Infection Prevention and Control
South Tees Hospitals NHS Trust takes MRSA and healthcare associated infections extremely seriously. We are committed to reducing infections in our hospitals and providing high quality health care service.
What is MRSA?
MRSA stands for Meticillin Resistant Staphylococcus Aureus. It means the bacterium (germ) Staphylococcus aureus has become resistant to the antibiotic meticillin and some, but not all, of the most commonly used antibiotics.
Where does MRSA live?
MRSA can be found anywhere on the human body such as on the skin, in the nose and sometimes in wounds and urine. It can live for short periods in dust.
What problems can MRSA cause?
Most patients identified as having MRSA carry the bacterium harmlessly on their body. When this happens the patient is said to be colonised with MRSA. In these cases, MRSA can cause problems such as boils, abscesses and wound infections. On rare occasions, MRSA can cause more serious infections such as blood poisoning.
Why is MRSA a risk in hospital?
Some patients are more vulnerable to picking up MRSA because of their illness or underlying medical condition or if they have a surgical wound or damaged skin. MRSA does not usually cause problems to fit, healthy people, including children and pregnant women.
How common is it?
The trust recognises MRSA as a serious issue. Because of this, prevention and control of hospital-acquired infections remains an essential part of quality patient care.
How do we prevent the spread of MRSA?
Keeping hospital areas clean and dust-free is important but the easiest way to preventing MRSA spreading is with careful hand hygiene by patients and especially staff. Visitors and all staff should wash their hands thoroughly with soap and water or alcohol gel before touching patients. It is your right as a patient to ask staff if they have cleaned their hands before they touch you.
Patients with MRSA are requested to stay in their rooms until they have had three negative screens. However, tests that take place in other departments may be necessary to attend. Physiotherapy may also be an essential part of the recovery process which involves coming out of the room for walking or stairs practice.
There may be times when this may not be possible, for example, if you have MRSA in your sputum, this will be discussed with the Infection Prevention & Control team should the occasion arise.
Why do we need to screen for MRSA?
The Department of Health have made it compulsory for all acute trusts in England to screen all planned operations, all MRSA previously positive patients and all emergency admissions to help combat healthcare associated infections in hospitals. Most people with MRSA do not show any symptoms. We need to know if someone is carrying MRSA in their nose or on their skin so that treatment can be given to reduce the risk of complications to them and other patients whilst they are recovering from their illness.
How will I know if I have MRSA?
Patients with MRSA colonisation do not look or feel different from other patients. MRSA can only be identified from specimens sent to the hospital laboratories. Patients may have been carrying MRSA on their skin or in a wound before coming into hospital or may have acquired it in hospital. MRSA is almost always spread by physical contact and not usually through the air.
What tests are done?
Swabs will be taken in line with Department of Health policy.
These include:
Most planned admissions (this may be in Pre-Assessment Clinic, Outpatient Department or at a GP surgery)
Patients known to have had MRSA in the past and admitted into hospital
Patients transferred from another hospital
Patients admitted as an emergency
We will take a swab from inside your nostrils, your groin and any open wounds. The test is painless and only takes a minute. The swabs are then sent to the laboratory for testing. It takes a couple of days to get the results back.
Is MRSA treatable?
Yes, despite popular belief, most MRSA colonisations and infections are successfully treated. Some people with MRSA may not need antibiotics if the bacterium is not causing any harm. However if antibiotics are needed then it will be in either tablet form or given through a drip in the arm.
Most patients with MRSA in hospital will receive treatment to try to remove MRSA from the skin. This treatment will consist of nasal cream and anti-bacterial hair and body wash. This is called decolonisation treatment.
Do patients with MRSA have to stay longer in hospital?
If you have an infection caused by MRSA then you may need extra time in hospital to get better.
Some individuals may carry MRSA for long periods of time but many become clear after the decolonisation treatment and when they become medically well. You can often go home as soon as your general medical condition allows. Whether you continue with decolonisation treatment at home depends on why you were in hospital and whether you are likely to come back in at a later date.
What happens next?
In hospital
If you are told you are MRSA positive during a hospital stay you will usually be placed in a single room to help reduce the risk of other patients acquiring MRSA. Upon entering the room staff will wear gloves and an apron.
Prior to leaving the room the gloves and apron will be removed and the staff will wash their hands. You will also receive decolonisation consisting of the body wash and ointment. Once you have had three negative screens at weekly intervals you may be removed from the single room.
