MRSA Guidelines for the Care of Service Users with Meticillin Resistant Staphylococcus Aureus (MRSA) Version: V5 Executive Lead: Lead Author: Approved Date: March 2012 Approved By: Infection Control Committee Ratified Date: 2 nd April 2012 Ratified By: Policy Panel Issue Date: 30 th May 2012 Expiry Date: 30 th May 2014 Target Audience: This Policy must be understood by all direct care staff and line managers.
Preface - concerning the Trust Policy Management System (PMS) Version Control Versio n Date Author Status Comment V1 Nov 03 Infection Control Team Superseded Archived V2 Jan 06 D Pinkney Superseded Archived V3 Feb 08 D Pinkney Superseded Archived V4 July 09 D Pinkney Superseded Updated with Department of Health (Dec 2008). Agreed Infection Control Committee 1.7.09 V5 March 2012 Performance Indicators D Pinkney Approved Infection Control Committee The Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and related guidance Criterion 9 Have and adhere to policies, designed for the individual s care and provider organisations, that will help to prevent and control infections Comments and Feedback on this document were obtained from: Infection Control Committee Infection Control Team Page 2
CONTENTS Section Page No: 1 Introduction 4 2 Purpose 4 3 3.1 3.2 3.3 3.4 3.5 3.6 4 4.1 4.2 4.3 5.0 5.1 5.2 Meticillin Resistant Staphylococcus Aureus (MRSA) What is MRSA How is it spread What does colonisation mean? What does infection mean? What does bacteraemia mean? What is special about MRSA? What precautions should be taken in the non acute healthcare setting General advice In Residential / Inpatient Units In Client s own homes MRSA Screening Screening sites Refusing Screening 4 4 4 4 5 5 5 5 5-8 8-9 9-10 10 10 10 6.0 Decolonisation 11 7.0 7.1 7.2 Infected MRSA positive service users Signs and symptoms Treatment 12 12 12 8.0 Management of MRSA positive staff 12 9.0 Visits to other Departments 12-13 10 Transfer Or Discharge 13-14 11 Last Offices 14 12 Responsibilities 14 13 Process for reviewing, approving and archiving this 14 document 14 Process for Monitoring Compliance with this document 14 15 Dissemination, Implementation and Access to this 15 document 16 Associated Documents 15 17 References 15-16 Appendix A Stop and Think Notice 17 Appendix B MRSA Care pathway 18-21 Equality Impact Assessment Stage One 22-24 Page 3
1. Introduction This guidance sets out the Trust requirements for managing the risks associated with infection prevention and control of Meticillin Resistant Staphylococcus Aureus (MRSA) as required by the Health and Social Care Act 2008 (revised December 2010) Code of Practice for the Prevention and Control of Healthcare Associated Infections. 2. Purpose To ensure that the Trust meets the following Health Act requirements for the control of MRSA: admission screening decontamination procedures for colonised patients; isolation of infected or colonised patients; transfer of infected or colonised patients within NHS bodies or to other healthcare facilities; and antibiotic prophylaxis for surgery. 3. Meticillin Resistant Staphylococcus Aureus (MRSA) 3.1 What is MRSA? Staphylococcus aureus is a common bacterium that is found on the skin and in the nostrils of about a third of healthy people. MRSA stands for Meticillin Resistant Staphylococcus aureus. MRSA is a type of Staphylococcus aureus (SA) that has developed resistance to meticillin (a type of penicillin) and some other antibiotics that are used to treat infections. MRSA is not a new bacterium. It was first found in the 1960 s following the widespread use of antibiotics including meticillin. MRSA is found in many countries. 3.2 How is it spread? SA and MRSA are mainly spread by touch via the hands. Therefore good hand hygiene is essential. Hands are the main route of transmission of MRSA and of most other bacteria. Staff may acquire MRSA by touching or rubbing their noses with unwashed hands after contact with MRSA positive patients or their immediate environment. Staff may also acquire MRSA colonisation of skin wounds or dermatitis, or in bitten nails and nail beds via the same routes. As SA and MRSA live on the skin and dust is made mainly of dead skin, if dust gets into wounds or onto hands it can be a vehicle for cross infection. 3.3 What does colonisation mean? Colonisation is when a person carries Staphylococcus aureus, including MRSA on areas of their body such as the nose and the skin. People are unaware that they carry MRSA because it does not harm them and they have no symptoms, unlike people who are infected with MRSA. Most people who are colonised with MRSA do not go on to develop infection.
