Hgs.uhb.nhs.uk
[pic]
Meticillin Resistant Staphylococcus aureus
(MRSA) Policy
Infection Control Manual
Contents
Meta Data
1. Summary………………………………………………………………..4
2. Introduction…………………………………………………………….4
3. Mode of Transmission………………………………………………..4
4. General Principles……………………………………………….…....5
5. Pre admission and admission screening.………………………...5
6. Additional Screening………….………………………………….......5
7. Sites for MRSA screening……………………………………………5
8. Actions to be taken when MRSA has been identified.…………..5
9. Transfers and visits to other Departments/ Hospitals.……….…8
10. Discharges to other hospitals or healthcare establishments.....8
11. Discharge home..…………………………………………………….....9
12. Visitors…………………………………………………………………….9
13. Laundering of patient clothing………………………….…………….9
14. Communication……………………………………………………….....10
15. Responsibilities………………………………………………………....10
16. MRSA Bacteraemia…………………………………………………….12
17. Staff Health…….…………………………………………………..……12
18. Monitoring Arrangements………………………………………..……13
19. References…………………………………………………………..….14
Appendix 1 Staff Information Leaflet
Appendix 2 MRSA Care pathway
Appendix 3 Patient Information Leaflet
Appendix 4 Treatment Regime
Appendix 5 Relative Guidance for laundering soiled / infected items of clothing
Meta Data
| | |
|Title: |Meticillin Resistant Staphylococcus aureus (MRSA) Policy |
| | |
|Date ratified by the Infection Control Executive Committee |2008 |
| | |
|Review date: |2010 |
| | |
|Created by: |Infection Control Doctor |
| |Infection Control Nurse |
| | |
|Source: |Infection Control Department |
| | |
|Stored Centrally |Trust Intranet |
| | |
|Linked Trust Strategies and Policies |Clinical Governance and Controls Assurance Strategy |
| |Risk Management Strategy |
| |All other infection Control Policies |
1. Summary
Staphylococcus aureus is a bacterium normally found in the nose or skin of 30% of the general population Meticillin Resistant Staphylococcus aureus (MRSA) - previously called Methicillin -is a strain of S. aureus that is resistant to the antibiotic flucloxacillin and also to all of the beta-lactam antibiotics i.e. all penicillins, cephalosporins and carbapenems. MRSA, like Meticillin Sensitive Staphylococcus aureus (MSSA) can cause a spectrum of illness ranging from asymptomatic colonisation through to life threatening infections e.g. bacteraemia. This policy sets out the approach of the Heart of England NHS Foundation Trust towards the management of patients infected/colonised with MRSA and the measures to be taken to prevent and control spread of MRSA.
This policy reiterates the general principles of infection control that all staff must adhere to at all times and outlines the importance of risk assessment, the appropriate actions that need to be taken with all MRSA patients and the responsibilities that staff have, ensuring that a high standard of infection control practice is achieved in all clinical areas by adhering to infection control policies.
2. Introduction
MRSA is now endemic in most UK hospitals. The patients and the public are increasingly seeing MRSA and rates of MRSA infections as indicators of quality care. They require reassurance that all healthcare professionals are taking reasonable and sensible precautions to minimise risk. Control is necessary in order to limit the spread and to minimise the clinical impact.
There has also been emergence of MRSA strains that are resistant to vancomycin, which are very hard to treat, and those carrying the panton valentine leukocidin (PVL) toxin, which can cause severe invasive disease.
This policy is based on the recommendations made in 2006 from a national joint working party of the British Society for Antimicrobial Chemotherapy, Hospital Infection Society and Infection Control Nurses Association. This policy will be reviewed after 2 years or sooner if there is new Department of Health guidance or scientific evidence to justify a change.
3. Mode of Transmission
MRSA can be spread in the following ways;
• By direct person to person contact usually by the contaminated hands of health care staff.