Pre-admission
Following pre-admission, if your results are negative then your admission can continue and you can have your procedure as planned.
If the results are positive you will be informed. If you are awaiting surgery you will be given treatment to reduce the number of bacteria on your skin. This consists of a five days course of special body wash to clean your skin and hair and cream for inside your nostrils. This is called ‘decolonisation treatment’. This course of treatment will be supplied to you by the Trust (see the How should I apply Octenisan bodywash section for information on how to apply the treatment).
Generally your planned procedure is likely to go ahead regardless of whether you are MRSA positive or not, however for some procedures your doctor may decided that it is better that you are clear of MRSA before they carry out your procedure. In some circumstances you will be given special antibiotics prior to your operation. You will also receive these antibiotics if you are to undergo surgery and you have had MRSA in the past.
Other reasons for decolonisation therapy
Certain wards and departments also utilise decolonisation therapy even before MRSA screening may have taken place. This is because those areas are thought to carry a higher risk of having patients that are admitted with MRSA.
Intensive care settings where the patients are more susceptible to developing infections also routinely decolonise patients admitted.
The Cardiothoracic division also utilise decolonisation prior to some surgical procedures.
Using the decolonisation treatment
Using the decolonisation treatment is simple. You should wash in the body wash for five days, also washing your hair twice in that time with the body wash.
As long as you have had the required contact time of the product (three minutes) you can use your own products after that if you wish. You will have some cream to put up your nostrils three times a day for the five days also.
If possible you should change and launder your clothing and bed linen on a daily basis (or as regularly as possible) for the duration of the treatment. This treatment should take place in the five days immediately before your operation.
MRSA positive
If you have screened positive for MRSA and have come back into hospital please tell a member of staff you have previously screened positive for MRSA.
How should I apply Octenisan bodywash?
Ensure that your hair and body are wet
Use 30ml of solution
Put the lotion onto a damp washcloth
Apply all over hair and body paying special attention to the darker shaded areas
Leave the lotion on your skin for three minutes before rinsing
Rinse off thorougly
Dry with clean, dry towel
Put on clean underclothes and nightwear every day
Other reasons for decolonisation therapy
Certain wards and departments also utilise decolonisation therapy even before MRSA screening may have taken place. This is because those areas are thought to carry a higher risk of having patients that are admitted with MRSA.
Intensive care settings where the patients are more susceptible to developing infections also routinely decolonise patients admitted.
The Cardiothoracic division also utilise decolonisation prior to some surgical procedures.
Does MRSA affect family, friends and other visitors?
MRSA is unlikely to affect family or friends, however they should always wash their hands before entering and leaving the hospital room of someone with MRSA. They do not need to wear aprons and gloves unless they are involved in direct patient care.
When someone with MRSA goes home they and their family should carry on as they were before coming into hospital. Good standards of personal hygiene are always important.
Please complete this short questionnaire and give to the nurse when you come for your procedure.
TO BE COMPLETED PRIOR TO YOUR PROCEDURE
Please complete this short questionnaire and give to the nurse when you come for your procedure.
Follow up MRSA screening questions:
If your MRSA screen was negative we will need to establish if you have received any further treatment or experienced any changes since your last appointment.
Please answer the following questions.
1. Have you been admitted into hospital, if so where?
2. Have you attended another outpatient department, if so which department?
If yes, what did you have done?
3. Have you been admitted to a care home?
4. Have you received any treatment which required an invasive device such as cannula,
urinary catheter, endoscopy?
5. Do you live with or provide care for anyone with MRSA?
6. Have you received care from a community nurse?
7. Do you have any wounds or damaged skin?
8. Are you a healthcare worker?
Where can I get further information?
The staff looking after you or the person you’re visiting should be able to answer your questions. If they cannot please ask them to contact the Infection Prevention and Control Team who will be more than happy to come and talk to you.
You can contact the Infection Prevention and Control Team on the following numbers:
The James Cook University Hospital
Telephone: 01642 854800
The Friarage Hospital, Northallerton
Telephone: 01609 762033
For more information on MRSA
Please visit gov.uk website or telephone NHS Choices on 111.
Patient experience
South Tees Hospitals NHS Foundation Trust would like your feedback. If you wish to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Department who will advise you on how best to do this.
This service is based at The James Cook University Hospital but also covers the Friarage Hospital In Northallerton, our community hospitals and community health services.
To ensure we meet your communication needs please inform the Patient Experience Department of any special requirements, for example; braille or large print.
T: 01642 835964
E: [email protected]