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MRSA Prevention and Control Policy

Introduction

Staphylococcus aureus is a common bacteria that is frequently found on the skin or in the nose of healthy people without causing an infection. If the bacteria invade the skin or deeper tissues, and multiplies, an infection can develop. This can be minor (such as pimples, boils and other skin conditions) or serious (such as bacteraemia, wound infections or pneumonia). Meticillin (previously known as Methicillin) is an antibiotic that was commonly used to treat Staphylococcus aureus, until some strains of the bacteria developed resistance to it. These resistant bacteria are called Meticillin Resistant Staphylococcus aureus (MRSA). Strains identified as meticillin resistant in the laboratory will not be susceptible to flucloxacillin – the standard treatment for many staphylococcal infections. These strains may also be resistant to a range of other antibiotics. MRSA is not usually a risk to healthy people. Research has shown that health and social care workers, who become colonised, have acquired the bacteria through their work, but the MRSA is usually present for a short time only.

Colonisation and Infection

Colonisation means that MRSA is present on or in the body without causing an infection. Up to 50% of the general population at any one time are colonised with Staphylococcus aureus (including MRSA) on areas of their body, e.g., nose, skin, axilla, groin. It can live on a healthy body without causing harm and most people who are colonised do not go on to develop infection. Less than 5% of colonising strains in the healthy population who have not been in hospital are Meticillin resistant, but it is more common in vulnerable people who are in contact with the health and social care system.

Infection means that the MRSA is present on or in the body and is multiplying causing clinical signs of infection, such as in the case of septicaemia or pneumonia, or for example, in a wound causing redness, swelling, pain and or discharge. MRSA infections usually occur in health and social care settings and in particular vulnerable Patients. Clinical infection with MRSA occurs either from the service user’s own resident MRSA (if they are colonised) or by transmission of infection from another person, who could be an asymptomatic carrier or have a clinical infection. Staphylococcus aureus infects a range of tissues and body systems causing symptoms that may be common to different infections caused by other bacteria.

Patients at risk of infection from MRSA

  • Patients with an underlying illness.
  • The elderly – particularly if they have a chronic illness.
  • The very ill – patients in intensive care.
  • Those with open wounds or who have had major surgery.
  • Patients with invasive devices such as urinary catheters, central venous catheters.

Routes of transmission

  • Direct spread via hands of health and social care workers or Patients.
  • Equipment that has not been appropriately decontaminated.
  • Environmental contamination (Staphylococci that spread into the environment may survive for long periods in dust).

Treatment

Any treatment required will be on an individual service user basis. Antibiotic treatment should only be prescribed if there are clinical signs of infection and following discussion with the clinician or the Consultant Microbiologist. Patients who are colonised with MRSA, i.e., no clinical signs of infection, do not usually need treatment.

Decolonisation and screening

Decolonisation/suppression treatment and screening in the community setting is not routinely required, however in certain situations this may be undertaken. Screening for MRSA will take place for planned admissions to hospitals. For specific advice contact the admitting hospital. Decolonisation/suppression treatment consists of:

  • An antibacterial solution, e.g. octenisan, Hibiscrub, or Prontoderm Foam, daily for 5 days, following the manufacturer’s instructions
  • For dermatology Patients, those with pre-existing skin problems, if not otherwise contraindicated, use octenisan or Prontoderm Foam, daily for 5 days
  • Nasal Mupirocin 2% ointment, e.g., Bactroban nasal, three times a day for 5 days
  • Topical Mupirocin 2% cream, e.g. Bactroban, for superficial wound areas, e.g., PEG sites (separate tube)
  • Compliance with the above programme is important and once commenced should be completed in order to prevent resistance to Mupirocin. Further screening or treatment is not required unless advised by the doctor.

Infection control precautions for Patients with MRSA in the community

Colonisation with MRSA may be long term. MRSA does not present a risk to other healthy individuals and carriers should, therefore, continue to live a normal life without restriction. Good hand hygiene practice and standard infection precautions should be followed by all staff at all times, to reduce the risk of transmission of infection.

  • There is no justification for refusing to admit Patients with MRSA into community care settings.
  • Patients with MRSA should not be prevented from visiting day centres, etc.
  • Standard precautions should be taken by all health and social care staff, including:
    • Hand hygiene essential before and after patient contact using either liquid soap and warm water or alcohol handrub
    • Disposable gloves and apron should be worn for direct care or when handling items contaminated with blood and/or body fluids
    • Normal laundry procedures are adequate with items washed either by a laundry or in a washing machine on a hot wash cycle. Items that are heat labile should be washed at the highest temperature the garment will withstand
  • Staff should ensure that the patient’s wounds are covered with an impermeable dressing.
  • Staff with eczema/psoriasis should seek advice from their GP. Persistent skin problems should be reported/investigated. Cuts and abrasions need to be covered with a waterproof plaster/dressing whilst at work.
  • No special precautions are required for crockery/cutlery and they should be dealt with in the normal manner.
  • All clinical waste should be disposed of as infectious waste.
  • There is no need to restrict visitors, but they should be advised to wash hands on leaving.

Environmental cleaning

  • If a MRSA positive service user has attended the GP practice for a procedure, then the immediate area should be cleaned with detergent and warm water followed by a hypochlorite solution, e.g., Chlor-Clean, Haz tabs, Presept and dried.

Transfer of Patients between health and social care settings

Staff preparing to transfer a patient user between one health and social care environment to another must make the department aware of the patient’s MRSA status so that appropriate infection control measures can be put in place before the patient arrives, e.g., the provision of a single room.

Precautions for MRSA positive patients attending health and social care settings

Outpatient Departments / GP practices

MRSA Patients should, wherever possible, be seen at the end of the session/clinic. Staff should wear disposable gloves and apron for direct patient care and the immediate environment cleaned afterwards with detergent and a hypochlorite solution, e.g., Haz tabs or Chlor-Clean.

Ambulance Transport

There is no evidence that ambulance personnel or their contacts are put at risk by transporting Patients with MRSA. However, to minimise the risk of transmission of MRSA to other patients, the ambulance staff or patient transport service staff should, as for every patient, decontaminate their hands before and after contact with a patient with MRSA. Most MRSA carriers can be transported with others in the same car or ambulance. However, Patients with invasive devices or who are immunocompromised / neutropaenic should not travel with patients who are known to be MRSA carriers. It is important to discuss any infection control issues with the ambulance service when booking patient transport so that appropriate segregation of patients can be maintained. No additional cleaning of the ambulance is usually required after transporting a service user with MRSA, routine linen changes and cleaning of the mattress is sufficient.

Ways in which MRSA bacteraemia may be prevented are:

  • Scrupulous hand hygiene and standard precautions
  • Scrupulous aseptic technique for the management of wounds and insertion and management of invasive devices
  • Correct use of antimicrobials – the correct antibiotic via the correct route, for the correct length of course

Death of a Patient with MRSA

Standard infection control precautions should be used when dealing with all deceased patients whether known to have had MRSA or not. Any lesions should be covered with impermeable dressings. Body bags are not required unless there is a risk of seepage from the body. Routine infection control precautions should be maintained by relatives, mortuary staff and undertakers.

Information for patients and family / visitors

Information about the infection should be given to patients and /or family and visitors. Information and factsheets are available to download at www.infectionpreventioncontrol.co.uk.

 

 

Date: January 2024

Version: 5 (Review)

Source: NHS