MRSA Guidance for Sheffield CCG and Primary Care
This guidance relates to the Essential Standards of Quality and Safety Outcome 8 Cleanliness and
Infection Control
September 2014
The current versions of all policies/guidance can be accessed at
http://www.intranet.sheffieldccg.nhs.uk/policies.htm
VERSION CONTROL
Date
Author
Status
Comment
October 2006
Nikki
Littlewood
Original
Policy
Superseded by version 2
March 2008
Alison
Thomas
Review
policy
Superseded by version 3
November 2010
Nikki
Littlewood
Review
policy
Superseded by Version 4
March 2013
Nikki
Littlewood
Review
policy
Superseded by CCG and Primary
Care Guidance
September 2014
Nikki
Littlewood
Current
Policy Number CL007/09/2016
1
1.0
Introduction
Previously there has been an MRSA Management Policy in place for the previous Primary
Care Trust. However since the formation of the Clinical Commissioning Group (CCG) and
the prior transfer of Community Services to Sheffield Teaching Hospitals Foundation Trust
(STHFT) aspects of that policy have been absorbed into the STHFT Guidelines for the
management and control of MRSA. To promote standardisation of best practice, section 2
contains particularly relevant information taken from that guidance.
2.0
The following sections are of particular relevance for Primary Care and are taken with
permission from STHFT guidance:
2.1
What is MRSA?
MRSA stands for Meticillin-resistant Staphylococcus aureus.
Staphylococcus Aureus is a bacterium, which colonises the skin, particularly the nasal
passages and warm moist areas of skin and the umbilicus in babies. The bacterium can live
in these areas without detection and without causing symptoms; this is known as
‘colonisation’. If the bacteria invades the tissues or other systems and multiplies, a patient
may go on to become ‘infected’. An infection may be recognized when the presence of the
bacteria results in a host reaction and the patient becomes symptomatic resulting in, for
example, wound, respiratory, skin or urinary tract infections.
Meticillin is an antibiotic no longer used in clinical settings. Resistance of Staphylococcus
Aureus to Meticillin is used to indicate resistance to all beta-lactam antibiotics (Penicillins,
Cephalosporins and Carbapenems). Staphylococcus Aureus strains that are resistant to
Meticillin are referred to as MRSA. Some of these strains are easily spread and are called
epidemic MRSA (EMRSA).
Infection generally occurs when an individual is more susceptible. This includes those who
have had surgery, are immuno-compromised, those receiving antibiotic therapy, those who
are undernourished, have chronic wounds and ulcers and people whose natural defences
have been breached or compromised in some way. The risk to healthy individuals, such as
staff and visitors is very low. However it must be remembered that staff can be a source or
vector for the transmission of MRSA.
References in this policy to high risk and low risk patients relate to the risks of transmission
of MRSA from an MRSA positive individual to others and the risk for that individual of MRSA
infection (including MRSA bacteraemia). Both these areas of risk can be addressed
effectively by taking a number of measures described in this policy.
2.2
Staff screening
On occasions the Infection Prevention & Control Team (IPCT) will decide that staff screening
is necessary for infection control purposes. The IPCT will only initiate staff screening if there
is reasonable evidence to do so, and staffs have a duty to comply with such requests in a
timely manner.
2.3
MRSA screening technique
A full MRSA screen should include swabs from the sites listed below:
2




Nose
Groin OR perineum
Umbilicus of new born babies
All broken/ compromised skin
o pressure sores
o ulcers
o surgical wounds
o eczema, psoriasis, dermatitis
o cuts and abrasions
o tracheostomy sites
o IV cannula site/long line site at next dressing change OR if an old site and still
leaking or appears infected
o Central line/tunnelled line site at next dressing change OR if an old site and still
leaking or appears infected
o Urinary catheter exit site – if producing exudates
o CSU – if catheterised
o Sputum – if patient has a productive cough
NB Axilla and throat swabs are NOT required for routine screening
The method to be used when screening a patient for MRSA is as follows:






2.4
Rub a swab (moistened with sterile saline/water if a dry site) firmly over the whole
area several times.
When sampling nose or groin, use one swab only for both sides.
Mark the request form "MRSA screen".
Several swabs can be placed in one bag with one form.
Clearly specify the site swabbed on each sample label e.g. "Left foot ulcer" as
opposed to "Wound swab"; using "Wound swab" is not specific enough.