3.4 What does infection mean? MRSA infections usually occur in healthcare settings and in particular in vulnerable individuals. Clinical infection with MRSA occurs either from the individuals own resident MRSA (if they are colonised) or by cross-infection from either another person who has MRSA or the immediate environment. MRSA can cause harm when it gets an opportunity to enter the body. It can cause simple local infections such as pimples and boils or more serious problems such as wound infection, chest infection or blood stream infections. 3.5 What does bacteraemia mean? Bacteraemia is when an infection spreads further into the body and MRSA/ S.aureus is present in the blood. Septicaemia can follow (this is the clinical term for a severe illness caused by bacteria in the bloodstream). The symptoms are not specific to MRSA and can be the same for other bacteria that cause septicaemia. These symptoms include high fever, a high white cell count, rigors (shivers), disturbance of blood clotting with a tendency to bleed and failure of vital organs. This is the kind of MRSA infection that has the highest death rate. (Department of Health, 2007). NHS Hertfordshire sets HPFT a ceiling rate every year, regarding the incidence of MRSA bacteraemia. Should the Trust go over the set ceiling rate, this will result in financial implications for the Trust. 3.6 What is special about MRSA? MRSA acts in exactly the same way as SA and can cause the same range of infections. Most people who have it feel normal and have no adverse effects at all. Essentially MRSA differs to SA in that it can resist the most commonly used antibiotics. Other antibiotics are still effective but they may be more difficult to use and may be more expensive. MRSA is not more likely to cause infection than SA. However if a person gets an infection it is usually more difficult to treat. In an acute general hospital setting, the patient s tend to be more susceptible to infection, so MRSA is more likely to cause infection rather than just colonisation. This is the reason that MRSA is cause for concern in acute general hospitals and why patients with MRSA may be isolated in side rooms. 4. What Precautions Should Be Taken In The Non Acute Healthcare Setting? 4.1 General Advice Colonisation with MRSA may be long term. For a healthy person, MRSA colonisation is asymptomatic and does not present a risk. Compared to the acute Trusts, the transmission of MRSA within Mental Health and Learning Disability units, is less likely to present a risk of infection, particularly where service users do not have invasive devices (e.g. urethral catheters, central venous lines or surgical wounds). Page 5
The MRSA Working Party (1998) reports that service users in Mental Health areas are at minimal risk of acquiring a serious MRSA infection. The overall needs of the service users should be considered and therefore isolation and MRSA screening are not routinely recommended for service users in Mental Health settings. The same advice would follow for those clients within Learning Disabilities and those in their own homes. For further information on isolation and MRSA screening, please refer to section 2.2 and 3.0 of this policy. When a service user has been identified as colonised or infected with MRSA, infection control advice should be sought from the infection control team. The MRSA status should be included as an alert on care notes and up-dated as and when the status changes. The MRSA care pathway should also be implemented. MRSA is not a reason to exclude a person from a shared living environment. However, a risk assessment should be completed to ensure that all the appropriate infection control precautions are implemented. Within the non-acute healthcare setting, good hand hygiene practice and standard infection control precautions should be followed by all staff all of the time, to reduce the risk of any cross contamination. It should also be remembered that a number of service users seen in community settings will be unknown carriers of MRSA. Adherence to Standard Precautions will also reduce the risk posed by these individuals. Hand washing Good hand hygiene practice by staff and clients is the single most important infection control precaution. If good basic hygiene precautions are followed, clients with MRSA are not a risk to other clients, staff, visitors or members of their family, including babies, children and pregnant women. Hands must be decontaminated immediately before and after every episode of direct contact with service users and after any potential activity or contact that potentially results in hands becoming contaminated Like any other client, those with MRSA should be helped with hand washing if they are not able to do so themselves. Hands also need to be decontaminated after glove use. Visitors Clients may receive visitors and go out to see family and friends. Visitors do not need to wear protective clothing for social contact, but as always, should be advised of basic hygiene precautions. In residential and inpatient units, visitors should be advised to wash their hands with liquid soap and water before leaving the room (as for any patient). Page 6
