NHS GRAMPIAN MRSA POLICY FOR COMMUNITY SETTINGS JUNE 2003

NHS GRAMPIAN MRSA POLICY FOR COMMUNITY SETTINGS JUNE 2003 Grampian NHS Board Grampian University Hospitals Trust Grampian Primary Care Trust

TABLE OF CONTENTS Aim 3 1 Introduction 4 2 Control of MRSA in the community 5 2.1 Safe Working Practice 5 2.2 Isolation 5 2.3 Screening 5 2.3.1 Household contacts/ residents in care 5 homes 2.3.2 Staff 5 3 Treatment / Decolonisation 6 3.1 Patients discharged form hospital 6 3.2 Residents/ Individuals diagnosed in the community 6 4 Treatment of infection and decolonisation protocol 6 4.1 Treatment of MRSA infection 7 4.2 Treatment for infected wounds 7 4.3 Decolonisation of MRSA 7 4.4 Decolonisation of normal skin 7 4.5 Decolonisation of abnormal skin 8 4.6 Colonised wounds 8 4.7 Decolonisation of nasal carriage 8 4.8 Decolonisation for throat carriage in adults 8 4.9 Decolonisation for throat carriage for children 8 and neonates 4.10 Urine 9 5 Transfer to hospital or other care homes 9 5.1 Communication 9 5.2 Ambulance transportation 9 6 Communication 9 6.1 Residents 9 6.2 Staff 10 7 Care of deceased residents 10 Appendix 1 Contact personnel 11 Appendix 2 Screening 12 Appendix 3 Swabbing Techniques 13 Appendix 4 Detection and testing of MRSA 14 Appendix 5 Discharge, Admission Information/communication 15 Appendix 6 Patient Information Leaflet 17 Appendix 7 Staff Information Leaflet 19 Appendix 8 Definitions 21 2

AIM This policy aims to ensure effective, appropriate management of MRSA positive individuals in community settings in Grampian. THIS POLICY MUST NOT BE ALTERED IN ANY WAY. IF YOU HAVE ANY CONCERNS REGARDING THE SUITABILITY OR APPLICATION OF ANY OF THE FOLLOWING POLICY CONTACT YOUR LOCAL INFECTION CONTROL TEAM (LISTED IN APPENDIX 1) INFECTION CONTROL TRAINING FOR CARE HOMES IS AVAILABLE FROM THE PUBLIC HEALTH INFECTION CONTROL NURSES HEALTH PROTECTION TEAM NHS GRAMPIAN 01224 558520 3

1 INTRODUCTION Approximately 30% of the population carry the organism Staphylococcus aureus (S. aureus). This is a bacterium, which is normally found in the nose and on skin. Most healthy people are unaffected by it, however it does have the potential to cause infection in those who have severely weakened immune systems. MRSA (Methicillin Resistant Staphylococcus aureus) is a form of S. aureus. It is transmitted in the same way, and causes the same range of infections as other strains of S. aureus, however it has developed resistance to the more commonly used antibiotics. This makes infections caused by MRSA more difficult and costly to treat, which is why every effort must be made to prevent its spread. The majority of individuals are COLONISED which is when the organism lives harmlessly on the body with no ill effects as opposed to INFECTED which is when the organism enters tissue and causes disease. Further definitions can be found in Appendix 8. In order to control and minimise the spread of MRSA there must be compliance with the following: Standard Precautions (formerly known as Universal Infection Control Precautions) Cleaning (domestic etc) must be of an acceptable standard Adherence to Infection Control Policies i.e. Clinical Waste, Laundry etc Infection control training Strict adherence to antibiotic policies Adequate resources for compliance Increasingly there are a number of individuals in the community who have acquired MRSA. MRSA is essentially a hospital problem. There are a number of reasons for this: Invasive procedures are frequently carried out in hospitals, which is an important route of infection. Hospitalised patients have lowered resistance to infection. There is widespread use of antibiotics in hospital People affected by MRSA do not present a risk to the community at large and should continue their normal lives without restriction. Many individuals are discharged into Care Homes and this should pose no problem to their ongoing care or that of the other residents as long as a few basic precautions are taken. 4