Separate swabs are required for MC&S requests i.e. when culture of organisms
other than MRSA is required.
Standard infection control precautions
Standard Infection Control Precautions apply at all times, for all staff and
patients. These are:





Correctly performed hand hygiene
Wearing of gloves and disposable aprons for contact with body fluids, lesions
and contaminated materials
The strict application of the principles of asepsis
High standards of cleaning of equipment and the patient’s environment
Segregation of all waste and its transport in a sealed bag of appropriate
strength and colour
3
The primary objectives of infection prevention & control (IPC) are preventing the acquisition
and spread of infection by patients and staff. The priorities for targeted control procedures
are those patients who are particularly susceptible to infection. Infection prevention & control
is the responsibility of all staff associated with patient care. A high standard of infection
prevention & control is required and is an important part of the concept of total patient care.
2.5
Topical Treatment
The treatment of patients with MRSA will be guided by the Infection Prevention & Control
Team and will usually follow the 1st line measures described below:
Check for any known allergies before using any topical treatment
Treatment of Patients who are Nasal Carriers




Apply a small amount of 2% Mupirocin (Bactroban®) thoroughly to the inner surface
of each nostril, using a cotton wool bud, three times a day for five days. It is
important that the treatment of nasal carriage is not prolonged beyond 5 days
because of the increased risk of resistance.
Allow 48 hours after completing the course of treatment before re-screening
All patients who are nasal positive for MRSA initially will also require body
decolonisation.
Patients who are receiving oxygen therapy via a nasal cannula or oxygen mask
should have these changed daily.
Treatment of Patients who are Skin Carriers









Patients carrying MRSA in any site should bathe/wash/shower daily for five days,
using an antiseptic wash such as chlorhexidine gluconate 4% or Octenisan®. The
antiseptic wash must be applied directly to the skin on a disposable cloth and not
diluted in water in a bowl, shower or bath.
Check for any known allergies before applying the antiseptic wash.
The skin should be moistened and the antiseptic wash applied thoroughly to all
areas and left in contact for the correct length of time before rinsing. Special
attention must be paid to axilla, groin, perineum and buttocks.
The hair must be washed twice weekly with the antiseptic wash selected. Ordinary
shampoo can be used afterwards if desired.
If skin irritation is reported with any of the antiseptic washes, discontinue their use
and inform the Infection Prevention & Control Team. Antiseptic washes must be
used with care in patients with eczema or dermatitis.
Single use disposable razors are recommended. Ideally wash face with
decolonisation treatment first then shave.
Tracheostomy tapes will require changing at least daily for the duration of the
antiseptic wash.
Allow 48 hours after completing the course of treatment before re-screening.
Patients should be advised that nose/body piercings may reduce the effectiveness
of decolonisation. Removal of rings, studs, foreign bodies etc. should be considered
if possible during decolonisation. Alternatively the piercing can be removed and
cleaned in alcohol daily.
4
The correct use of topical treatments should also be discussed with the patient and an
information leaflet given (MRSA patient information leaflet).
NB Ciprofloxacin should NOT be used in any patients who are, or previously have
been, MRSA colonised or infected. If there is no alternative, this should be discussed
with the microbiologist and the patient must be on topical decolonisation treatment
while they are taking Ciprofloxacin and for 48hrs after the cessation of Ciprofloxacin.
2.6
Antibiotic Prophylaxis for clinically indicated catheter change
Patients with urinary catheters in situ and where MRSA has been detected in a urine sample
should be treated with an appropriate antibiotic 30-60 minutes prior to re-catheterisation
unless they are already receiving a course of antibiotics known to be active against their
strain of MRSA.
Outpatient & Community Settings
Doxycycline or trimethoprim can be used depending on the organism sensitivity pattern as
documented on the most recent laboratory report.


2.7
Doxycycline 200mg stat dose one hour prior to re-catheterisation OR
Trimethoprim 200mg one hour prior to re-catheterisation and a second 200mg dose
12 hours after the initial dose.
Catheter change as part of decolonisation procedure
When a patient has a urinary catheter in situ and MRSA has been detected in the urine
sample the efficacy of MRSA decolonisation is greatly reduced. In some circumstances it is
recommended that the urinary catheter is changed as part of the decolonisation procedure.
Patients should be assessed and managed as follows:
Remove catheter unless needed.