Visitors can reduce the possibility of spreading MRSA to other people if they do not sit on the bed. Protective clothing Staff should wear sterile disposable gloves and aprons when attending to dressings, or performing aseptic techniques. Non- sterile gloves and aprons should be worn when emptying catheter bags and contact with blood, body fluids, secretions, excretions or hazardous substances is likely Disposable gloves must be discarded after each procedure. Household gloves may be used for cleaning the environment and must be correctly colour coded. All gloves that are punctured or torn must be discarded immediately. Disposable plastic aprons are single use items an must be worn as single use items for one procedure of episode of service user care and then discarded. Masks, spectacles or visors must be worn whenever there is a risk of body fluid splashing to the eyes or mouth. Disposable protective clothing should be disposed of as clinical waste. Hazardous Waste All hazardous waste, i.e. waste that is contaminated with body fluid must be discarded into an orange infectious waste bag. The bag must be securely sealed and labelled with the name of the clinical unit prior disposal. Hazardous waste must not be decanted from one bag to another. All bags must be stored safely and separate from other waste for collection. Equipment Equipment must be decontaminated between each service user use. All equipment sent for repair must be accompanied by a declaration of contamination status form. Health Care Workers Staff with eczema or psoriasis should contact Occupational Health as to the advisability of caring for known MRSA carriers Page 7
4.2 In Residential / Inpatient Units; Follow the general advice in 4.1 Also Isolation Clients should be encouraged to live a normal life without restriction and generally do not require isolation. They may share a bedroom, providing the other people within the room do not have open wounds, catheters or other indwelling devices. It is good practice for all routine hygiene procedures e.g. washing and dressing, where possible, to be undertaken in the clients room. They may join other clients in communal areas e.g. sitting room or dining room, so long as all wounds are covered with an appropriate dressing, which are regularly changed so that there is no strike through. Any non-urgent clinical procedures, such as dressing changes should be undertaken in the client s own room. A stop and think sign must be clearly displayed either by the entrance to the room or by the service users bed area, to signify that further infection control precautions may be required. Care must be taken to maintain service user confidentiality and to avoid stigmatisation of the isolated service user. MRSA positive service users with eczema/psoriasis (skin shedders) should be nursed in a side room with the door shut. However, this should only be employed after a risk assessment has been carried out and after discussion with the Infection Control Nurse. Cleaning The room/bed environment must be visibly clean, free from dust, soilage and acceptable to Service Users, their visitors and staff (Department of Health, 2001). All staff should report where cleaning is not to the expected standard, whether due to under-cleaning or the results of events after a cleaning procedure has been completed (Auditor General 2000). On discharge, the room must be thoroughly cleaned with detergent and water. Wall washing is not routinely required. Curtains will require changing if they are soiled. Page 8
Equipment to be used by other clients, such as commodes/ baths, should be cleaned thoroughly with detergent and hot water after each use. Refer to the Trust A/Z guidance for further information. Linen and laundry Linen, domestic and clinical waste should be managed in the same way as for any other service user (Department of Health 1998). Where linen is washed on the premises, ideally the clients own linen should be washed separately. The washing machine must not overfilled with linen (so that any micro organisms are more likely to be mechanically washed away). The machine temperature should be set at the highest temperature the fabric can stand and, where possible, the linen should be tumble dried and ironed. Crockery and cutlery Crockery and cutlery must be washed in a dishwasher after each service user use. 4.3 In a client s own home; Please also refer to general advice in 4.1 Hand Washing Health care workers visiting any clients in their own homes (even if not known to be MRSA positive) should: Wash hands with liquid soap and water and dry with paper towels (where possible) on arrival at, and on leaving, the client s home. Disinfect hands with alcohol gel prior to aseptic procedures (and on leaving the client s home if only bar soap and/or cloth towels are available). Cleaning Any medical equipment used in the client s home should either be disposable or decontaminated appropriately before use with another client (refer to Decontamination Guidelines ). Hazardous Waste Any service user cared for in the community and diagnosed with MRSA is not necessarily infectious. Only waste that is contaminated with body fluids must be regarded as infectious and placed into an orange bag for disposal. Linen In their own home, the client s linen may be laundered with the other household linen as usual. Page 9