• Indirectly via fomites, e.g. communal items, medical equipment,
• In dust particles that settle on furniture and fixtures and fittings in the clinical environment. The physical environment of any health care institution should be clean and cleaning is everyone's responsibility not just the domestics (A matrons charter; An action Plan for Cleaner Hospitals)
• Endogenous or self-infection occurs when a micro-organism colonising a site on the host enters another site and establishes infection
4. General Principles
The general principles of infection control apply to all wards/departments and are applicable to the control/management of communicable infections, including MRSA.
• Hand decontamination is the single most effective way to prevent the spread of hospital acquired micro-organisms. Therefore, correctly performed handwashing/hand disinfection as per the Trust Hand Hygiene Policy is essential.
• The use of personal protective clothing (PPE) i.e. disposable aprons must be worn for close physical contact with a patient. If it is anticipated that contact with blood or body fluids, lesions and contaminated materials and equipment, gloves should be worn, as per the Trusts Standard precautions policy.
• Careful handling of used linen and its transport in sealed red bags.
• High standards of aseptic techniques, especially when managing indwelling medical devices such as cannulas and catheters.
• There must be a rational use of antibiotics and adherence to the Trusts antibiotic policy
• The need for intra and inter ward transfers of patients must be reviewed and minimised where possible.
• Adequate and appropriately skilled nursing and other staff levels must be maintained.
• There must be regular monitoring of compliance with infection control policies through effective audits.
• A High standard of ward cleaning is essential which is monitored and reported to the executive team.
5. Pre – admission and admission screening
See separate MRSA admission screening policy.
6. Additional Screening
• All haemodialysis patients will be screened prior to line insertion and every three months by the Renal Directorate according to local policy.
• Haematology/Oncology patients will be screened prior to ‘Hickman’ line insertion by the Haematology / Oncology Directorate according to local Policy.
• All patients who have a prolonged stay in an ITU or High Dependency area should not only be screened on admission but also at weekly intervals whilst in the area according to local policy.
• All patients who have received decolonisation treatment must be screened on completion of the course of treatment. Swabs should only be taken when treatment has been stopped for two days (see appendix 4)
• Ward/clinical staff will not be screened as a matter of routine. The decision to screen staff will be taken by the Infection Control team; following a full risk assessment of the individual(s) level of clinical involvement or clinical area of practice. Staff members found to be carrying MRSA are dealt with in a confidential manner by the Occupational Health department. Staff who experience recurrent boils or lesions must be referred to occupational health for screening of the lesions.
7. Sites for MRSA screening
• See separate policy regarding sites to screen for pre-admission and admission screening.
• See local policies for sites to screen for haemodialysis patients, haematology/ oncology and patients with prolonged stays on ITU/ HDU.
• The following screening procedure must be followed for all patients that have had a positive MRSA result.
• Swabs must be moistened in sterile saline or water before swab is taken.
• Swabs are taken from
o Both anterior nares (nasal) using one swab
o Axilla
o Groin
o Skin lesions and open wounds/ break in skin (if present)
o Any invasive device site i.e. NG tube, PEG site, drain site, tracheostomy
o sites etc.
In addition
o A sputum sample if the patient has a productive cough
o A urine sample if the patient is catheterised.
• All MRSA screens that are taken and results when received must be recorded in the Patient Care pathway (See Appendix 2).
8. Actions to be taken when MRSA has been identified
1. Informing of results
• All new MRSA positive results will be placed on the hospital reporting system.
• The infection control team or the Duty microbiologist will telephone all new MRSA clinical specimen results through to the ward and inform the staff of the result. If the patient has been discharged the patients consultant will be contacted by letter. If the patient has a booked re admission and treatment is advised prior to admission.
• MRSA screening results will not be telephoned to the ward or department; all members of staff should access the results using the hospital reporting system.
2. Documentation and communication
The nurse in charge of the patient should:
• Document the results in the patients medical notes
• Place a yellow MRSA sticker inside the medical notes
• Inform the medical team that MRSA has been isolated
• Commence the MRSA Care Pathway (Appendix 2 )
• Inform the patient and explain to them about MRSA. A patient information leaflet, which can be accessed via the Trust infection control intranet and ‘Patient Advice and Information database’ should be given to the patient.