If successful MRSA decolonisation is a realistic possibility (i.e. other than a urinary catheter
being in-situ there are no other risk factors for prolonged colonisation such as skin breaks,
ulcers, dermatitis, tracheostomy etc) then the catheter should be removed on day 3 of topical
eradication therapy. Antibiotic prophylaxis is required and should be prescribed as per the
guidance in Section 2.6 of this policy.
If possible, delay re-catheterisation for 48 hours following removal of the catheter.
If it is not possible to delay re-catheterisation, insert the new catheter immediately following
removal of the old catheter. A single dose of antibiotics will suffice as prophylaxis - see
Section 2.6.
If it is possible to delay catheterisation for 48hrs, re-catheterise prior to completion of topical
eradication therapy (day 5) and use antibiotic prophylaxis, as described above, prior to
insertion of the catheter – see Section 2.6.
2.8
Discharge of patients

MRSA patients should be discharged promptly from hospital when their clinical
condition allows.
5



2.9
The General Practitioner and other healthcare agencies involved in the patient's
care must be informed of their MRSA status on the discharge documentation.
If the patient is discharged to a nursing or convalescent home the medical and
nursing staff must be informed in advance and a Care Home Communication Form
will be completed by the ward. Carriage of MRSA is not a contraindication to the
transfer of a patient to a nursing or convalescent home.
MRSA carriers will not normally require special treatment after discharge from
hospital. STHFT Infection Prevention & Control Team will advise if a course of
treatment still needs to be completed. See Appendix 1 for risk factors that might
prompt treatment of MRSA carriers after discharge.
Community Referrals
High Risk Service Users
Referrals to Community Healthcare Workers using the Intra-Healthcare infection control
MRSA form should be made by the STHFT ICNs for patients who are MRSA positive and fit
one or more of the criteria below. These patients are at higher risk of MRSA infection,
including bacteraemia please see Appendix 2.
a) MRSA isolated in urine where the patient has an indwelling urinary or supra catheter
insitu
b) Diabetic with leg or foot ulcer
c) Deep, extensive or problematic wounds
d) Chronic respiratory disease with MRSA isolated in sputum
e) Central venous line insitu e.g. tunnelled lines
f) Patients on Ciprofloxacin
g) IV Drug user if known
h) Gastrostomy (PEG/PEJ) in situ
The above criteria will apply to patients who are discharged from STHFT hospitals or have
been discharged into the community but are within two weeks of discharge from STHFT
hospitals (refer to Appendix 2). Please note: if you have a patient who meets these
criteria but does not have a SPA referral i.e. not recently discharged from hospital
please contact the CCG IPC Team on 0114 3051156/3054192 for further advice.
Low Risk Service Users
Patients who are discharged from STHFT before a first positive result is known are unlikely
to be aware of their MRSA status (refer to Appendix 1). It is good practice to inform the
patient and their GP. Therefore STHFT will send a letter to both the GP and patient. This
should mean that
a) The patient is made aware of the result and can contact the GP for further advice and
discussion
b) The treatment options available are discussed and implemented if required
c) The patient will have the opportunity to have any questions they have answered
The STH IPCT will contact GPs by telephone with positive results for previous positive
patients that have been discharged before the result was known and do not fall into the ‘High
Risk Service User’ criteria but only if the sample is from sites other than nose & groin and
may require treatment
6
GP samples
The clinician who has taken the swab is responsible for following that result up, as they
would with any other diagnostic investigation they initiated. GPs should obtain results via
ICE or contact the Microbiology Department.
If this is the first positive result a letter will be sent to both patient and GP (refer to Appendix
3 and Appendix 4).
Care Homes/ Intermediate Care Bed
The relevant IPCT will contact the Care Home for patients who have been discharged before
a positive result is known and give advice on topical treatments.
NB the letter to the GP will arrive independently of any discharge summary from the
admitting clinician at STHFT
3.0
ADDITIONAL INFORMATION FOR PRIMARY CARE
3.1
Patients with MRSA Attending Health Centres / Clinics
 Patients who normally attend a clinic or health centre should continue to do so, even with
a MRSA diagnosis.
 If your patient is visiting another clinic/out-patients please inform the clinic that the patient
has MRSA so infection prevention and control precautions can be maintained.
 If able, remove any unnecessary equipment from the room.
 Gloves and aprons must be worn if exposure to blood/body fluid anticipated, for example
in wound management.
 If possible treat the patient who has MRSA last, so that cleaning with a detergent and
chlorine based product can be undertaken after the patient has left the clinic.