Order of Visits While standard infection control precautions reduce the risk of cross infection, some individuals will be particularly vulnerable to infection. Therefore, where possible, clients with invasive devices (e.g. PEG tubes, Hickman Lines etc) should be seen early in the day and prior to known MRSA carriers. 5. MRSA Screening Service users admitted to mental health / learning disability trusts should not be carried out routinely. However, some individuals may have other clinical conditions that may put them at risk of MRSA infection and they should be screened for that reason. Individuals who are at higher risk include:- Those who are admitted to HPFT following surgical procedures Those who are admitted to HPFT following admission to an acute hospital Trust Those who have been a resident of residential / nursing care facilities Those who are intravenous drug users Those who self harm and have wounds/cuts on their body Those with chronic wound e.g leg ulcers Those with indwelling devices e.g urinary catheter, PEG tube Those who are known to have been infected or colonized with MRSA in the past. Service users who regularly attend the A&E departments for short periods of time, do not need to be screened on each re-admission to HPFT. (Guidance for the control and prevention of Meticillin resistant Staphylococcus aureus in healthcare facilities (2006) 5.1 Screening sites Screening should include the nose (the commonest site for MRSA), and groin. Swabs should also be taken from any skin lesion, wound site or catheter insertion sites. Urine specimen (CSU) to be obtained from service users with a urinary catheter. 5.2 Refusing screening Service users who are at high risk of MRSA infection should be screened on admission to HPFT. Individuals cannot be forced to comply with a request for a screen for MRSA. If a service user refuses to be screened, please inform the infection control link persons for advice. Page 10
6. Decolonisation As soon as a service user is identified as an MRSA carrier, a decolonisation regimen should be started (this is for NEW isolates only). Topical protocol must only be started if advised by a member of the Infection Control Team (ICT) and must only be given for the prescribed period. It must not be prescribed for individuals under the age of 16. Advice from the Consultant Microbiologist must be sought for these individuals. Treatments differ according to the sensitivity of the MRSA strain isolated but will generally consist of:- Antiseptic washes Triclosan or Hibiscrub, to be used as a liquid soap/shower gel daily for 5 days to eradicate MRSA from the skin. Caution is required if the client has eczema, dermatitis or any other skin conditions Nasal ointment Mupirocin (Bactroban ) 2%, 3 times a day for 5 days or Naseptin 4 times a day for 10 days to eradicate MRSA from the nose Antiseptic shampoo, such as Betadine shampoo every other day for 5 days (alternatively, Triclosan or Hibiscrub may be used) to eradicate MRSA from the hair follicles Treatment for MRSA colonised wounds will depend on the size, site and condition of the wound. Where topical protocol is being given, the service user must have clean towels daily and use disposable wash cloths in place of flannels or sponges. These cloths are to be discarded daily. The purpose of decolonisation is to reduce the risk of:- The service user developing an MRSA infection with their own MRSA during a medical or surgical treatment; and Transmission of MRSA to another service user Repeat screening following completion of topical protocol is rarely required in the community/non-acute setting and should only be carried out on the advice of the ICT. Page 11
7. Infected MRSA Positive Service Users 7.1 Signs and symptoms of infection Wound Infection -Wounds appear red and inflamed. The wound may also be swollen and painful. The wound may break open or fail to heal and a wound abscess could develop. The service user may develop a temperature. Invasive devices - MRSA may infect the entry site of an invasive device, causing local inflammation with pus. From this, the MRSA can enter the bloodstream, causing bacteraemia. Urine Infection - Service users with a urinary tract infection may have abdominal pain and a temperature and infection often causes the urine to go cloudy and smell. 