3. Isolation and barrier precautions
• Standard source isolation procedures should be instigated for colonised and / or infected MRSA patients (see Isolation Policy) regardless of the patient being in a side room or in a main bay.
• Isolate the patient in a side room if available
• When a side room is not available a risk assessment must be carried out (in conjunction with the infection control team if needed) and documented in the patients medical notes. The patient can be source isolated in the bay.
8.4 Ensure that the following are in-place:
• Isolation sign placed on the side room door or outside the bay if the patient is nursed in a bay.
• Gloves, yellow aprons are available outside the side room or at the entrance to each bay and that alcohol gel is available at the bed space.
• Staff from other wards and departments e.g. physiotherapists, radiographers, other medical team etc. must speak to the nurse in charge before approaching the isolated patient.
8.5 Cleaning and equipment
• If a patient is source isolated, isolation cleaning of the room and / or bed space must be undertaken at least daily and terminal cleaning following the patient discharge and / or transfer to alternative location (see Isolation Policy).
• All equipment should be single patient use if it is available i.e. disposable hoist slings, blood pressure cuffs etc. If single patient use items are not available, specific equipment should be allocated specifically for that patient, wherever possible.
8.6 Decolonisation Treatment
• Topical treatment and nasal ointment can help eradicate skin and nasal colonisation.
• Topical treatment should be prescribed for all patients found to be colonised with MRSA for 5 days and then stopped for 2 days followed by patient re-screening (Appendix 4).
• If patients are not decolonised after one course of treatment a second course should be given. If unsuccessful the courses should not be repeated, advice should be sought from the microbiology team.
• Invasive devices, such as urinary catheters, often extend the period of colonisation. Aseptic techniques must be used when handling the device and the device removed as soon as clinically possible
• Patients with a clinical infection may require a course of systemic antibiotics. The choice of antibiotic depends upon the site of infection and on the particular strain of MRSA. Advice can be sought from the On Call Microbiologist via the hospital switchboard.
9. Transfers and Visits to Other Departments/ Hospitals
• Transfer of MRSA patients to other wards in the hospital should be minimised to reduce the risk of spread, but this should not compromise care, such as rehabilitation or diagnostic investigations.
• If visits to other departments are necessary i.e. for investigation or treatment, the receiving department should be informed so that they can implement the appropriate measures i.e. environmental cleaning.
• When attending other departments, the patient should attend at the end of the working session if clinical condition permits.
• The patient should spend the minimum time in the department i.e. should be sent for when the department is ready and not left in the waiting area with other patients.
• When transporting infected / colonised MRSA patients to other departments:
o All lesions should be covered with an impermeable dressing
o Staff are not required to wear aprons and gloves whilst transporting patients between departments.
o Aprons should be worn if handling and moving the patient from bed to wheelchair/trolley etc. These must be removed once the patient is settled and before leaving the isolation room or department.
o Aprons should be disposed of as clinical waste and hands washed after removal.
o Gloves are only required if it is anticipated that there may be contact with the patients blood or body fluids.
o The trolley or chair should be decontaminated, using soap and water or a detergent wipe, after use by the patient and before being used for another patient.
o Staff should decontaminate their hands thoroughly after dealing with a patient and/or cleaning the trolley or chair.
• All staff in the receiving department must ensure that basic infection control measures as outlined in the MRSA care pathway in Appendix 2 are implemented.
• Equipment and the number of staff attending should be kept to a minimum.
• All surfaces that the patient has had direct contact with should be decontaminated using ‘chlorclean’ or cleaned with detergent followed by hypochlorite 1,000ppm (see Isolation Policy for further details).
10. Discharges to other hospitals or healthcare establishments
• Inter-hospital transfers should not be prevented or delayed although unnecessary movement should be avoided.
• Before transfer, a member of the clinical team for the patient should inform the receiving ward/ hospital of the MRSA status and any treatment that has been received.
• The patient's general practitioner and other healthcare agencies involved in the care must be informed of the MRSA status on discharge. MRSA carriers discharged home or into the community setting will not normally require continuation of their eradication treatment. MRSA is not a contraindication to the transfer of a patient to a nursing home. The medical and nursing staff however should still be informed in advance so that the basic principles of infection control practice are adopted.
