MRSA 2006 Community Infection Control Nurses Leicestershire, Northamptonshire & Rutland PCT’s Health Protection Agency Nurses Leicestershire, Northamptonshire & Rutland Social Care Providers 2006

Methicillin Resistant Staphylococcus Aureus

What is MRSA? MRSA (methicillin resistant Staphylococcus aureus) is a strain of bacteria that is resistant to common antibiotics, including methicillin. It can cause boils, abscesses and impetigo plus osteomyelitis and septicaemia Osteomyelitis is inflammation of bone either localised or generalised. Bone is infected by bacteria circulating in the bloodstream, which seed the infection. Over 90% of acute osteomyelitis cases are caused by Staphylococcus aureus but Streptococcus pyogenes and Haemophilus influenzae may also cause acute infection of the bone Typically, acute osteomyelitis affects the growing points of long bones since blood-flow is sluggish through these regions. This allows an opportunity for bacteria in the circulation to settle and to set up an infection at these sites ( extracted from medical source - not me!) Septicaemia is the presence in the blood of large numbers of bacteria or toxins. MRSA is not resistant to ALL antibiotics but those that it can be treated with are not normally freely available and may have to be obtained and/or administered with non routine procedures which may possibly only be undertaken in a hospital setting

MRSA – The Facts MRSA is found today in both the community and hospital settings. - Most residents with MRSA do not become ill - MRSA is rarely a danger to the general public If you look for MRSA you will find it !

Colonisation verses Infection Colonisation is the presence and multiplication of bacteria on the body without causing harm to the health of that person Infection is the invasion of a person’s body tissues by harmful and opportunistic organisms causing clinical signs of infection to that person Colonisation. Staph aureus is an organisms that can be found on as much as 30% of the population. Of that 30% some will have a strain that is resistant to methicillin. Staph aureus can colonise a persons body and can usually be found on the skin in warm, moist areas e.g. nose, throat, perineum (between the legs and around the anus) around the axillae (under the arms) It can also be found colonising chronic wounds e.g. leg ulcers and pressure sores as well as catheter (urinary/vascular sites) It is only a problem if it becomes an infection e.g. it migrates into the blood stream. Clinical signs of infection e.g., Pain or tenderness / Localised swelling/ Redness or heat – or raised temperature

How is MRSA Diagnosed? The only way to tell if someone has MRSA is to take a swab. It is not recommended that persons in residential care are treated, or sampled repeatedly, in an attempt to rid them of colonisation. Extracted from: Infection Control Guidance for Care Homes (DoH 2006) Taking a swab of a normal healthy person will possibly reveal that they are colonised but that does not mean they are infected or ill It is possible for healthy residents and staff in any unit or health care setting, unbeknown to themselves and the staff to be colonised with MRSA The only time it will be necessary to monitor infection of MRSA is if that person is to undergo elective surgery but this should be discussed directly with the infection control team in the hospital concerned

Treatment of MRSA Occasionally treatment of colonisation is recommended if a resident is to undergo surgery, but this should be discussed directly the with Infection Control Team at the hospital concerned. Infection Control Guidance for Care Homes (DoH 2006) Because colonisation can be very long-term, it is not appropriate to isolate patients/clients

How is MRSA Spread From one person to another by direct contact usually: - On the hands of healthcare workers - Contaminated equipment (e.g. towels, hoists) - Contaminated environment Good hand hygiene and the use of standard precautions will help to minimise the spread in a community setting. Persons receiving care in a community setting are likely to be susceptible to any infection because they are old and frail , very young or persons may be recuperating from another illness, underweight or dehydrated etc etc and MRSA could be passed on to them through poor infection control and cross contamination from any of the other residents not just from a known carrier which is why standard infection control procedures and practices are so important

Effective Hand Decontamination The single most important measure in preventing the spread of MRSA as with other Healthcare Associated Infections is: Effective Hand Decontamination Use the 6 step technique and advice on hand hygiene available in the departmental guidance

