MRSA

What is MRSA?

There are lots of micro-organisms (germs) on our skin. They are in the air we breathe, the water we drink, and the food we eat. Most of them are harmless, some are beneficial, and a very small proportion can potentially cause harm. Staphylococcus aureus is a common germ that is found on the skin (as part of the normal skin flora) and in the nostrils of about a third of healthy people. It can cause harm if it enters the body, for example through cuts and sores. Meticillin (also called Methicillin) is a type of Penicillin, an antibiotic that is used to treat infections.

MRSA are types of Staphylococcus aureus that have developed resistance to Meticillin, and some other antibiotics used to treat common infections. Some people carry MRSA on their skin and/or in their nostrils quite harmlessly. Some people carry MRSA for just a few hours or days, but other people carry MRSA for weeks or months. They may not be aware of being an MRSA carrier because they have no symptoms, and it does not harm them - this is called ‘colonisation’.

MRSA and other germs cause problems in hospitals. Complicated medical treatments, including operations and intravenous lines (drips), provide opportunities for germs to enter the body. MRSA and Staphylococcus aureus can also cause local skin infections such as boils and, in more vulnerable patients, they can cause more serious infections in wounds, bones, lungs and the bloodstream that will require treatment.

The following make patients vulnerable to infections:

• Their underlying medical condition
• The number of operations they have had
• The presence of open wounds
• How frequently they use antibiotics

What is the difference between colonisation and infection with MRSA?

MRSA colonisation means that the bacteria is simply sitting on the skin (in any site) but is causing no harm to the person. MRSA infection means the bacteria are causing signs of infection, for example, fever and/or pus discharging from a wound. These patients will usually be given appropriate treatment for the infection.

How do you know if someone has MRSA?

People who carry MRSA do not look or feel different from anyone else. The MRSA does not harm them, and they have no symptoms of infection. When patients come into hospital, a nurse may take swabs for laboratory tests to check for MRSA. In some instances, you may be screened more than once.

Patients who have an infection may develop signs and symptoms, such as a high temperature or a fever. An infected wound may become red and sore and discharge pus. Many different germs can cause these signs and symptoms. Only laboratory tests can show whether MRSA or other germs are the cause of this infection.

How do we care for patients with MRSA?

We take MRSA very seriously. Patients are routinely screened for MRSA based upon certain relevant criteria such as being prepared for or admitted for certain surgical procedures, having an overnight stay in the ROH, or are known to have previously carried MRSA. This routine testing involves taking swabs from different parts of the patient’s body (from the nose and groin, and wounds and/or device sites if present) to check if MRSA is present and to ensure that appropriate infection prevention and control precautions can be implemented. Patients found to carry MRSA are treated and their care discussed to ensure that they can still have surgery or investigations even with MRSA.

Patients who have had an MRSA positive screen are usually treated with an antimicrobial body wash (which can also be used on the hair) and a nasal ointment, which reduces or removes MRSA from hair skin, and nostrils - this process is called MRSA decolonisation.

Decolonisation therapy is important before your surgery to reduce the risk of infection. Patients who have had MRSA positive screens prior to surgery will receive the treatment of the antimicrobial wash and nasal ointment for the five days before their surgery, which will then continue for the day of surgery and for a further four days after the procedure, either in hospital or at home. After the 4 days post-surgery the nasal ointment will be stopped with patients continuing to use the antimicrobial wash for the remainder of their hospital stay. Patients who have been discharged need only use the antimicrobial wash whilst still using the nasal ointment – information regarding this will be provided by the nurse who discharges you.

If the surgery is urgent or cannot be postponed patients who have had MRSA positive screens will have decolonisation treatment commenced on admission to ROH.

Patients who have been in receipt of an MRSA positive screen will be cared for in a room on their own or in a separate area for people who have also had an MRSA positive screen.

How does MRSA spread?

Carriers of MRSA can have it on their hands/skin, and they can transfer it to people and objects that they touch. Other people can then pick it up on their hands and pass it on to others.

How to protect yourself / stop the spread of MRSA

Simple hygiene measures reduce the risk of acquiring and spreading MRSA. Use good hand hygiene while you are in hospital. Before and after meals, and after using the toilet or bedpan, wash your hands thoroughly with warm water and soap. Everyone should clean their hands before and after touching patients. Hands can be cleaned with soap and water, or alcohol hand rub. It’s okay to ask any member of staff if they have decontaminated their hands using alcohol gel or washed their hands with soap and water before they commence your treatment, examination, or any form of personal care if you have not seen them do so. Staff will wear gloves and aprons when they care for a patient who has MRSA.

Do patients have to stay longer in hospital because they have MRSA?

Patients who carry MRSA do not usually have to stay longer in hospital. Patients who have an MRSA infection or any other infection may have to stay in hospital until it shows signs of clearing up. They may stay until they have completed their course of antibiotics, or they may need to continue treatment when they go home. A patient who carries MRSA can go home or be cared for safely in a nursing home or residential home, using simple hygiene measures without the risk of it spreading to others in the family or care home. Please try not to worry if you have an MRSA positive test result.

Can MRSA harm friends and family visiting patients in hospital?

MRSA does not usually affect healthy people. It does not usually harm elderly people, pregnant women, children, and babies. In rare circumstance it can affect people who have serious health problems and people who have chronic skin conditions or open wounds. Visitors can reduce the risk of spreading MRSA to other people by:

• Cleaning their hands on arrival and at the end of their visit to the hospital wards using alcohol hand gel or soap and water.
• Not sitting on the patients’ beds
• Taking advice from clinical staff if someone who has a long-term health problem wants to visit a patient who has had an MRSA positive screen or if a patient who has had an MRSA positive screen wants to visit another patient in the hospital.

Can I still go home?

You will not have to stay in hospital any longer than necessary; you will be allowed home when medically fit.

What will happen when I go home?

Not all precautions taken in hospital are necessary at home. However, hand washing is important. It is important when visiting other healthcare environments that you inform them you have had MRSA, so appropriate treatment if required is prescribed.

Further information

If you have further questions, please speak to a member of the ward team or ask them to contact the Infection Prevention and Control team.