11. Discharges home
• Patients with MRSA should be discharged promptly from hospital when their clinical condition allows.
• Patients with MRSA may be discharged into the community either back into their own home or a residential/nursing home, their must be effective communication between the hospital and community staff. The MRSA status must be written on the patients discharge letter to the GP.
• Patients should be advised that if in the future they are hospitalised they should advise admitting staff that they have previously been identified as carriers of MRSA to ensure that they are appropriately managed.
• There are no special precautions that families need to undertake at home providing family members are fit and well. Family members may have contact with the MRSA patient but should remember good hygiene practices, i.e. hand washing, environmental cleanliness etc. If a family member is unwell please speak to the Infection Control Team for further advice.
12. Visitors
• Visitors can still visit patients who are colonised or infected with MRSA.
• Visitors should report to the nurse in charge prior to entering the side room / isolation area.
• In addition to decontaminating hands on entering and leaving the ward, all visitors should decontaminate their hands on entering and leaving the side room or when visiting MRSA patients in the bay.
• All visitors should wear a disposable yellow apron and decontaminate hands on entering an isolation room. Hands must always be decontaminated after removal of the apron and on leaving the room. The same procedure should be followed if visiting a MRSA colonised patient in a bay.
• Relatives should not sit on the bed.
• Relatives should wear gloves when participating in personal care if contact with blood or body fluids is anticipated.
• All staff should be aware of the requirements for visitors / relatives so that staff can give this information out as necessary.
13. Laundering of Patient Clothing
• Patients own clothing should be laundered by relatives /friends as the Trust does not have the facility to launder patients own property.
• See Appendix 5 for the laundry leaflet which staff should give to relatives. The leaflet gives some guidance for relatives / friends on laundering soiled / infected items of clothing safely at home.
14. Communication
• In order to help reduce the anxieties and concerns felt by patients and visitors about MRSA there must be effective communication between health care staff and patients and visitors.
• An MRSA information leaflet for patients and visitors can be found as Appendices and these are available on the Trust Intranet page ‘Patient Advice and Information Database.’
• In order to help allay fears and concerns about MRSA through misinformation, MRSA patient information leaflets should be freely available throughout the Trust.
• All staff should be aware of the concerns that the public and patients may have related to MRSA and Health Care Associated Infections in general. All concerns raised should be addressed immediately by the nursing and medical teams. If the concerns persist, the Infection Control team should be contacted for further advice and further discussions with patients and family as needed.
• Documentation and communication are key aspects of managing patients with MRSA. Staff need to ensure that there is full and accurate information in the patients notes.
15. Responsibilities
1. Trust Management are responsible for:
• Ensuring that there are appropriate staffing levels enabling staff to attain high standards of infection control practice.
• Ensuring that wards are funded adequately to provide single use equipment for all MRSA positive patients such as blood pressure cuffs, tourniquets, hoist slings.
• Funding additional resources necessary to control outbreaks of MRSA. This may include increased staffing as well as funding specimens taken during the outbreak.
• Contributing to the control of MRSA outbreaks by attendance at outbreak control meetings and Control of Infection Committee meetings.
2. The Infection Control Team (including microbiologists) are responsible for:
• Educating clinical staff caring for the patients so that they are aware of this policy.
• Advising staff on the appropriate actions to be taken to prevent / limit hospital outbreaks of MRSA infection.
• Informing staff of MRSA infected / colonised patients and giving advice as appropriate.
• Giving advice on treatment of MRSA infection and colonisation.
• Informing GP’s via letter of any patients found to be MRSA positive either following discharge or when attending out – patients.
• Undertaking ongoing MRSA surveillance and feeding back surveillance data to clinical departments/ Directorates so that it can be used locally to inform practice.
• Monitoring compliance with this policy.
• Initiating additional screening of any patients / staff if there has been an MRSA outbreak
• Communicating increased MRSA infection risks to Trust Management.