2 CONTROL OF MRSA IN THE COMMUNITY 2.1 Safe working practice NHS GRAMPIAN SAFE WORKING PRACTICE INFECTION CONTROL DOCUMENT MUST BE USED IN CONJUNCTION WITH THIS DOCUMENT Staff should adhere to the NHS Grampian Safe Working Practice Infection Control in the Community document, which is based around the principle of Standard Precautions (previously known as Universal Infection Control Precautions). These precautions should be applied to all residents at all times irrespective of diagnosis. This document should be located with each organisation s Infection Control documentation. All sections of the Safe Working Practice Infection Control guidelines should be applied. Additional guidance for use with patients/individuals with MRSA Laundry Individuals with MRSA do not need to have their laundry washed separately. If possible a biological pre-wash or detergent should be used with the hottest temperature suitable for the fabric. Cutlery and Crockery Cutlery and crockery requires no special treatment and can be washed in the sink or dishwasher with other items. Cleaning and Disinfection As per the organisation s agreed local Infection Control Policy. 2.2 Isolation There is no need to isolate residents to their own room if they have MRSA. It is preferable although not essential for residents who have MRSA to have a single room or be cohort nursed with other affected residents. 2.3 Screening 2.3.1 Household contacts / Residents There is normally no need to screen household contacts or other residents in care homes for MRSA. For further advice discuss with appropriate infection control team. (See screening protocol Appendix 2 and swabbing technique Appendix 3) 2.3.2 Staff 5

It is not necessary for work colleagues or carers to be screened for MRSA. 3 TREATMENT/ DECOLONISATION 3.1 Patients discharged from hospital When patients are discharged from hospital back into the community (including care homes) they may still be undergoing treatment for MRSA infection. This should be continued. When patients are discharged from hospital back into the community (including care homes) they may still be undergoing decolonisation for MRSA. This should be continued as per the protocol (see 4.3.3) If the post discharge decolonisation is unsuccessful. The individual should be assessed and usually one further attempt to decolonise the individual should be undertaken if: It is known or is likely that the individual will be admitted to hospital in the foreseeable future The individual has no invasive devises e.g. catheter The individuals skin is intact The individual does not have a skin condition e.g. eczema Further advice should be sought from the Infection Control Team of the discharge hospital (Appendix 1) if the individual has: Invasive devises e.g. catheter Broken skin Skin conditions e.g. eczema 3.2 Residents/Individuals diagnosed in the community Individuals with clinical infection caused by MRSA should always be treated promptly as with any other infection. If the individual is receiving systemic antibiotics these should be completed before undertaking a full MRSA screen. A full MRSA screen should be undertaken 48 hours after treatment is complete, to establish which sites are still positive (see Appendix 2). Individuals who are colonised with MRSA will not generally require decolonisation unless it is known or is likely that the individual will be admitted to hospital in the foreseeable future. Discuss with the GP/Infection Control Team. Further advice may be sought from the appropriate Infection Control Team (Appendix 1) 4. TREATMENT OF INFECTION AND DECOLONISATION PROTOCOL It is essential that current local policy be adhered to however in the unlikely event of any adverse reaction please stop the treatment and seek advice promptly. 6

