Practice No.
450
Reference: 10/06
Version 1
HCC AS 20/06
HCC AS 20/08
HCC AS 21/06
HCC AS 22/01
Page 1 of 4
New June 2010
NMC Code of Professional
conduct
GSCC Code of Practice for
Social Care Workers
Marsden Manual of Clinical
Nursing Procedures
METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS (MRSA)
IN RESIDENTIAL AND COMMUNITY CARE
This summarises the nature, cause and effect of MRSA and the management of
incidences which may occur in residential and community care.
1.
WHAT IS MRSA AND IS IT IMPORTANT IN THE COMMUNITY?
1.1
MRSA stands for Methicillin-Resistant Staphylococcus Aureus.
Staphylococcus Aureus is a common bacterium which in some cases may
need to be treated by antibiotic therapy, however, some strains of
Staphylococcus Aureus have developed a resistance to some antibiotics, one
of which is Methicillin.
1.2
About one in three people carry the Staphylococcus Aureus (S. Aureus)
bacteria in their noses or on the surface of their skin, (especially in folds like
the armpit or groin), without developing an infection. This is known as being
colonized by the bacteria which may be carried for weeks or months without
harm to the carrier.
1.3
In general, people may also carry the Methicillin-Resistant strain of S. Aureus
without harm to themselves or others, and without being aware of the
presence of the bacteria, as, similarly to the Methicillin receptive strain, there
are no symptoms of infection. If basic good hygiene precautions are followed,
MRSA carriers are not a hazard to the general public or members of their
families, including babies, children and pregnant women. But, if the skin is
broken e.g. by cuts, open wounds or sores, or where a person is recovering
from surgery, their resistance to infection is compromised and they are
particularly vulnerable to this type of bacteria.
1.4
Antibiotic resistant S. Aureus manifests in the same way as ordinary S.
Aureus and does not cause different or more serious infections. But, the
infections they do cause are more difficult to treat as there are fewer effective
antibiotics with which to treat them.
2.
2.1
Admission of an MRSA Carrier to a Residential Establishment
Carriage of MRSA should not be a reason for stopping admission to a nursing
or residential home, or for discharging or barring service users from the
service. If it is known that a potential or new resident or service user is an
MRSA carrier, the following people must be informed:
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The Registered Unit Manager
The Service Manager
The Designated lead on infection control within the unit
The Designated lead for infection control for the service
The Care Manager for the individual or the lead care manager for
the unit
 The prospective resident’s GP – to determine if any other
professional contacts should be informed
2.2
Individuals with active MRSA will not be admitted to residential or nursing
homes until they are clear of the infection.
2.3
Individuals with active MRSA will not be accepted into the care of the
Community Response Team until they are clear of the infection.
3.
Care of Residents and Service Users with MRSA in community and
residential settings
3.1
All work bases must have a designated member of staff to deal with matters
of infection control, and to ensure that the manager’s responsibilities to
provide adequate arrangements for prevention of infections in the home, as
set out in Regulation 12 of the Health and Social Care Act 2008 (Regulated
Activities) Regulations 2010, are fulfilled.
3.2
Isolation of MRSA carriers is not recommended in residential accommodation
as this may effectively disable them. A colonised resident or service user,
without open wounds, may participate as fully as they wish in the activities of
the home and visitors should be encouraged, as with all other residents.
3.3
Where an MRSA carrier has open lesions these must be covered. Where
there is a urinary drainage catheter in situ, this must continue to be managed
aseptically. All residents with wounds should have them covered for
protection.
3.4
All residents should be encourage to practice normal good hygiene with hand
washing, especially after using the toilet and before eating. This is particularly
important where the resident is an MRSA carrier. Prompting or assistance
with hand washing may be required if mental capacity or a physical condition
makes it difficult for this to be done unaided.
4.
Management of staff caring for Residents or Service Users with MRSA
4.1
Staff must practice good hygiene at all times. This is vital for the prevention of
the spread of all infections, not just MRSA.
4.2
Managers must ensure that appropriate risk assessments are undertaken to
protect the health of residents, other service users, staff and visitors, where
MRSA, or any other infection, is present.
4.3
An incident report must be raised and the Infection control lead for the service
informed.
4.4
A ‘Statutory notification about a person who lives in a care home’ under
Regulation 37 until 30/9/2010, and from 1/10/2010 Regulation 18 must also
be sent to CQC.
4.5
Staff with eczema and/or psoriasis, particularly on their hands and forearms,
or those who are pregnant or receiving fertility treatment, should not
undertake personal nor intimate nursing care of residents or service users
with MRSA, (colonized or active), but social contact is acceptable. It is
advisable for staff in these categories to seek the advice of the County
Occupational Health Adviser as part of the risk assessment.
4.6
Where staff may be the main carer for a friend/relative undergoing regular
medical treatment, e.g. renal dialysis or cancer treatments, these staff should
seek further advice from the Communicable Disease Control Team (CDCT).
4.7
It is not necessary to screen routinely for the presence of MRSA unless there
is a clinical indication for doing so. Screening should be undertaken when a
wound is deteriorating or new lesions have appeared. In these situations,
swabs must be taken for general microbiological investigation, not only for
MRSA screening. However, where there is existence or a history of a
resident having MRSA, the laboratory must be informed on the pathology
form accompanying the sample.
4.8
In the community, MRSA carriers will not normally require special treatment
after discharge from hospital. If a course of treatment needs to be completed,
the hospital must be asked for full details of this. All Infection Control
procedures must be followed.
4.9
If a colonised service user has to travel by ambulance, the ambulance service
must be informed, but a special ambulance is not required.
4.10 If an MRSA carrier has to visit the hospital for outpatient treatment, the
relevant hospital department must be informed.
5.
Summary of Precautions to be taken to prevent the spread of MRSA
infection
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Staff must practice good hand hygiene before and after contact with
all residents
Disposable protective equipment (apron and gloves) must be worn for
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close contact with the resident who has MRSA, e.g. providing
personal or nursing care or assisting with moving and handling
If the resident is using a communal bath/shower, they should use this
after other residents
The bath/shower must be cleaned immediately after use, using a bath
cleaner/cream cleanser. No special disinfectant is needed.
Clothing/bed linen should be washed in a hot cycle on the washing
machine i.e. Hospital Programme (thermal disinfection on commercial
washing machines), or dry cleaned
The following extract from “Control of Communicable Diseases Manual”
(Benenson, 1995) should be noted: “The role of contaminated objects has
been over stressed; the hands are the most important instrument for
transmitting infection. Airborne spread is rare.” An example of airborne
spread could be MRSA pneumonia, although this is rare.
6.
Re-Admission to Hospital
6.1
As hospital patients are those most at risk from MRSA infections, the Duty
manager must inform the Infection Control Doctor or Infection Control Nurse
at the hospital, if a resident who has or had MRSA, needs to be admitted to
hospital. They are normally based in the Department of Medical Microbiology.
The Infection Control Doctor or Nurse is normally available via the hospital
switchboard.
6.2
This information must also be included on the information sheet which
accompanies the resident.
6.3
The hospital infection control staff may need to make arrangements for
admission of the resident into a side room whilst screening is carried out to
check whether the MRSA is still present.
7.
Further Information
Further information may be sought from the Occupational Health Adviser or
Nurse Advisor who can be contact via Hantsdirect on 0845 6035630.