3.2
Decontamination of the Environment/Equipment:
 Equipment must be thoroughly decontaminated between patients.
 Neutral detergent and hot water should be used to clean the equipment followed by a
chlorine based product at 1000 parts per million of available chlorine or an alcohol wipe.
Alternatively, uses a multi-purpose wipe (detergent and disinfectant in one), for example
Clinell (Gama Healthcare) Universal Sanitising wipes or Tuffie 5 (Vernacare) Universal
Wipes. Please check manufacturers guidance for cleaning equipment as some equipment
cannot tolerate chlorine or alcohol.
 Any loaned equipment for use within the home should be designated ‘single patient use’
until no longer required. Prior to reuse by another patient, all loaned equipment must be
thoroughly decontaminated as per manufacturers’ instructions. Please refer to Sheffield
CCG Standard Infection Prevention and Control Precautions Guidance for further
information.
 The environment of any clinical setting must be kept clean and uncluttered to minimise
dust accumulation and to facilitate effective environmental cleaning.
 Horizontal surfaces must be cleaned after the clinical care has been undertaken and the
patient has left the room, using the products identified for equipment as above.
7
3.3
Visiting Patients with MRSA in their Own Home
 If possible visit last on the list. If this is not possible risk assess the list of patients that
need visiting and see the high-risk susceptible patients (for example those that are
immunocompromised or have wounds) before visiting the patient with MRSA.
 Avoid taking non-essential equipment in to the home.
 Essential equipment taken into the home by the member of staff must be cleaned with a
multi-purpose wipe as above before leaving the home.
3.4
Patient information
See Appendix 5 - Advice for those affected by MRSA outside of hospital 2008
See Appendix 6 - A Simple Guide to MRSA provides further information for the patient. Both
these appendices can be photocopied by the Practice staff and given to the patient.
3.5
MRSA Bacteraemia Post Infection Review
Significant work has been undertaken in the NHS in recent years and the incidence of MRSA
bacteraemia and has been reduced nationally (between 2004 to 2009) by 74%. Although
there is no longer a target to reduce MRSA Bacteraemia incidence, there is now a Zero
Tolerance approach to all MRSA Bacteraemia.
Trusts (including CCGs) must undertake a Post Infection Review (PIR) within 14 days of
notification by the Public Health England HCAI database. The PIR involves an MDT with
relevant Health Care Workers. It provides an opportunity for new learning about the cause
and for this learning to be shared if appropriate across the healthcare community.
If a case occurs in a care home or is a community patient with GP involvement then the
CCG IPC Team will lead the PIR with Dr Rob Townsend Consultant Microbiologist. If it is an
acute case then the trust will lead the PIR. As part of the drive to reduce the incidence of
MRSA bacteraemia, screening of community patients perceived to be at a high risk is
undertaken. See Community referrals, high risk service users section of STHFT guidelines.
3.6
References and Further reading:
Department of Health (2006) Essential Steps to Safe, Clean Care: Reducing healthcare
associated infections. London: DH 2006
Department of Health (2008) Health and Social Care Act. Code of Practice for the
Prevention of Health Care Associated Infections. (2010) London DH
Department of Health and Infection Prevention Society, “Advice for those affected by MRSA
outside of hospital” 2008
Loveday H.P, Pellowe C.M, Jones S.R.L.J & Pratt R.J (2006): A systematic review of
evidence for interventions for the prevention and control of meticillin-resistant
Staphylococcus aureus (1996-2004): report to the joint MRSA Working Party (Subgroup A).
The Journal of Hospital Infection Vol 63 Supplement 1 May 2006
8
NHS England (2014): Guidance on the reporting and monitoring arrangements and post
infection review process for MRSA bloodstream infections from April 2014 (version 2)
9
Appendix 1
MRSA POSITIVE PATIENT WHO IS LOW RISK/UNAWARE OF RESULT
Community Decolonisation & Screening Protocol
STHFT send letter to GP and post patient letter (including information leaflet)
Informing them of MRSA +ve result
GP to document MRSA status on medical records permanently
GP to ensure community follow-up of patient either by:Themselves, Practice Nurse, Community Matron, Case Manager or Community Nursing
Team (CNT) as appropriate
Community Clinician to contact patient to arrange surgery / home consultation appointment
as appropriate
Clinician discusses result, treatment options, offers practical reassurance
Patients consent to treatment?
