays with high risk patients, such as major vascular or implant surgery, or where CVCs
are present.
Due to the high profile of MRSA in the Press and on TV, communication is very
important. If any patient or visitors have any concerns or queries that staff feel they are
unable to answer, please contact a member of the infection prevention & control team
(IPCT) who will come to speak to them.
Medical, nursing and allied health personnel must raise awareness of hand washing
and must lead by example. Hands must be cleaned in line with the ‘5 Moments for
Hand Hygiene’.
Isolation rooms
It is desirable that all patients who are infected or colonised with MRSA are nursed in a
single room.
The room will have an individual hand washing sink and a red Infection Prevention &
Control ‘warning’ card on the door.
The door should be kept closed, taking into account the patient’s psychological and
physical needs. If staff feel that the patient is not safe to be cared for in a room with a
closed door, please discuss this with one of the IPCT who will give advice.
The door to the patient room must be kept closed during procedures likely to increase
dispersal of organisms (e.g. chest physiotherapy or bed making).
Environment and Equipment
Bedding must be changed daily and prior to transfer to operating theatre. Send
bedding to the laundry as infected linen. Infected linen should be first placed into a hot
water-soluble alginate bag, and then into an outer impermeable bag for transport to the
laundry.
Clean the room daily by damp dusting to avoid accumulation of dust and unwanted
items.
Fans should not be used to control the patient’s temperature.
Room to have own cleaning equipment i.e. bucket and mop. Mop head to be changed
daily.
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Following patient discharge/transfer, the patient’s room will require terminal cleaning
(see IPC31).
Patient equipment (e.g. commode, hoist, sling or BP cuff) should be capable of being
decontaminated before use with other patients, or single-patient use equipment may
be used.
Visitors
The patient’s privacy regarding diagnosis must be maintained to prevent
embarrassment.
Visitors who only have social contact with the patient do not need to wear gloves or
aprons, but they must clean their hands on leaving the room.
Antibiotic Stewardship
As antibiotic therapy encourages the persistence of carriage, all patients with MRSA
should have their antimicrobial therapy reviewed, with a view to discontinuation at the
earliest possible time. Please refer to the FPH antibiotic policy.
Please contact the on-call Consultant medical microbiologist for antibiotic advice.
Antibiotic ward rounds take place three times a week, and antibiotic audit results are
reported at quarterly HICC and in Matrons/Clinical Directors’ Board reports.
Diagnostic testing or therapy
A patient who has MRSA may leave wards to have essential diagnostic tests (e.g. xrays) performed or for therapy (e.g. physiotherapy). The doctor, nurse or allied
healthcare professional that arranges for the testing/therapy must inform the receiving
department prior to transfer.
Any wound must be covered by a dressing prior to leaving ward or clinical area.
The patient should be called when the department is ready for them and return to the
ward/clinical area immediately the testing is completed.
Staff who transfer the patient (e.g. Porters or other healthcare staff) who have only
social contact with the patient, do not need to wear gloves or aprons for the transfer.
However, aprons should be worn if there is to be close body contact with the patient,
such as rolling the patient. Hands must be cleaned according to the ‘5 Moments for
Hand Hygiene’.
MRSA Theatre Guidelines
In mechanically filtered operating theatres, the number of air exchanges should make it
unnecessary to place MRSA positive patients at the end of a theatre list
(BSAC/HIS/ICNA 2006). Cleaning procedures, minimising staff movement, and
allowing only essential equipment in theatre, should be in place for every patient, not
just exclusively for MRSA. If patient must be shaved, clippers with a disposable blade
must be used (Pratt et al 2007). There is to be no shaving of patient hair in the theatre
(DH 2003).
Hand hygiene is the single most important way to prevent the spread of infection, and
theatre staff must clean their hands in line with the ‘5 Moments for Hand Hygiene’.
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DISCHARGE PLANNING
Transfer or discharge to other hospitals
When a patient who is, or has been, MRSA-positive while in FPH is to be transferred,
the receiving hospital must be notified in advance by the person arranging the transfer.
