DW148. MRSA in Domiciliary Care
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MRSA in Domiciliary Care Policy
{{org_field_name}} believes that having effective infection prevention and control policies and procedures in place is of paramount importance in ensuring the safety of both people who use the services and staff from the spread of infectious diseases such as Methicillin-resistant Staphylococcus Aureus (MRSA).
Goals
The goals of the service are to ensure that:
- people who use the services, their families and staff are as safe as possible from MRSA
- all staff are aware of the causes of the spread of MRSA and are trained to avoid these
- people who are colonised with MRSA receive the highest quality of care and are not discriminated against.
Policy Background
MRSA is a variant of Staphylococcus Aureus, a type of bacterium carried normally by about a third of the population. In most people, Staphylococcus Aureus causes no harm, however, when the skin is broken or where a patient is otherwise unwell the bacteria can cause boils or pneumonia and can prevent wounds from healing properly. MRSA behaves in much the same way as its more common relative but, while Staphylococcus Aureus is readily treatable with modern antibiotics, MRSA has a high resistance to antibiotics which makes MRSA infections much harder to treat.
Many people carry MRSA in the same way that they carry Staphylococcus Aureus without it causing any harm to themselves or others. These are said to be “colonised” with MRSA rather than “infected” as they are not ill and there are no visible signs that they are carrying MRSA. However, when MRSA does cause an infection this can be very dangerous, even life threatening, and is especially problematic in elderly or vulnerable patients who are debilitated.
In healthcare settings, MRSA is spread by hand from person to person unwittingly by healthcare employees who do not wash their hands sufficiently between person contacts. It can also become established in clinical areas, on equipment and in such things as bedding and clothes and extremely vigorous cleaning and infection control techniques are required to eradicate it or halt its growth.
Legal Considerations
{{org_field_name}} will adhere to all relevant legislation, including:
- the Health and Safety at Work, etc Act 1974
- the Public Health Infectious Diseases Regulations 1988
- the Control of Substances Hazardous to Health Regulations 2002 (COSHH).
Under the above legislation, and associated codes of practice, {{org_field_name}} understands its legal and moral duty to ensure the health and safety of both staff and people who use the services and to protect them, wherever practicable, from dangerous substances in the workplace, including the risk of transmission of infections.
Guidance
This agency seeks at all times to comply with evidence-based best practice in infection control, particularly with the Health and Social Care Act 2008 Code of Practice on the Prevention and Control of Infection and Related Guidance published by the Department of Health and Social Care (the Hygiene Code). The organisation understands that in England compliance with this guidance is an effective way to help it to meet its regulatory requirements with the Care Quality Commission under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Key guidance to ensure compliance with the Hygiene Code is understood to include Infection Prevention and Control (IPC) Resource for Adult Social Care, updated in April 2024 by the DHSC and applicable to domiciliary care as well as care homes.
In addition, the agency will comply with all other relevant best practice infection control guidance.
For instance, applicable guidance from the National Institute for Health and Care Excellence (NICE) includes:
- CG139: Healthcare-associated Infections: Prevention and Control in Primary and Community Care (updated February 2017)
- PH36: Healthcare-associated Infections: Prevention and Control (November 2011).
Specialist advice and support will be obtained from the local public health protection team.
Policy on Preventing MRSA
In healthcare organisations, MRSA carriers should not be a hazard to staff or other people who use the services and, according to Department of Health and Social Care (DHSC) guidelines, the implementation of sound infection control techniques, especially rigorous attention to handwashing, are sufficient to control the spread of the bacteria.
Therefore, in this agency:
- all staff should comply with all infection control policies and procedures and adhere to best practice in infection control at all times
- all staff should comply with the agency’s handwashing policy at all times, ensuring that their hands are thoroughly washed and dried on arrival and before leaving a person’s home, between seeing each and every person where direct contact is involved, after handling any body fluids or waste or soiled items, after handling specimens, after using the toilet and before handling foodstuffs; the organisation believes that, consistent with modern infection control evidence and knowledge, handwashing is the single most important infection control measure whether a person is a known carrier of MRSA or not
- disposable gloves and aprons should always be worn when attending to dressings, performing aseptic techniques, dealing with blood and body fluids or when assisting with bodily care, all gloves and aprons should be changed and disposed of after each procedure or contact and always between contacts with different people
- cuts, sores and wounds on staff and people should be covered with suitable impermeable dressings
- blood and body fluid spills should be dealt with immediately according to the agency’s infection control policy
- clinical waste should be disposed of according to the agency’s infection control policy
- sharps should be disposed of into proper sharps containers
- equipment (such as commodes) should be cleaned thoroughly with detergent and hot water after use
- people who use the services and staff should not need routine screening for MRSA unless there is a clinical reason for such screening to be performed (for example, a wound getting worse or new sores appearing), in such cases screening should be requested by a GP or by the local health protection team
- if a person’s wound gets worse or does not respond to treatment then the person’s GP should be advised immediately
- MRSA risks should be included in COSHH assessments and any appropriate control measures taken to reduce identified risks.
If a person is identified as colonised with MRSA:
- they may receive visitors and go out, for example, to see their family or friends, and should not be discouraged from normal social contact
- they should not be isolated (according to DHSC guidelines the isolation of colonised people in nursing organisations is not necessary and may adversely affect the person’s quality of life)
- staff with eczema or psoriasis should not perform intimate nursing care on people with MRSA.
When arranging care for a new person receiving care or when transferring people to or from hospital:
- the relevant care manager should always ask in the initial assessment of a potential person receiving care if there is any record that the applicant is colonised or infected with MRSA and this should be entered into the plan of care, however, colonisation with MRSA should never be reason for refusing a place to a potential person receiving care, for preventing discharge from hospital or for any other form of discrimination
- domiciliary care staff should always inform a hospital if a person that they care for who is admitted to hospital is known to be infected with or colonised with MRSA
- people with MRSA should not normally require special treatment after discharge from hospital but if a specialised course of treatment needs to be completed, the hospital should be asked to provide all the necessary details and agree in advance in the discharge plan that the agency is agreeable
- domiciliary care staff should seek and follow expert infection control advice from the local public health protection team in any case where support is required and for any person with MRSA who has a post-operative wound or a drip or catheter.
Local health protection team contact details are as follows:
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Reporting
MRSA is not a notifiable infection under RIDDOR which obliges the agency to report the outbreak of notifiable diseases to the Health and Safety Executive. The presence of MRSA in a person can only be ascertained by the laboratory investigation of swabs and any positive result will be notified to the person’s GP. Domiciliary care managers should therefore liaise with the GP if a positive result is received and should work with all relevant members of the healthcare team to revise the person’s plan of care and to ensure that everybody involved in the care of the person is informed.
Training
All new staff should be encouraged to read the policies on infection control as part of their induction process. In-house training sessions covering basic information about infection control should be conducted at least annually and all relevant staff must attend. Clinical staff and those with special responsibilities for infection control and risk assessment should also be offered additional advanced training on infection control.
Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
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