Standard Infection Control Precautions Always maintain hand hygiene Before and after contact with the resident After handling body fluids and items contaminated with body fluids After removing gloves and aprons Before handling invasive devices (e.g. catheters) Liquid soap and water is usually adequate but alcohol hand rubs/gels can be used if hands are visibly clean As a general rule staff do not need to use alcohol rubs except where hand washing facilities are unsuitable or unsafe e.g. for home care workers who visit a dirty household where there are no clean towels available, hard contaminated soap bar etc. etc

Standard Infection Control Precautions Maintain a clean environment There should be a clear plan stating what is to be cleaned and how often it should be clean. Any blood or body fluid spillage should be dealt with immediately according to standard infection control procedures. Cleaning schedules should be arranged with the full knowledge of all relevant staff and contain details of how, what and how often to clean plus COSHH information as required Bedrooms are particularly important areas to keep clean as so much skin is shed in them and this can contain MRSA bacteria Each room should be cleaned daily as a minimum. If a client is being isolated for an infectious condition then there should be a check clean in the evening if necessary. Colour coding may vary from one local authority to another –ensure at each unit that the staff are all aware of the significance of each colour and why colour coding is needed Cleaning equipment should be colour coded i.e. Red mop, bucket, cloths, gloves for toilet areas. Blue mop, bucket, cloths, gloves for general areas. Yellow mop, bucket, cloths, gloves for kitchen areas.

Standard Infection Control Precautions No additional cleaning requirement are necessary when residents are known to be colonised with MRSA Use disposable gloves and aprons when handling blood or body fluids Dispose of waste safely - double bagged as domestic waste

Standard Infection Control Precautions Linen should be removed from a resident’s bed with care to avoid the creation of dust. All linen, including personal linen, should be placed directly into a linen bag and not on the floor. Linen should be washed on the hottest temperature the fabric will allow. Dust can contain bacteria and viruses in any circumstances because it is made up of shed skin Bacteria and viruses can be viable in the dust for up to 24 hours or longer in certain circumstances Bedrooms are particularly important areas to keep clean as so much skin is shed in them and this can contain MRSA bacteria

Standard Infection Control Precautions Gloves and plastic aprons should be worn if handling linen soiled with blood or body fluids Hands should be decontaminated after removal of gloves and aprons and/or after handling used linen. Manual soaking/sluicing must never be carried out. The pre-wash/sluice cycle in the washing machine should be used after removing any solids (by disposing of them down a toilet is that what is meant ???)

Treatment of MRSA Residents with MRSA may: Socialise with others, eat and drink with others as long as their wounds or open sores are covered with the appropriate dressing Receive visitors and go out of the home to see family and friends Share a room with another person who does not have open sores, wounds, urinary catheters or have IV cannulaes People with MRSA do not pose a risk to the community at large and should continue their normal lives without restriction. MRSA is not a contraindication ( reason not to allow) to admission to a home or a reason to exclude an affected person from the life of a home. However, in residential settings where people with open post-operative wounds or intravascular (IV) devices are cared for, infection control advice should be followed if a person with MRSA is to be admitted or has been identified amongst residents.-- because they have more readily infected , exposed sites on their skin for the bacteria to colonise and gain access to the blood stream ???? Persons receiving care in a community setting are likely to be susceptible to any infection because they are old and frail , very young or persons may be recuperating from or have an other underlying illness, underweight or dehydrated etc etc and MRSA could infect them through poor infection control and cross contamination from any of the other residents not just from a known carrier which is why standard infection control procedures and practices are so important If a resident previously known to be colonised with MRSA requires admission to hospital, this information should be added to the referral note.

Risks to Staff Staff have healthy immune systems so the risks to staff are minimal Staff with broken skin should cover wounds with a waterproof dressing to prevent any further risk Effective hand hygiene will reduce the risk of acquiring any infection not just MRSA

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