Under the Health & Social Care Act (DH 2008b) it is a legal requirement for details of
the MRSA results to be recorded in the Nursing and Medical transfer letters (DH 2008b
& 2006b)
Refusal to accept transfer of the patient is not justifiable on the basis of the risk posed
to other patients by an individual’s carriage of or infection with MRSA. All units should
have procedures in place and adequate facilities for containment of MRSA
(BSAC/HIS/ICNA 2006).
Good infection control practices and routine cleaning of ambulances should suffice to
prevent cross-infection.
Discharge of patients into the community setting
If the patient is being transferred for community-based care, the District Nursing
Services should be informed in advance of the transfer.
For patients being discharged to Nursing/ Residential Homes or other care facilities
(such as hospices or other hospitals), details of the MRSA results must be recorded in
the Nursing and Medical transfer letters (DH 2008b & 2006b).
As above, MRSA carriage should not prevent transfer of a patient to a care home.
MRSA suppression therapy protocol for patients should be discontinued on discharge.
Details of a patient found to be MRSA colonised on or during a hospital stay should be
communicated to the GP in their Discharge (TTO) letter.
Last offices
Colonised or infected MRSA patients do not need special precautions on death.
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Monitoring
Clinical staff are required to participate in the Preventing Surgical Site Infection (High
Impact Intervention no. 4) Saving Lives audits as part of the continuous audit
programme. The staff undertaking the audits must promptly feedback the findings of
their observations so that practice can be improved when needed (DH 2006).
The IPCT also undertake a rolling programme of audits of compliance with MRSA
screening and decolonisation throughout the Trust. This audit is based on the
monitoring tool on page 23 of this policy.
Compliance with this policy is monitored by the Infection Prevention and Control
Nursing team:
It is monitored on a monthly basis by the IPCNs where a review of all elective and
non-elective admissions is undertaken to confirm that all relevant patients have
received MRSA screening.
An annual report is presented to the Hospital Infection Control Committee (HICC)
by the IPCNs in April of each year. Accompanying this is the MRSA Monitoring
Report which includes
a. Compliance with patient screened
b. Compliance with results available within 5 days of sent
c. Compliance with documentation (on the MRSA care pathway) that
patient and clinician were informed
d. Compliance with commencement of suppression therapy within 24
hours of positive result
Any recommendations and actions are agreed and monitored six-monthly by the
Main HICC.
Contact IPCT if unable to follow guidelines in clinical area.
End Note
MRSA have a gene mecA coding for a penicillin-binding protein (PBP-2A) with a
reduced affinity for beta-lactam antibiotics. As a result of this, antibiotics are not able
to attach to the bacterium or lyse it. MRSA is resistant to all beta-lactam antibiotics
(penicillins/ cephalosporins/ carbapenems).
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References:
Department of Health 2014. Implementation of modified admission MRSA screening
guidance for NHS. Department of Health, London. Accessed via:
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/3
45144/Implementation_of_modified_admission_MRSA_screening_guidance_fo
r_NHS.pdf
Department of Health 2010 MRSA Screening: Operational Guidance 3 Department of
Health, London.
Department of Health 2010 Screening elective patients for MRSA – FAQs Department
of Health, London. Accessed via:
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset
/dh_114999.pdf.
Department of Health 2010 Screening emergency patients for MRSA - FAQS
Department of Health, London. Accessed via:
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset
/dh_115000.pdf.
Department of Health Feb 2009 Screening elective patients for MRSA: frequently
asked questions Department of Health, London.
Department of Health Dec 2008a MRSA Screening – Operational Guidance 2. (MRSA
Guidance 2008231.pdf) Department of Health, London.
Department of Health 2008b The Health and Social Care Act 2008 (Revised Dec
2010). Code of Practice on the prevention and control of infections and related
guidance Department of Health, London.
Department of Health 2007 Screening for meticillin resistant Staphylococcus aureus
(MRSA) colonisation London: Department of Health. (Available at
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndG
uidance/DH_063188) .