Yes
No
Document response & close
case
Undertake skin assessment & prescribe topical treatment / nasal ointments according to
treatment regimes & sensitivities – see section 4.1 & 4.2. Ensure patient understands when
to and for how long to apply treatments
Arrange rescreen appointment in 2 weeks.
One course of skin & nasal treatment to be prescribed to reduce bacterial load
Patient completes topical treatments &
attends pre-arranged rescreen appointment
Clinician undertakes full MRSA screen
Clinician obtains results via ICE. Contact
Microbiology if not on ICE system
Inform patients of results.
No further action unless risk factors
If patient presents in future with clinical signs
of infection, consider full MRSA screen
If aware of any admissions to hospital please
inform admitting ward of MRSA history.
Risk factors to consider in the
patient and household are: Immunocompromised
 Diabetic with venous ulcers
 Deep, extensive or
problematic wounds
 Any invasive device insitu
 Chronic respiratory Disease
 Renal dialysis patients
 IV drug users
 Care home resident
 Patients on Ciprofloxacin
DOCUMENT ALL
STAGES
10
Appendix 2
HIGH RISK MRSA POSITIVE PATIENT (Not Bacteraemia)
Community Decolonisation & Screening Protocol
STHFT fax SPA Intra-Healthcare Infection Control MRSA form
SPA will fax the referral to GP + appropriate Community Nursing Team (CNT)
& a copy to community infection control for information only.
In most cases the patient should be aware of their MRSA status, as they have been an inpatient and may have already started topical treatment. However, CNT or GP may need to
inform patient (and family where appropriate). Give patient MRSA Patient information leaflet
Prescribe topical treatments according to
regimes & sensitivities if necessary see
section 4.1 & 4.2
DOCUMENT ALL
STAGES
Commence topical treatment
Continue Topical Treatment including
hair washing
If at Weekend/Bank Holiday screen
on next working day
Discontinue Topical Treatment
Leave 2 days before screening all sites.
If taking antibiotics, complete course &
leave 2 clear days before screening
GP or CNT to obtain results via ICE. Contact
Microbiology department if not on ICE system
+ve following 2nd course of treatment contact
Microbiologist for advice
If -ve
2 further screens required
Stop screening after 3 –
ve results. If clinical signs
of infection present in
future, consider full
MRSA screen.
If + ve
Inform patient. Repeat
treatments once only. Nasal
ointment according to sensitivity
If + ve
If aware of any
admissions to
hospital please
inform admitting
ward of MRSA
history
Contact Microbiologist for advice
BOX 1
Risk factors to consider in the patient and household
contacts are
 Immunocompromised
 Diabetic with venous ulcers
 Deep, extensive or problematic wounds
 Any invasive device insitu
 Chronic respiratory disease
 Renal dialysis patients
 IV drug users
 Care home resident
 Patients on Ciprofloxacin
11
These risk factors would prompt repeat treatment
Appendix 3
GP letter from STHFT regarding the First positive result Sample taken by GP
GP Name
GP Address 1
GP Address 2
GP Address 3
GP Address 4
GP Post Code
Date: (today’s date)
NHS Number:
Infection Prevention & Control Department
Northern General
Hospital
Admin Corridor, C
floor
Herries Road
Sheffield
S5 7AU
Tel: 0114 2714569
Fax: 0114 2715439
Royal Hallamshire
Hospital
Dept of Microbiology, F
floor
Glossop Road
Sheffield
S10 2JF
Tel: 0114 2713120
Fax: 01142712921
Hospital Number:
Date of Birth:
Patient Name:
Dear Dr xxxxxxxxxx
Re: MRSA – Meticillin Resistant Staphylococcus Aureus
We have recently received a sample from your practice which showed your patient, (details
above), was found to be colonised with the above organism. This may be a recent event, or the
patient may have acquired the organism in the past. It is our practise to inform the patient’s
general practitioner when we become aware of the result, so that they can take this into
account when prescribing antibiotics and to ask them to inform hospital staff, should the patient
need to attend hospital in the future.
1 - DELETE AS APPROPRIATE
The patient is unlikely to be aware of their MRSA status. The patient has been advised of the
result by letter and also sent an advice leaflet. To ensure an appropriate assessment and
treatment plan is agreed please ensure you arrange a consultation with the patient to discuss
their recent result and prescribe decolonisation treatment where appropriate. The patient may
require practical reassurance as well as decolonisation treatment.