• Communicating up to date information relating to MRSA outbreaks to appropriate personnel within the Health Economy.
• Offering advice to the Occupational Health department for any Trust employee that has an MRSA infection.
• Surveillance MESS data, monthly reports, reports for committees
3. The Occupational Health Team are responsible for:
• Alerting the Infection Control Team of any MRSA infections amongst Trust employees.
• Undertaking a joint risk assessment of the staff member in conjunction with the Infection Control Team.
• Undertaking the appropriate follow up of staff.
• Co-ordinating staff screening specimens and reporting of staff symptoms during an MRSA outbreak, as applicable.
4. Bed Managers are responsible for:
• Liaising with ward staff to ensure that patients are placed appropriately in isolation / single rooms where possible
• Ensuring that where the above is not possible due to limited availability, a risk assessment has been undertaken in conjunction with the Infection Control team
• Facilitating the movement of patients requiring isolation to other wards where appropriate.
5. All Managers / Matrons / Senior Sisters of all patient areas are responsible for:
• Ensuring dissemination of this policy to wards and departments.
• Enforcing this policy in their area.
• Facilitating the delivery of education provided by the Infection Control Team and ensuring staff attend annual infection control training.
• Ensuring that the correct personal protective equipment is readily available in their ward or department.
• Informing the Infection Control team if there is any indication of cross infection between patients.
2 Medical staff are responsible for:
• Ensuring that topical treatment is commenced for all in-patients and systemic antibiotics as required.
• Ensuring that a discharge letter is sent to the patient’s GP informing them about their patient that has had MRSA isolated whilst an in-patient.
• All staff that have patient contact or work in patient areas are responsible for:
• Ensuring that this Policy is followed and that the appropriate actions are instigated as applicable.
• Ensuring that patients relatives are informed of the appropriate actions that they need to follow when visiting a patient with MRSA.
• Ensuring that their own infection control practice (e.g. hand decontamination, use of personal protective equipment, correct handling of laundry, waste disposal, decontamination of equipment and the environment, isolating the patient etc) is:
1. of a high standard
2. maintained at all times
3. an integral part of total patient care.
• Prompt notification to the Infection control team or duty microbiologist of any suspected RSA outbreak.
• Challenging the poor practice of others if this Policy has not been followed.
• Ensuring that they attend an annual infection control update
• Contacting the Infection Control team for further advice if they have any further questions surrounding this Policy or their own infection control practice.
16. MRSA Bacteraemia
1. Reporting of MRSA Bacteraemia
• All MRSA bloodstream isolates (MRSA bacteraemia) are reported to the Regional Surveillance Unit of the HPA, as part of the national mandatory surveillance scheme.
• All cases are reported as an untoward incident using a Trust IR1 form – this is completed by the Infection control nurse and sent to the clinical Risk Department.
• The clinical risk department will report all MRSA bacteraemias as SUI’s, as agreed with the PCT.
16.2 Root Cause Analysis
• A root cause analysis (RCA) must be performed on all cases of MRSA bacteraemia, in line with national guidance.
• If the blood culture was taken greater than 48 hours after admission, an email will be sent to the Consultant under whose care the patient was at the time of the blood culture to inform him/he of the result and the need to perform a RCA. Undertaking the root cause analysis is the responsibility of the Consultant under whose care the patient is at the time the blood culture is taken. The purpose is to identify any contributory factors and ensure lessons are learnt
• A multidisciplinary “case conference” should be held within 24 hours (core time) of the MRSA bacteraemia and will be organised by the Directorate Manager. The root cause analysis on-line tool should be commenced at this meeting and action planning completed.
• If the MRSA bacteraemia occurred within the first 48 hours of admission of the patient, the PCT will be informed by the Microbiology team so that they may undertake a RCA investigation.
17. Staff Health
• Staff colonisation in particular nasal carriage is usually transient, in some cases only lasting for hours. For this reason routine screening of staff is not undertaken and staff should not screen themselves on the ward.
• If staff are concerned they should discuss their concerns with either the Infection Control team or the Occupational Health Department.
• Staff screening of symptomatic staff will be done by Occupational Health as appropriate following consultation with the Infection Control team.