Department of Health 2006 Saving Lives: A delivery programme to reduce healthcare
Associated infection including MRSA “A simple guide to MRSA” Department of Health,
London www.dh.gov.uk/reducingmrsa .
Department of Health 2006b The Health Act 2006 – Revised January 2008. Code of
Practice for the Prevention and Control of Health Care Associated Infections
Department of Health, London.
Department of Health 2003 Winning Ways: Working together to reduce Healthcare
Associated Infection in England Report from the Chief Medical Officer.
Frimley Park Hospital NHS Foundation Trust Antibiotic policy.
Joint BSAC/HIS/ICNA Working Party on MRSA. 2006. Guidelines for the treatment and
prevention of methicillin-resistant Staphylococcus aureus (MRSA) in healthcare
facilities Journal of Hospital Infection 63 Supplement 1.
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Pratt RJ et al 2007 epic2: National Evidence-based Guidelines for Preventing Healthcare Associated Infections in NHS Hospitals in England Journal of Hospital Infection
65S:S1-S64.
Royal College of Nursing 2005 Meticillin-resistant Staphylococcus aureus (MRSA)
Guidance for nursing staff Royal College of Nursing, London.
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Additional references:
Ayliffe et al.1969. Journal of Hygiene 79, 299.
Ayliffe GAJ, Babb JR, Collins BJ. 1969. Journal of Hygiene 79, 299
Ayliffe GAJ. 1991. Review of Infectious Diseases 13(sup 10): 800
Alexander et al 1983. Arch Surgery 118:347-52
Cruse 1986. Hospital Infection 2nd edition. 423-36
Davies et al. 1978. British Journal of Surgery 65-855
Lewis et al .1990. Journal of Hospital Infection 15: 35
Lowbury and Lilley. 1979. Journal of Clinical Pathology 32: 382-5
Maki DG et al 1982. New England Journal of Medicine. 307: 1562
Millward 1992 Nursing Times 88(6): 58-62
Patel SR Urech D & Werner NP. 1998. Institute of Sterile Services Management
Journal 3: 19
Peterson 1986 Nursing times 31(5): 68-70
Seropian and Reynolds 1971 AM. J. Surg 121: 251-6
Schiebel JW, Jensen & Petersens. 1991. Journal of Hospital Infection. 19: 167
Whyte W 1998. Journal of Hospital Infection 11 (sup c): 2
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APPENDIX I
MRSA Screening Algorithm
Screen:
Elective and Emergency Admissions in pertinent specialties/clinical
areas
(Check Pre-Op screen - Patients who have been screened
in pre-op assessment do not require admission screening)
Including:
Babies admitted to SCBU/NNU
High risk Paediatrics (i.e. previous MRSA and interhospital transfers).
Follow yellow MRSA Screening & Suppression Therapy Chart for protocol
and documentation of screening
Nurse to check screening result on WINPATH 24 hours after screen
(Swabs must have reached the lab by 10am for results to be available by 12
noon the following day)
MRSA-Positive
MRSA-Negative
Is there a record of
previous MRSA
suppression therapy?
No
Adults: Follow suppression protocol on yellow
Screening & Suppression Therapy chart.
(Babies: contact on-call Medical Microbiologist)
Yes
MRSA-Negative
Isolation not required.
Re-screen weekly in
ICU/HDU/SCBU.
Do not routinely re-screen the patient after
suppression therapy
NB. A positive screen should not delay admission for
elective surgery. MRSA suppression protocol should be
stopped on discharge of elective patients.
MRSA-Positive
Refer to isolation prioritisation chart (on
reverse).
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MRSA-Negative
Continue isolation until discharge or until
higher priority case requires room.
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APPENDIX II
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APPENDIX III
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APPENDIX IV
Inpatient Placement of MRSA Cases
This priority chart should be used as a guide for placement of MRSA-colonised patients and
infections, but if in any doubt (eg. if patient’s clinical condition makes it unsafe to isolate),
please contact the Infection Prevention & Control Team or the on-call Consultant Medical
Microbiologist.