7.2 Treatment The resistance patterns of MRSA vary from one service user to another. Therefore, it is impossible to give blanket advice on appropriate antibiotic treatment. The advice of the Consultant Microbiologist is available where an MRSA positive service user may require antibiotics If a client has been prescribed antibiotics for a clinical infection, where possible, specimens for microscopy, culture and sensitivity should be taken before the first dose is administered. The inappropriate and prolonged use of any antibiotics to which the MRSA is resistant, contributes to the resistance and spread of MRSA within healthcare settings. 8. Management of MRSA Positive Staff The routine screening of staff for MRSA is not recommended practice. In exceptional circumstances, the Infection Control team may advise screening when there are particular epidemiological features to indicate that a staff member or members may be the source of linked cases of MRSA infection. Where staff are identified as being MRSA positive (either as a result of organised screening or by the staff member s General Practitioner), Occupational Health must be informed, and a risk assessment regarding the advisability of remaining at work will be made in conjunction with the Infection Control Team. 9. Visits To Other Departments Service users should NEVER be refused emergency or routine admission to any area/unit on the grounds of their MRSA status. Page 12
When MRSA positive service users visit other healthcare areas, (e.g. visiting a hospital department for treatment) the area must be informed in advance so that the appropriate precautions to reduce the risk of transmission to others can be employed. If a surgical procedure is to be undertaken, there is no microbiological need for the client to be placed at the end of the list (Meers et al,1997), although this may be done for practicality and convenience and to ensure basic cleaning is undertaken. All equipment with which the patient has had direct contact (e.g. examination couch) should be decontaminated according to manufacturer s instructions. Standard Infection Control Procedures and Decontamination guidelines should be followed. 10. Transfer or Discharge When service users who are currently or have been previously MRSA positive, are to be admitted or transferred to another healthcare establishment, the receiving unit must be informed of the person s MRSA status. The clinician responsible for the service user should contact the Medical Team at the receiving unit to inform them of the patient's MRSA status. Additionally the nursing staff should inform the staff of the receiving unit well in advance, so that any requirements for screening prior to admission can be fulfilled. The Trust Inter-healthcare infection control transfer form must be completed (Trust Healthcare Associated Infection Risk Assessment Guidelines) to offer written information on care pathway, future actions etc. This should be completed on all service users, including home discharge. This information should be given to the G.P, district nurse, nursing home manager, unit manager etc The ambulance crew must be informed, if an MRSA positive service user has a desquamating skin condition, e.g. eczema. These service users should not be transported in the same vehicle with other service users. If the MRSA positive service user does not have a skin condition, then they may travel along with other service users. If a patient has wounds, they must be covered. If a service user has open skin lesions that are unable to be covered with an impermeable dressing, the advice of the Infection Control Team should be sought (London Ambulance Service Infection Control Manual 2000). Generally, there is no requirement for service users colonized with MRSA to continue with extended eradication protocol after discharge. This may be varied in the event of anticipated re-admission to a hospital, especially for a planned invasive procedure. It is the responsibility of the GP to carry out a risk assessment regarding screening, decolonisation, treatment and ongoing care of the service users who are resident in their own home, care home. To prevent any unnecessary anxiety and concern when returning to the home environment, service users and their appropriate contacts should be fully Page 13
briefed and given any relevant information on MRSA, its implications and significance prior to discharge. 11. Last Offices The precautions for the laying-out of deceased service users should be the same as those observed during life. Plastic body bags are NOT necessary unless there is a risk of leaking body fluid. 12. Responsibilities The organizational responsibilities for infection control within the Trust are set out in the Management of Infection Prevention & Control Policy. Line Managers Line Managers are responsible for ensuring all staff undertake infection control induction training and updates as identified in the Trust Training Needs Analysis, local compliance with the Trust Healthcare Associated Infection Risk Assessment Guidelines and attendance at audit and link personnel meetings when required. Healthcare Professionals All healthcare professionals are required to promote infection control and encourage colleagues and other Trust users to use good practice. To prevent and control the spread of infection all healthcare professionals are expected to: Read, understand and comply with this guidance. Assist in raising the awareness of other HCW s of the importance of infection control and adherence to the Trust s policies and procedures. Attend training in relation to infection control. Comply with the requirements of their professional code of conduct. 