• MRSA colonised/infected staff will be managed in a confidential manner by the Occupational Health Department in liaison with the Duty Consultant Microbiologist/Infection Control Doctor.
18. Monitoring Arrangements
18.1 Regular Monitoring
The policy will be monitored annually using an audit tool. Results will be reported to the Infection Control Executive Committee who will review compliance and if necessary nominate a manager to develop an action plan to achieve the standards / process set out in the document. This
Action plan will also be monitored via this Committee.
Where appropriate the Risk Register will be updated.
18.2 Monitoring through exceptions
Compliance with this policy can be monitored via exception only which may be reported via associated standing agenda items for committees. (I.e. increased outbreaks of MRSA of C Diff, may prompt a further investigation of compliance with infection control policies).
19. References
Joint Working Party of the British Society of Antimicrobial Chemotherapy, the Hospital Infection Society and the Infection Control Nurses Association (2006) for Consultation. Guideline for the Control and Prevention of Methicillin Resistant Staphylococcus Aureus (MRSA) in Hospitals.
Royal College of Nursing (2004 Revision) Methicillin Resistant Staphylococcus Aureus (MRSA) Guidance for Nursing Staff.
Screening for meticillin-resistant Staphylococcus aureus (MRSA) colonisation, Saving l ives programme Department of Health 2007.
Appendix 1 Staff Information Leaflet
What is MRSA?
• Staphylococcus aureus is an organism that is commonly found on the skin, the anterior nares, perineum and umbilicus. MRSA is a more antibiotic resistant variant of Staphylococcus aureus.
• Meticillin resistance means the same as flucloxacillin resistance.
• When there is resistance to meticillin, the bacterium is labelled MRSA
• MRSA also commonly survives in the same body sites as Staphylococcus aureus without causing infection – a state known as colonisation.
• A patient becomes clinically infected if the organism invades the skin or deeper tissues and multiplies to cause a localised or systemic response, for example in septicaemia.
• . Some strains of MRSA – known as epidemic strains or EMRSA – are more likely to spread.
• To date, 17 epidemic strains have been identified in the UK. The most common strain seen in the Midlands is EMRSA-15 with occasional EMRSA-16.
• Individuals may acquire MRSA as a result of treatment with antibiotics or via transmission (see below)
• Individuals may acquire MRSA as a result of exposure to antibiotics, or from exposure to the organism, for example from previous contact with health care.
• The consequences of developing a serious infection with MRSA can be severe because the range of effective antibiotics is limited, costly and potentially toxic. Therefore it is important to take precautions to prevent transmission, especially in patient groups that are susceptible to infection.
How is MRSA transmitted and how can it be prevented ?
• As well as occurring in the colonised sites described above, MRSA may also colonise chronic wounds, for example in eczema, varicose and decubitus ulcers.
• MRSA may spread in the same ways as sensitive strains of Staphylococcus either by endogenous or exogenous spread.
Endogenous spread
• This occurs when a person with staphylococci spreads the bacteria from one part of their body to another.
• Endogenous spread can be prevented by both encouraging patients to wash their hands and discouraging them from touching wounds or damaged skin
Exogenous spread
• This occurs when the organism is spread from person to person by direct contact with the skin. In health care, this is usually via the hands of healthcare workers.
• MRSA can also be spread by a contaminated environment or equipment.
• Skin scales may contaminate the environment if they become airborne, for example during activities such as bed making, or if the affected person is heavily colonised, or has a condition such as eczema which causes shedding of high numbers of organisms.
• Staphylococci that are shed into the environment may survive for long periods in dust.
• Some of the ways exogenous spread can be prevented are:
- hand washing or using an alcohol hand rub after contact with a colonised person or potentially contaminated equipment
- applying topical treatments to reduce skin carriage
- keeping the environment and equipment as clean and dry as possible
- Ensuring that doors are kept closed during airborne generating procedures.