2 - DELETE AS APPROPRIATE
The patient is unlikely to be aware of their MRSA status. The patient has been advised of the
result by letter and also sent an advice leaflet. To ensure an appropriate assessment and
treatment plan is agreed please ensure you arrange a consultation with the patient to discuss
their recent result and prescribe decolonisation treatment where appropriate. The patient may
require practical reassurance as well as decolonisation treatment. They have also been
referred to SPA for further follow-up as they are at higher risk of MRSA infection, including
bacteraemia.
The involvement of GPs in the care and treatment of patients with MRSA is advised by the
Department of Health. For further information Sheffield GPs should refer to the protocol titled
‘Guidelines for the Management and Control of Meticillin – Resistant Staphylococcus Aureus
12
Appendix 3
(MRSA)’ on the Sheffield Teaching Hospital Intranet page (visit http://nww.sth.nhs.uk/ and click
Clinical Guidelines and search MRSA).
Please would you ensure that the patient’s MRSA status is ‘flagged’ permanently (for lifespan of
patient) on their medical records? We recommend permanent flagging because low level
carriage (which may not be easily detectable) can persist even after decolonisation treatment.
Flagging of records helps ensure that:
 Infection control precautions are adhered to
 Appropriate antibiotic choices are made for this patient in future
 All relevant clinicians are aware of the patient’s MRSA status prior to any healthcare
intervention, including hospital admission/outpatient appointment
This letter has been sent out by the Infection Prevention and Control Team. Details of the
dates and sites of MRSA positive samples can be obtained from ICE. If you do not have
access to ICE or need advice about treatment, please speak to a member of the Infection
Prevention and Control Team (contact details above). Alternatively, contact the Microbiology
Medical Team on 0114 2712607 or 0114 2714527.
Thank you for your co-operation.
Yours Sincerely
On behalf of the Infection Prevention and Control Team
Sheffield Teaching Hospitals NHS Foundation Trust
13
Appendix 4
Patient letter written by STHFT for GP generated samples
PLEASE INSERT GP ADDRESS AND CONTACT DETAILS
Date:
Dear …………………(Please insert patient name)
The results of the swabs taken recently by your GP show that you are carrying MRSA.
Please find enclosed a patient information leaflet on MRSA
Having MRSA up your nose or on your skin (known as ‘carrying’ MRSA) is not in itself a
serious problem and many people carry the germ for years without ill effect. MRSA is not a
problem to healthy people and children. Treatment can be given which will help to reduce
the amount of MRSA present and, in most cases, clear it from your nose/skin altogether.
Treatment may be considered if you have an underlying medical problem or require surgery
in the near future.
The best treatment option for you, if you require any at all, will depend on your particular
circumstances and therefore we would advise you to contact your General Practitioner (GP)
to arrange for an appropriate assessment to be made. We have contacted your GP to inform
them of the MRSA results, so they are aware of the situation and the need for an
assessment.
In the meantime, if you have any questions, please contact your GP Practice.
Yours sincerely
On behalf of the Infection Prevention and Control Team
Sheffield Teaching Hospitals NHS Foundation Trust
14
Appendix 5
Appendix 5
The following table content has been taken from The DH and Infection Prevention
society, “Advice for those affected by MRSA outside of hospital” 2008
http://www.thh.nhs.uk/documents/_Patients/PatientLeaflets/infectioncontrol/MRSA/DoH_MR
SA_Advice.pdf
Can I still do these?
Activity
Swimming
Work
School and nursery
Friends and partners
Partners and sexual
relationships
Breastfeeding
Cleaning the house
Laundry
Pets
Care home
Towels
Washing and bathing
Shaving
Clothes
I have MRSA and:
I don’t need treatment
I am being treated
Yes (but not if you have open Yes (but not if you have open
wounds)
wounds)
Yes – as normal
Yes – as normal
Yes – as normal
Yes – as normal
Yes – keep any open
Yes – keep any open
wounds covered
wounds covered
As normal
As normal
Yes – be aware of signs of
Yes – be aware of signs of
mastitis as usual
mastitis as usual
Usual cleaning regime
Usual cleaning regime
Wash clothes at hottest
Wash clothes at hottest
temperature for the fabric
temperature for the fabric
using usual detergent. Avoid using usual detergent. Avoid
overloading the machine
overloading the machine
Wash your hands after
Wash your hands after
handling pets
handling pets
You can go back to your care You can go back to your care
home as normal. Wounds
home as normal. Wounds
should be covered
should be covered
As normal
You shouldn’t share personal
towels and should change
them daily
As normal
Follow treatment instructions
given by your healthcare
professional
Don’t share shaving
Don’t share shaving
equipment
equipment
As normal
Use fresh clothes / nightwear
daily
15
Appendix 6
A Simple Guide to MRSA
This guide explains what MRSA is, how it developed and ways in which it can cause
infection.