4.1 Treatment of MRSA infection Patients who demonstrate clinical signs of infection will require treatment with the appropriate antibiotics. The agent used will depend on the site of infection. If the individual is receiving systemic antibiotics these should be completed before undertaking a full MRSA screen. Once treatment is complete, a full MRSA screen should be undertaken after 48 hours to establish which sites, if any, are still positive (see Appendix 2). Advice can always be obtained from Medical Microbiologist (Appendix1). It is important that the treatment should be based on the current set of full MRSA screening swabs. It is easier for both patients and staff if the treatment for the identified sites all commence at the same time 4.2 Treatment for infected wounds Where possible all wounds should be covered with an occlusive dressing Advice on appropriate systemic antibiotics should be sought from the Medical Microbiologist. Important: Do not apply topical treatments to acute infected surgical wounds 4.3 Decolonisation of MRSA Appropriate decolonisation should be considered when the patient s clinical condition allows. Once decolonisation is complete, a full MRSA screen should be undertaken after 48 hours to establish which sites, if any, are still positive (see Appendix 2). The eradication procedure used will depend upon which body sites are colonised with MRSA. Site Nasal carriage only Throat carriage Axilla or groin carriage Action Nasal decolonisation only Nasal and throat decolonisation Nasal and body decolonisation 4.4 Decolonisation of NORMAL skin Skin products should not be diluted. Infection Control Team Advice can be sought from the appropriate 1 st Line Direct application of 4% chlorhexidine (Hibiscrub) to all skin using a damp disposable cloth or freshly laundered flannel, daily for 5 7

days i.e. use chlorhexidine as a soap substitute and rinse off. Wash hair twice in the 5-day period with chlorhexidine. Alternatives include 2% triclosan (aquasept) or 7.5% povidine-iodine. Hair conditioners and body lotions can be used after treatment if required. 4.5 Decolonisation of ABNORMAL skin As it is difficult to eradicate MRSA from abnormal and/or chronic skin conditions, the decolonisation protocol should not be commenced until advice has been sought from a dermatologist or medical microbiologist. 4.6 Colonised wounds Seek advice from Infection Control or Tissue Viability Team. 4.7 Decolonisation of nasal carriage 1 st Line Mupirocin ( Bactroban ) nasal ointment 3 times daily to inner surface of each nostril for 5 days. Apply with cotton wool bud In the event of mupirocin resistance: Naseptin cream (0.5% neomycin plus 0.1% chlorhexidine) provided the organism is neomycin susceptible. Further advice can be sought from Infection Control Team (Appendix 1) 4.8 Decolonisation for throat carriage in adults Oral hygiene is very important, as teeth/dentures have been known to harbour MRSA. 1 st Line adults - Oral trimethoprim 200mg twice daily and 500mg fusidic acid tablets twice daily for 5 days. If using fusidic acid liquid, 750mg twice daily for 5 days. In the event of fusidic acid resistance or patient intolerance: Oral rifampicin 600mg once daily and trimethoprim 200mg twice daily (if susceptible) for 5 days. Patients may require an anti-emetic. 4.9 Decolonisation for throat carriage for children and neonates Before treating children and neonates advice must be sought from the Medical Microbiologist (Appendix 1) 8

4.10 Urine Elimination of MRSA from urine is not usually possible in the presence of a urinary catheter. If treatment is required discuss with the Medical Microbiologist and the clinician managing the patient. 5 TRANSFER TO HOSPITAL OR OTHER CARE HOMES 5.1 Communication If a resident is to be re-admitted to hospital please ensure that the receiving ward/unit are fully aware that the patient has had MRSA in the past. This will ensure that the hospital can take appropriate precautions (Appendix 5) If a resident is being transferred please ensure the receiving care home are fully aware of the residents MRSA status if known. 5.2 Ambulance transportation The Scottish Ambulance Service classifies patients who are MRSA positive into two categories. Category 1 Most patients colonised by MRSA or who have infected wounds or skin lesions which are covered by an occlusive dressing may be transported with others and require no special precautions. Category 2 Patients, who are heavily colonised by MRSA and are considered to be heavy shedders, eg have severe psoriasis or eczema. Patients who have infected exposed wounds or skin lesions, eg external fixation devices, burns etc should be transported by themselves. Patients who are clinically infected Patients who are colonised in the upper respiratory tract and present with active symptoms, eg cough Patients in category 2 should not be transported with others. The Ambulance Service will implement appropriate precautions applicable to this category. 6 COMMUNICATION Ensuring good communication about a resident s MRSA status is a responsibility of all staff. 6.1 Residents 9