PATHWAY TO BE FOLLOWED IF PATIENT IS:
▪ Known to be MRSA positive on admission
▪ Readmitted and previously known to be MRSA positive*
▪ Identified as being MRSA positive during present inpatient stay
▪ Patients screened pre-operatively or on admission as outlined in screening policy
* NB MRSA status information is recorded on the EPR alert system or at front of patient’s notes
For further information refer to Trust MRSA Policy or contact the Infection Control Nurse
DATE PATIENT STARTED ON PATHWAY ……………………………………WARD ………………….
|Before signing the care* complete this section and sign initials on subsequent pages. |
| | | | |
|PRINT FULL NAME |POSITION & DISCIPLINE |FULL SIGNATURE |INITIALS |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
* The person giving the care should sign e.g. Registered General Nurse, Clinical Support Worker, Patient, Medic, PAMS etc
| | |MET |UNMET |DATE |TIME |
| | |Initials |Initials | | |
|2 |“Isolation Precautions” notice fixed to outside of door | | | | |
|3 |Need for isolation explained to patient and relatives | | | | |
| |(MRSA patient information leaflet given to patient) | | | | |
|4 |Multidisciplinary team informed i.e. doctor , Domestic etc | | | | |
|5 |Topical treatment has been prescribed * | | | | |
|5 |Alcohol gel dispenser at patients bedside is clean and in working order | | | | |
* All patients to have at least one course of topical treatment prescribed i.e. Chlorhexidine and Bactroban regardless of site. Remember: 5 days treatment, 2 days off treatment, full screen on Day 8.
Record any variations to the Initial Actions Below:
|No |VARIANCE |CAUSE OF VARIANCE |ACTION / OUTCOME |
| | | |(Sign, date & time subsequent notes) |
| | | | |
Full Screen entails:
Nasal, any open skin lesions and invasive devices, sputum if coughing and CSU if patient is catheterised
Previous MRSA patients will have a full screen on admission
Patients who have just had MRSA identified will have 5 days treatment, 2 days off treatment before the full
screen is taken on Day 8. Do not take screen whilst on treatment.
|Date |Nose |Wound |Invasive devices |Other |Date next screen due |Signature |
| | | | | | | |
| | | | | | | |
| | | | | | | |
| | | | | | | |
| | | | | | | |
| | | | | | | |
Name: ……………………………… PID: ……………………………...
|Cycle 1 DATE: |
| |Met |Unmet |DATE |TIME | |Receiving |
| |Initials |Initials | | | |departments/|
| | | | | | |units |
| | | | | | |informed |
| | | | | | |that of |
| | | | | | |patient MRSA|
| | | | | | |status; |
| | | | | | |include on |
| | | | | | |referral |
| | | | | | |form |
|IF SURGERY: Operating theatres informed in advance of surgery of MRSA status | | | | | | |
|On discharge: | | | | | | |
|Inform GP of MRSA status on GP discharge letter | | | | | | |
|Inform District Nurses of MRSA status on referral (if having DN support) and include in District Nurse discharge letter. Ensure copy of letter is | | | | | | |
|in patient’s notes | | | | | | |
|If discharged to nursing home/residential home ensure they are aware of MRSA status. Record this in patient’s notes | | | | | | |
|If transferred to another hospital inform receiving ward and include in transfer letter | | | | | | |
|WHEN MOVING PATIENT TO OTHER BED SPACE AND ON DISCHARGE |
|TERMINAL CLEAN/ DISINFECTION AND CURTAIN CHANGE |
| |Met |Unmet | |Met |Unmet |
| |Initials |Initials | |Initials |Initials |
Record variances to Daily Care, Transfer or Discharge below
|DATE |VARIANCE |CAUSE OF VARIANCE |ACTION/OUTCOME |
| | | |(Sign, date & time subsequent notes) |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
Appendix 3 – Patient Information Leaflet
To be finalised
Appendix 4 Treatment Regime
Standard Topical Treatment
The following topical treatment should be prescribed for all known colonised or infected MRSA patients
• Chlorhexidine body wash – daily for 5 days (Should be used ideally by the patient as a liquid soap when washing, bathing or showering. Can be diluted in wash bowl if patients have sensitive skin – speak to pharmacy re dilution).