Staphylococcus aureus is a bacterium which one third of the population carry on their skin or
in their nose, without any associated problems. It can sometimes cause boils, abscesses
and wound infections.
What is MRSA?
Some strains of Staphylococcus aureus have developed resistance to some of the
antibiotics commonly used to treat infection. These strains are described as Meticillin
Resistant Staphylococcus aureus, commonly known as MRSA.
MRSA
The Staphylococcus aureus family of bacteria, to which MRSA belongs, is carried more
easily on skin that is broken, such as a cut, sore or leg ulcer. As such, it can be a common
cause of bacterial infections such as boils, carbuncles, infected wounds, deep abscesses
and bloodstream infection (or bacteraemia).
What does it do?
Staphylococcus aureus behaves in two distinct ways in the body:
1.
The organism can “colonise” the body, where the patient is carrying the MRSA bacteria
but has no symptoms. This means that the bacteria are present on the body, but they
may cause no ill effects and will remain unrecognised unless they are specifically
sought, e.g. laboratory swab results, or infection should occur. “Colonisation” or
“carriage” sites are most commonly the nose and the skin, especially in folds such as
axilla (armpit) or groin.
2.
More rarely, Staphylococcus aureus can cause infection. This happens when the
bacteria begin to multiply on the body, invade it and begin to cause ill effects. Infection is
usually recognised by the development of inflammation, pain, swelling and a fever, or in
some cases, by failing to respond to antibiotic treatment.
What Does MRSA Cause in Patients?
There is no specific 'MRSA disease', as there is with tuberculosis or typhoid.
The list below shows some of the ways MRSA affects patients and how it can be identified.
Wound Infections
S.aureus is the commonest cause of wound infection – either after accidental injury or
surgery. The obvious signs are that the wound is red and inflamed, has yellow pus seeping
from it and may easily break open or fail to heal. A wound abscess could develop.
16
Appendix 6
Superficial Ulcers
MRSA can infect pressure ulcers, varicose ulcers and diabetic ulcers (all of which are
caused by poor blood supply and superficial skin damage) if the skin breaks. The ulcer is
then harder to heal.
Deep Abscesses
If MRSA (or any S.aureus) spreads from a local site into the bloodstream, it can lodge at
various sites in the body (e.g. lungs, kidneys, bones, liver, spleen) and cause deep
abscesses. Patients are likely to be in considerable pain and may have high fever, a high
white cell count in the blood and signs of inflammation near the infection. The patient will be
unwell and may have rigors (shivers) and low blood pressure (shock).
If untreated over a period, the body will enter a catabolic state where tissues begin to break
down, the patient loses weight and vital organs will fail. This is usually linked with an
associated septicaemia.
Bacteraemia / Septicaemia
MRSA can enter the normally sterile bloodstream either from a local site of infection (wound,
ulcer, and abscess) or via an intravenous catheter (placed there for the patient’s medical
care).
Bacteraemia is when MRSA is in the blood – and it can lead to septicaemia, the clinical term
for a severe illness caused by the bacteria in the blood stream. This is the kind of MRSA
infection that has the highest death rate.
The symptoms are not specific to MRSA and can be the same for other bacteria that cause
septicaemia. Typically, symptoms can include high fever, raised white cell count, rigors
(shaking), disturbance of blood clotting with a tendency to bleed and failure of vital organs.
What Can We Do To Prevent The Spread of MRSA?
1.
To reduce the likelihood of spreading infection, Healthcare workers must always wash
their hands or use of alcohol hand rub (as appropriate), before and after patient contact.
2.
Healthcare workers and patients must wash their hands after using the toilet and before
and after eating.
3.
Patients who are undergoing surgery (or admitted to some specialist units in hospital)
should be screened for MRSA colonisation. If the MRSA screen shows MRSA carriage,
decolonisation treatment to the skin and/or nose is recommended before they are
operated on.
Infection Prevention and Control Team Sheffield CCG. July 2014, adapted from the
Department of Health (DH) “A simple guide to MRSA” 2005 and 2007.
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