Residents found to be colonised or infected with MRSA should be informed of this. The resident and their visitors should have MRSA explained to them. A patient/relative information sheet is available (Appendix 6) 6.2 Staff A staff information leaflet is available (Appendix 7) For further information contact the appropriate Infection Control Team. 7. CARE OF DECEASED RESIDENTS The precautions for handling these patients are the same as when alive (i.e. Standard Precautions (formerly known as Universal Infection Control Precautions) Lesions should be covered with an impermeable dressing Body (cadaver) bags are not necessary since there is no risk to healthy contacts unless the deceased patient has extensive burns, skin loss and/or extensive discharging wounds There are no contraindications for Last Offices including viewing 10

Appendix 1 CONTACT PERSONNEL Organisation Name & Title Number NURSING Grampian University Hospitals Trust ARI, Foresterhill Woodend Hospital Grampian University Hospital Trust (Dr Grays) & Grampian Primary Care Trust (Moray) Grampian Primary Care Trust Anne Smith, Infection Control Nurse Diane Pacitti, Infection Control Nurse Frances Murray, Infection Control Nurse Hilarie Fryer, Infection Control Nurse Roy Browning Infection Control Nurse Louise McBeath Infection Control Nurse 01224 552118 Ext 52118 Bleep 2313 01224 559431 Ext 59431 Bleep 3443 01343 543131 Ext 67571 Bleep 07623 810848 01224 663131 Switchboard 01224 556747 Ext 56747 Bleep: 07699 616196 NHS Grampian, Health Protection Summerfield House 2 Eday Road Aberdeen AB15 6RE Fiona Browning, Public Health Infection Control Nurse Jayne Leith, Public Health Infection Control Nurse 01224 558639 Ext 58639 01224 558636 Ext 58636 MEDICAL (Microbiology) Grampian University Hospitals Trust & Grampian Primary Care Trust (Aberdeen & Elgin) Foresterhill, Aberdeen (Public Health) Health Protection Team Summerfield House 2 Eday Road Aberdeen AB15 6RE Dr T M S Reid, Consultant Microbiologist Dr I M Gould, Consultant Microbiologist Dr Helen Howie, Consultant in Public Health Medicine (CD&EH) Dr Arun Mukerjee, Consultant in Public Health Medicine (CD&EH) 01224 681818 Switchboard 01224 553507 Ext 53507 01224 554952 Ext 54952 01224 558520 Ext 58520 01224 558520 Ext 58520 11

Appendix 2 SCREENING TECHNIQUE: Swabs should be moistened with sterile saline and rubbed firmly over the area to be screened. Send promptly to the Microbiology Laboratory. Label as Known MRSA screening swabs MRSA Swab Sites 1. If MRSA is initially identified from a routine swab or specimen, i.e. urine, wound, etc., then a full MRSA screen should be undertaken. (Send as known MRSA ) A B 2. A full screen includes the following:- A) Nasal swab (where suitable, use one swab for both nostrils) B) Throat swab (back of throat) C) Axillae (use ONE swab only for left and right) D) Groin (use ONE swab only for left and right) C The following should also be included as part of a full screen (if applicable):- E) Individual wounds/lesions or abnormal skin (e.g. eczema), also include peg/ gastrostomy sites. F) A CSU (if patient catheterized). G) Please label all swabs accurately and consistently including description and site. 3. Once a full screen has been undertaken to establish MRSA status DO NOT undertake further swabbing until MRSA treatment or decolonisation has been undertaken. D 4. Post-treatment swabbing should commence at least 48 hours after treatment/decolonisation has finished. This comprises of three full MRSA screens at least 48 hours apart (GUHT 1 st results must be negative before 2 nd and 3 rd sets are taken). 5. Once three consecutive full MRSA post-treatment screens are identified as negative (all individual swabs) then a patient is deemed CLEAR of MRSA. Please make sure that clearance of MRSA is confirmed by Microbiology or the Infection Control team. 6. Please allow at least three working days for results. 12