• Chlorhexidine as hair wash – twice weekly in first week
• Mupirocin 2% Nasal ointment three times daily for 5 days – apply thoroughly to inner surface of each nostril.
• Mupirocin 2% topical ointment for small lesions etc. as advised by clinical team. Up to three times daily for 5 days. For further advice on repeat courses, please contact the on-call microbiologist.
Change clothing, towels and bedding daily following application of topical treatment. Ensure door to side room is closed when making bed.
Treatment and screening regime is continued on the next page.
Appendix 4 cont’d
Appendix 5
PATIENT NAME: HOSPITAL PID:
Guidance for Relative / Friend for laundering soiled / infected items of clothing
Dear Relative / Friend
The responsibility for the laundering of personal items of clothing remains the responsibility of the patient / relative / friend as the Trust does not have the facility to launder patients own property.
The Trust acknowledges that at times there may be contaminated items i.e. from patients with MRSA or Clostridium difficile or soiled items that need laundering however, staff are not able to ‘sluice’ these items safely within the Trust. This purpose of this guidance is to assist you in the safe handling and laundering of these items.
All items of patients clothing that are either from an infected patient or that have been contaminated will be placed in a water soluble bag inside a patient property bag (which includes washing instructions). The bag will be named and dated if it contains items of clothing that have been soiled. The bag will then be placed either in the patients locker or kept in the sluice if heavily soiled.
The water soluble bag has a strip that dissolves in domestic washing machines at normal temperatures allowing the bag to open and release the clothes. Once the cycle has finished, the bag can then be removed. The bag should not be placed in tumble driers.
Although soiled/ infected clothing has been identified as a source of infection, the risk of spread of disease is low if handled correctly.
• The water soluble bag should be placed directly into the washing machine using Marigold/rubber gloves. If you do not have gloves available, please ask a member of nursing staff who will give you some disposable gloves.
• The items of clothing contained in the water soluble bag should be washed alone without other household items of clothing.
• If possible a pre wash cycle should be used first.
• Clothing should be washed at the hottest temperature that the clothing will withstand, using detergent.
• Clothing should be thoroughly dried ideally in a tumble dryer, where possible, and then ironed.
• Wash hands after handling soiled clothing.
• If Marigold gloves used, wash them and keep the gloves for handling your relatives clothing or use a fresh pair of disposable gloves each time.
[pic]
-----------------------
Integrated Care Pathway
MRSA
Meticillin Resistant Staphylococcus Aureus
Name: ………………………………………
PID: ……………………………………..
Affix ID Label
INITIAL ACTIONS
MRSA SCREENING / RESULTS
DAILY CARE - INPATIENT
HOW TO SIGN FOR CARE
CORRECT INCORRECT
|Met |Unmet | |Met |Unmet |
|MB | | |" | |
| |MB | | |" |
If goal not met, document reason & action taken on PAGE 4
Origin SIGN FOR CARE
CORRECT INCORRECT
Met |Unmet | |Met |Unmet | |MB | | |√ | | | |MB | | |√ | |If goal not met, document reason & action taken on PAGE 4
Original Policy: 1998
1st Revision: 2005
2nd Revision: 2008
Date ratified by Infection Control Executive Committee: January 2008
Date of Next review 2010
Positive result
Rescreen
Yes, eradication likely. Retreat for 5 daysegative result
If positive
Take 2 further screens within 7 days apart
If all negative patient can come out of isolation
If positive, discuss further treatment and rescreening with the on call microbiologist
Negative result
No, eradication unlikely
DO NOT restart treatment or rescreen. Continue to isolate until discharged
Positive result
Assess likelihood of potential for eradication i.e. patient has leg ulcers, PEG tube, tracheostomy etc
Is eradication likely?
If all negative patient can come out of isolation
Take 2 further screens within 7 days
Negative result
Day 0 – Positive MRSA result received
Day 8 rescreen *do not restart treatment Await Results
Day 6 Stop treatment
Days 1 – 5 Topical treatment of chlorhexidine and Mupirocin
Appendix 2
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.