High Risk Areas
Orthopaedics
All MRSA-positive cases must be placed in single rooms.
ITU/ HDU/ SDU/ ADU/ SCBU (Critical Care)
All MRSA-positive cases should be placed in single rooms.
If no single rooms are available, due to higher priority infections, or if isolation is inappropriate
due to clinical need, Inform Infection Prevention & Control Team. The patient must not be
placed in a bay with high risk patients (ie. no major vascular or implant surgery, no CVCs).
General Surgery
All MRSA-positive cases should be placed in single rooms.
If no single rooms are available, due to higher priority infections, or if isolation is inappropriate
due to clinical need, Inform Infection Prevention & Control Team. The patient must not be
placed in a bay with high risk patients (ie. no major vascular or implant surgery, no CVCs).
Moderate Risk Areas
Maternity
All MRSA-positive cases should be placed in single rooms.
If no single rooms are available, due to higher priority infections, or if isolation is inappropriate
due to clinical need, Inform Infection Prevention & Control Team.
Urology
All MRSA-positive cases should be placed in single rooms.
If no single rooms are available, due to higher priority infections, or if isolation is inappropriate
due to clinical need, Inform Infection Prevention & Control Team. The patient must not be
placed in a bay with high risk patients (ie. no major vascular or implant surgery, no CVCs).
Dermatology
All MRSA-positive cases should be placed in single rooms, especially if the case is a skin
disperser.
If no single rooms are available, due to higher priority infections, or if isolation is inappropriate
due to clinical need, Inform Infection Prevention & Control Team. The patient must not be
placed in a bay with high risk patients (ie. no major vascular or implant surgery, no CVCs).
Low Risk Areas
General Medical
All MRSA-positive cases should be placed in single rooms.
If no single rooms are available, due to higher priority infections, or if isolation is inappropriate
due to clinical need, Inform Infection Prevention & Control Team. The patient must not be
placed in a bay with high risk patients (ie. no major vascular or implant surgery, no CVCs).
Elderly Care and Stroke Unit
All MRSA-positive cases should be placed in single rooms.
If no single rooms are available, due to higher priority infections, or if isolation is inappropriate
due to clinical need, Inform Infection Prevention & Control Team. The patient must not be
placed in a bay with high risk patients (ie. no major vascular or implant surgery, no CVCs).
IPC06
V13 – 2014
Page 21 of 23
Monitoring the Management of MRSA Policy
Ward/Dept:
Monitored on:
Yes
Management
MRSA swabs taken within 48 hours of admission (or prior to admission for
elective patients)
MRSA screens/swabs are recorded on yellow MRSA screening and
suppression therapy chart
When a patient’s screens are newly MRSA positive, suppression therapy must
be prescribed and started within 24-hours of positive results (prescribed and
given for 5-days as per suppression therapy chart)
Clinician aware of MRSA positive result: they have prescribed the suppression
therapy
All results recorded on yellow ‘MRSA’ screening and suppression therapy
chart
MRSA care pathway completed as per policy
Documented that patient has been informed of their MRSA status (checking
that this was done within 24-hours of the result being available)
On questioning, the patient can explain why they have been isolated/
decolonised and what other advise they were given
Documented that patient nursed in an isolation room with hand hygiene sink
Red infection control warning card on the door and door shut.
If open, reason documented on pathway
IPC06
V13 – 2014
Page 22 of 23
No
Management
Yes
Staff must following Hand Hygiene Policy (PPE) and 5 moments hand
hygiene from World Health Organisation (WHO) also FPH bare below elbow
(BBE) policy
Visitors must wash hands on leaving an isolation room or affected
bay
MRSA result must be recorded in transfer letter when patient is
discharged/transferred to another care facility/another hospital,
MRSA status recorded in GP/TTO letter on discharge
A terminal clean (terminal clean policy) is undertaken prior to admission of a
new patient to an isolation room
Comments:
Monitored by:
Signed:
IPC06
Dated:
V13 – 2014
Page 23 of 23
No