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

2. Methicillin
Resistant
Staphylococcus
Aureus

3. 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

4. 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 !

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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.

12. 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

13. 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

14. 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 ???)

15. 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.

16. 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

17. Any Questions