Appendix 3 SWABBING TECHNIQUES Nasal swab Nose Dip the swab in sterile saline/water and swab round both nostrils using the same swab. Throat Rub the back of the throat firmly with a swab. (Do not swab other areas of the mouth unless requested). Throat Swab Throat Rub the back of the throat firmly with a swab. (Do not swab other areas of the mouth unless requested) Axillae / Groin Using a non-touch technique, dip the swab in sterile saline/water and swab the area required. One swab can be used for both axillae and another swab for both groins. Wounds Dip the swab in sterile saline/water, then zig-zag and rotate it across the wound. Do not let the swab touch the surrounding skin. Send a sample of exudate or pus if present. Clearly identify the wound type, location, etc. Use the same identification details each time e.g. sacral sore left buttock Abnormal Skin (e.g. eczema, etc) Dip the swab in sterile saline/water then rotate the swab over the abnormal skin area. Clearly identify the abnormal skin area (i.e. type, site, etc). Use the same identification details each time. 13

Appendix 4 DETECTION AND TESTING OF MRSA MRSA Screen Each specimen is processed individually Plate onto ORSAB agar (Oxacillin Resistance Screening Agar Base) Incubate at 37ºC for up to 48 hours Identify and test colonies of S. aureus (see below) Routine isolates All isolates of S. aureus are tested for susceptibility to methicillin using oxacillin 1mg disc on Mueller Hinton agar at 35 C for 16 18-hours Isolates showing reduced zone size compared to the susceptible control or colonies within the zone should be tested further. Identification and Testing of MRSA Confirm as S. aureus by repeat coagulase test DNAse test Disc susceptibility to oxacillin co-trimoxazole penicillin linezolid erythromycin quinupristin clindamycin rifampicin tetracycline ciprofloxacin gentamicin Confirm if necessary as oxacillin resistant by E test (mic mg/l) Phage typing takes place in a reference laboratory. Note: Isolates from patient known to have MRSA need only be confirmed as S. aureus and grow on ORSAB agar (Oxacillin Resistance Screening Agar Base) Reporting The duty doctor and the Infection Control Nurse should be informed as soon as a new case of MRSA is suspected. The first isolate from each patient should be reported Growth of Methicillin resistant Staph. aureus with full susceptibilities. Subsequent isolates should be reported referring to previous specimens for susceptibilities. 14

Appendix 5 Discharge, Admission Information / Communication When a known or suspected MRSA patient is due for admission and/or discharge/transfer the following information should be relayed to the receiving establishment: Patient Name (Date of Birth and Identification Number), MRSA Status (Positive sites), Treatment/ Decolonisation Details (date treatment commenced) and any screening undertaken. Communication Channels Patient from: Home / Community Other Hospital / Ward Care Home Information to be given by: Information to be passed to receiving ward prior to admission. GP / District Nurse Ward Staff (Nursing / Medical) ADMISSION Matron / Home / Care Manager or Staff IN-PATIENT HOSPITAL Information to be passed to receiving area prior to discharge / transfer) DISCHARGE / TRANSFER Ward Staff (Nursing / Medical) Patient to: Home / Community Other Hospital / Ward Nursing Home Residential Home Information to be given to: GP / District Nurse Ward Staff (Nursing / Medical) Matron / Staff Home / Care Manager If a patient is identified as being positive after discharge, information must be passed on to the appropriate person by the Infection Control Team. 15