13. Process for reviewing, approving and archiving this document This document will be reviewed annually or whenever national policy or guideline changes are required to be considered (whichever occurs first) by the author, following which it will be subject to re-ratification. 14. Process for Monitoring Compliance with this document Monitoring of infection control requirements for MRSA is as follows: Monthly MRSA surveillance figures are forwarded from the Infection Control Team at the acute hospitals to the HPFT Infection Control Team. The Modern Matrons forward an infection control report quarterly to the Infection Control Team which includes instances of MRSA. This report is monitored by the Infection Control Team for compliance with the guidance and who respond if necessary for local action. Page 14
MRSA surveillance data is included in the infection control nurses quarterly report to the Infection Control Committee. Any issues arising regarding the requirements for improved processes are discussed and monitored via the Infection Control Team. The above information is included in the end of year infection control report to the HPFT Quality and Safety Group, the Health, Safety and Security Group, Performance Strategy and the Trust Board. The report is published on the HPFT Public Website. 15. Dissemination, Implementation and Access to this document 14.1 This policy is disseminated throughout the Trust following ratification via the policy guardians and is published on the HPFT staff website. Access to this document is open to all via the Trust public website. 14.2 Infection control link persons are responsible in conjunction with the ward/team manager for the dissemination of infection control information and other duties with regard to the implementation of infection control policies and procedures. For medical staff this responsibility lies with the supervising clinician. 16. Associated Documents This policy should be used in conjunction with the following Hertfordshire Partnership NHS Foundation Trust Infection Control policies all of which are available on the HPFT staff website: Hand hygiene Standard infection control precautions Decontamination Handling and Disposal of Waste Management of Infection Prevention & Control Policy Management Of Needlestick Injuries And Incidents Involving Exposure To Blood And Body Fluids Trust Healthcare Associated Infection Risk Assessment Guidelines MRSA Care Pathway Policy, Guidance And Procedure Following The Death Of A Service User and the Support of the Bereaved Single Equality Scheme Antimicrobial Guidance 17. References Auditor General (2000) A clean bill of health? A review of domestic services in Scottish hospitals. Published by Audit Scotland: April 2000. The Department of Health (2010). The Health and Social Care Act 2008: The Code of Practice for the Prevention and Control of Healthcare Associated Infections Page 15
Department of Health (2001) The epic Project: Developing National Evidence-based Guidelines for Preventing Healthcare Associated Infections, Journal of Hospital Infection 47 Supplement, Jan. Department of Health, (2007) Saving Lives: reducing infection, delivering clean and safe care. Screening for meticillin-resistant Staphylococcus aureus colonisation. A strategy for NHS trusts: a summary of best practice Department of Health,(2007) Essential Steps to safe, clean care Managing MRSA in a non acute setting :a summary of best practice. Department of Health (1997) MRSA what nursing and residential homes need to know leaflet K52/003 13609 Department of Health (Dec 2008), MRSA Screening Operational Guidance 2 Gateway reference number 11123 Joint BSAC/HIS/ICNA Working Party on MRSA (2006) Guidelines for the control and prevention of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities, Journal of Hospital Infection 63 Supplement, May. London Ambulance Service NHS Trust (2000) Infection Control Manual. Meers P. McPherson M. Sedgewick J. (1997) Infection Control in Healthcare, 2 nd ed., Cheltenham, Stanley Thornes. Page 16
Stop and Think!!! Please Report to the Nurse in Charge Standard I.C precautions