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Can it be treated? Appendix 6 Some antibiotics are still effective against MRSA but they are very powerful and may cause side effects. Because of this they are reserved for patients with serious infections such as bone infections and septicaemia (blood poisoning) etc. It is essential that we extend every effort to prevent the spread of this germ rather than depend on treating it with antibiotics. For further advice regarding MRSA please contact the trained ward staff, or the Home Manager MRSA (Methicillin Resistant Staphylococcus Aureus) NHS Grampian Area Control of Infection Committee May 2003 Patient/Relative Information Leaflet Issued by the Health Protection Team Grampian NHS Board Summerfield House, 2 Eday Road Aberdeen AB15 6RE Tel 01224 558520 Fax 01224 558566 17 Grampian NHS Board Grampian University Hospitals NHS Trust Grampian Primary Care NHS Trust

What is MRSA? Is MRSA harmful? What precautions should be taken MRSA is a germ (a bacterium called Staphylococcus aureus) which has become resistant to many antibiotics normally used to treat infections. This has happened in part as a result of inappropriate use of antibiotics over the last 30 years or so. Staphylococcus aureus can normally be found on the skin, the groin area, and in the nose and throat and for the most part causes no problems. Under certain circumstances Staphylococcus aureus (and MRSA) can be pathogenic which means that it is able to cause infection. How does it spread? MRSA is like any Staphylococcus aureus in that it can be carried in the nose, throat, skin and in the groin areas without causing infection. This is called colonisation. MRSA is generally spread on the hands when hands are not thoroughly washed. The germs can be spread from the nose and throat for example through coughing, sneezing. MRSA can also survive in the environment in dust that is largely made up of human skin scales. If dust is allowed to collect the germ can survive for long periods and it is possible for staff and patients to become colonised from this source. MRSA is extremely unlikely to cause problems in healthy people living at home. Many people are unaffected by Staphylococcus aureus, but when symptoms are present they usually take the form of boils, wound infections and urinary tract infections (particularly in patients with a catheter). In hospital it is necessary to prevent the spread of MRSA to areas where seriously ill patients are cared for due to the difficulty of treating the infection with antibiotics. The reason that MRSA causes no problems in some people and infection in others is unclear but is probably related to additional underlying medical conditions, eg after an operation. For this reason the presence of MRSA in hospitals is taken more seriously. Fit, healthy individuals are unlikely to develop an infection caused by MRSA and if they do it is likely to be a mild wound infection which would probably clear up spontaneously without antibiotics. Household and personal laundry During your stay in hospital we would ask that all your personal laundry is taken home to be washed. At home all laundry should be washed at the hottest temperature possible for the fabric. Laundry does not need to be washed separately. As always, hands should thoroughly washed after handling soiled laundry. Thorough handwashing, ensuring the web spaces and finger tips are cleaned, with soap and water followed by careful hand drying after visiting the toilet and before skin to skin contact with hospital patients contact with surfaces which may have MRSA on them, eg. wound dressings handling catheters or catheter bags visiting ill patients in hospital handling catheters or catheter bags feeding the very young and elderly All surfaces should be dusted regularly using a damp cloth to prevent the build up of dust Soiled dressings should be placed in a plastic bag for disposal and hands washed thoroughly. 18

I m pregnant, will it harm my baby? Appendix 7 MRSA is no more likely to harm a baby in the uterus (or out of it) than any other Staph.aureus. These organisms are carried on the skin by a considerable proportion of the population and are not associated with damage to or loss of the foetus. What about my family? Family members at home are at no more risk of acquiring infection, no matter what their age, from MRSA than from ordinary Staph. aureus that many of them will be carrying. Because they are not exposed to the antibiotic selection pressures of hospitals the y are very unlikely to become colonised with MRSA. For further advice regarding MRSA contact your Infection Control Nurse. NHS Grampian Area Control of Infection Committee May 2003 MRSA (Methicillin Resistant Staphylococcus Aureus) Staff Information Leaflet Issued by the Health Protection Team Grampian NHS Board Summerfield House, 2 Eday Road Aberdeen AB15 6RE Tel 01224 558520 Fax 01224 558566 Grampian NHS Board Grampian University Hospitals NHS Trust Grampian Primary Care NHS Trust 19