MRSA CARE PATHWAY Appendix B (TO BE USED IN CONJUNCTION W ITH THE TRUST MRSA POLICY) SERVICE USER DETAILS Name---------------------------------------- D.O.B---------------------------------------- NHS Number------------------------------- Address------------------------------------- PLEASE CONTACT THE INFECTION CONTROL NURSES PRIOR TO STARTING ANY MRSA DECONTAMINATION PROTOCOL MUST NOT BE USED IN INDIVIDUALS UNDER THE AGE OF 16 Preferred Name---------------------------- Consultant---------------------------------- AIMS OF CARE To prevent and control the transmission of MRSA to others To prevent the service user developing an MRSA infection with their own MRSA To minimise the potential psychological effects of a positive result. When applicable, to reduce / eradicate colonisation / infection To appropriately screen high risk individuals for MRSA TERMINOLOGY Colonised (Organism is present but not causing any symptoms of clinical infection) Infected (Organism is present and has resulted in signs and symptoms of clinical infection) Summary of details Signature The initial date the service user was identified as being MRSA positive ----------------------------------------------------------------------------------------------- The initial site/s where MRSA was isolated ----------------------------------------------------------------------------------------------- Date of admission to the unit--------------------------------------------------------- Page 18
Name of Unit service user admitted to--------------------------------------------- Name of unit the service user was transferred/discharged from------------ ------------------------------------------------------------------------------------------ Does the service user have a resistance to any of the treatment? --------------------------------------------------------------------------------------- Is the service user colonised or infected? (See above for clarification of terminology) Infected Colonised BEST PRACTICE An alert has been identified on care notes regarding the MRSA status of the service user? Yes Date and signature No Date and signature Comments All members of the nursing team have been alerted to the positive MRSA result? Service user /carer informed of result? Housekeepers have been informed of the necessary infection control precautions? Infection control Nurse has been informed of the result or readmission? Modern Matron has been informed of the result or re admission? The result has been placed in the medical notes/care notes? MRSA information leaflets have been given to service the user to support explanation? The service user agrees/is able to be compliant with infection control precautions? Staff are aware of the relevant infection control procedures as laid out in the Trust MRSA policy? The stop and think notice has been placed in a prominent, relevant place e.g entrance to bedside area? If there is a clinical infection, has the Consultant Microbiologist been consulted for advice? Page 19
Topical protocol must only be started if advised by a member of the Infection Control Team (ICT)and must only be given for the prescribed period. Treatments differ according to the sensitivity of the MRSA strain isolated but will generally consist of:- 1. Antiseptic washes Triclosan or Hibiscrub, to be used as a liquid soap/shower gel daily for 5 days to eradicate MRSA from the skin. Caution is required if the client has eczema, dermatitis or any other skin conditions 2. Nasal ointment Mupirocin (Bactroban ) 2%, 3 times a day for 5 days or Naseptin 4 times a day for 10 days to eradicate MRSA from the nose 3. Antiseptic shampoo, such as Betadine shampoo every other day for 5 days (alternatively, Triclosan or Hibiscrub may be used) to eradicate MRSA from the hair follicles Treatment for MRSA colonised wounds will depend on the size, site and condition of the wound. Where topical protocol is being given, the service user must have clean towels daily and use disposable wash cloths in place of flannels or sponges. These cloths are to be discarded daily. Repeat screening following completion of topical protocol is rarely required in the community setting and should only be carried out on the advice of the ICT. AFTER 5 DAYS OF TOPICAL TREATMENT PROTOCOL Stop topical treatment protocol after 5 days Date treatment commenced Date treatment stopped Date screening swabs taken (if applicable) Results Infection Control Team contacted for advice Yes Signature Date Comments No Signature Page 20
COMPLETE THIS SECTION IF SERVICE USER IS TRANSFERRED OR DISCHARGED from a HPFT unit DATE FROM TO COMMENTS Service user being transferred/discharged Receiving Medical Team informed Receiving Nursing team informed Infection Control Team informed Modern Matron informed Housekeeper informed All bed linen has been removed from room and washed according to Trust policy All surplus/used clinical items has been disposed of, unless they have been stored in cupboard All non-disposable equipment has been decontaminated with detergent and water or following manufacturers instructions. All surfaces have been allowed to dry before using equipment/room? Protective clothing has been discarded after use as clinical waste and hands have been washed? Date informed Comments Room has had a thorough clean? RISK ASSESSMENT SCREENING Individuals admitted to mental health and learning disability trusts should not be routinely screened. Only high-risk individuals should be screened. High Risk individuals who are admitted to HPFT, include any service users who :- Has had a recent surgical procedure Has had a recent admission from an acute Trust Has had a recent admission from a Nursing or Residential Home Has had a previous history of MRSA Are an intravenous drug user Self harm and have cuts/wounds on their body Have chronic wounds e.g leg ulcers Have an indwelling devices eg urinary catheter, IV device Have a previous history of being MRSA positive Review Date Dec 2013 Page 21
Equality Analysis Record Form for Trust Policies To be completed by the Policy Author Name of Policy Guidelines for the Care of Service Users with Meticillin Resistant Staphylococcus Aureus (MRSA) Description of Policy This guidance sets out the Trust requirements for managing the risks associated with infection prevention and control of Meticillin Resistant Staphylococcus Aureus (MRSA) Authors Name Deborah Pinkney Job Title Lead Infection Control Nurse Date May 2012 Is this for a New or Reviewed Reviewed Policy Policy? Have you completed the Yes Trust s E-Learning on Equality and Diversity The Trust, as a Public Sector Organisation has an equalities duty. There are 3 main aims, please show how these are taken into account in this Policy. Eliminate unlawful discrimination, harassment and victimisation. All individuals have micro organisms on or in their bodies. All have the potential for transmitting infection. Therefore, staff are required to implement standard infection control precautions on every individual. Advance equality of opportunity between different groups. Some individuals have an increased risk of acquiring an infection eg the very young or the very old. Individuals who are being transferred from a high risk area eg acute general hospital/nursing home where the incidence of MRSA is high, may have an increased risk of acquiring the infection. As a Trust, we have a duty to protect these individuals from potentially harmful diseases. Foster good relations between different groups. This policy is a requirement of The Health Act, 2008. Code of Practice for the Prevention and Control of Health Care Associated Infections and NICE guidance. It aims to minimise the spread of infection amongst individuals and provides assurance that HPFT has in place an appropriate framework to control and prevent healthcare associated infections. Page 22
More specifically, has the policy addressed the needs of any of the protected groups in a positive or negative way? For those that apply, please complete all the boxes below. Protected Characteristic (under the Equality Act 2010) Positive Negative Any Concerns Age: E.g. older or younger people Race: people from different ethnic groups Disability: physical/sensory/learning/ mental/other health Ethnicity/Race: inc issues relating to ethnicity & culture x x None Reasons supported by any evidence you have gathered The young and elderly may be at increased risk of infection due to their reduced immune system. E.g babies immune system has not yet fully developed Other existing medical conditions may also increase the risk of transmission of infection e. respiratory and cardiac illnesses. May also have other risk factors eg wounds Actio ns to address areas of concern By assessi ng the risks appropr iately, this will minimis e the risks of transmi ssion of infectio n By assessi ng the risks appropr iately, this will minimis e the risks of transmi ssion of infectio n Gender (sex): Men/Women None Gender reassignment: the process of transitioning from one gender to another (Trans) Marriage or civil partnership (inc next of kin, nearest relative etc) Pregnancy or maternity None None None Page 23
Religion/belief: people who holding religious and non religious beliefs. None Sexual orientation: lesbian, gay or bisexual, heterosexual etc. None What Equality information, if any, has influenced this Policy? Service user demographic data Staff demographic data Results of consultation Results of Staff Survey Results of Service User survey National research into inequality in healthcare Other (please specify): Please explain any you have used below. To be completed by the Policy Panel The Outcome of analysis and the recommendation is:- No major change needed: equality analysis has not identified any potential for discrimination for adverse impact and all opportunities to promote equality have been taken Adjust the policy to remove barriers identified by equality analysis or to better promote equality Stop and remove the policy/strategy/service or proposal as equality analysis has shown actual or potential unlawful discrimination Adverse impact - but continue. If this is selected you should consider whether there are sufficient plans to reduce the negative impact and/or plans to monitor the actual impact and list clear actions of how any mitigating measures will be implemented (including timescales). x Summary to support the decision and any further advice. The Equality analysis is satisfactorily completed. No additional comments to add. Name Dawn De Coteau Department Equality Department Date 29 th May 2012 Page 24