What is MRSA? MRSA is Staphylococcus aureus resistant to all β lactam As a result drugs of heavy including, use of antibiotics methicillin, over flucloxacillin, penicillins, cephalosporins and all related drugs. Some strains are, in addition, resistant to other groups of antibiotics such as Macrolides (eg Erythromycin), Aminoglycosides (eg Gentamicin) and Quinolones (eg Ciprofloxacin) Where has MRSA come from? As a result of heavy use of antibiotics over the last 30 years or so some strains of Staph.aureus have become resistant to many antibiotics. The continued use of antibiotics results in these resistant strains being selected out in hospital bacterial populations. Does it matter? There is no difference between MRSA and ordinary Staph.aureus - both are potentially pathogenic ie able to cause infection. However when MRSA does cause an infection this can be very difficult to treat because it is resistant to most available antibiotics. Often the only agent active against MRSA is Vancomycin that has to be given intravenously and is potentially toxic. It is therefore better to control the spread of this organism, and minimise the risk of patients developing an infection. How does it spread? MRSA is like any Staph.aureus. It can be carried in the nose, throat and/or on the skin of people without causing any infection (colonisation). Failure to follow normal hygiene procedures such as washing hands after examining a patient or changing dressings etc. may result in spread of the organism, on the hands, to other patients. MRSA can also survive in the environment. Dust is largely made up of human skin scales, ordinary Staph.aureus and MRSA can be shed from carriers on these skin scales and survive for long periods if dust is allowed to collect. It is possible that patients and staff may then become colonised from this source. Some people are heavy shedders of Staph.aureus. If the strain they carry is MRSA this may be the source of the spread of the organism. Even with good hygiene practice if an individual member of staff carried MRSA in their nose they may spread the organisms to patients while examining them or changing dressings. How do I stop MRSA spreading? How do I stop MRSA spreading? As the As most the likely most way likely of way spreading of spreading MRSA MRSA is on is your on hands, your thorough hands, hand thorough washing hand using washing soap using and water soap followed and by water careful followed hand drying by careful after hand any contact drying after with patients any or potentially contact with contaminated patients surfaces, or potentially is the best way contaminated to minimise surfaces, the risk of is spread. the best It way is also to important minimise to clean the (damp risk of dust) spread. all horizontal It is also important surfaces, push buttons to clean etc (damp regularly dust) to prevent all horizontal build up surfaces, of dust where push MRSA buttons (or ordinary etc regularly Staph.aureus) to prevent may build persist. up of dust where MRSA (or ordinary Staph.aureus) may persist. What type of infections does it cause? MRSA is likely to cause the same type of infections as ordinary Staph.aureus. These are usually infections of the skin such as wound infections or boils. Occasionally it may cause urinary tract infections and more rarely may cause deep infections such as abscesses, bone infections or septicaemia. It is this last group in particular that can be extremely difficult to treat. Will MRSA harm me? Fit healthy individuals are unlikely to develop infections due to MRSA. It they do they will most probably be superficial wound infections which often clear without antibiotics anyway. There is concern about hospital inpatients developing infections because they are already unwell and debilitated and therefore more likely to acquire infection. Also they may be subjected to invasive procedures such as catheterisation which increases the risk of infection. Finally patients are often receiving antibiotics which, by killing their normal bacteria, allow resistant organisms such as MRSA to colonise their skin. 20

Appendix 8 Definitions Colonisation Infection Systemic Agar colonisation is when the organism lives harmlessly on the body with no ill effects is when the organism penetrates tissue and causes disease (usually when the skin is breached e.g. due to surgery, or when the immune system is impaired e.g. due to an underlying medical condition). relating to or affecting the body as a whole, rather than individual part and organs gel medium to used to culture bacteria NB The majority of MRSA carriers are colonised as opposed to infected 21