MRSA in Care Homes Policy

This care service 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 home are to ensure that:

people who live here, 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.

Personnel

_______________ is the infection control lead for the home.
Other infection control personnel in the home are: _______________
_______________ who is responsible for infection control risk assessment and staff training.
_______________ who is responsible for the cleaning and hygiene of the home.

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

This care service 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

{{org_field_name}} 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 home 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.

In addition, the home 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).

Guidance is also available from the Department of Health and Social Care (DHSC) and from the Health and Safety Executive (HSE) in the form of:

Infection Prevention and Control (IPC) Resource for Adult Social Care (updated March 2024), DHSC
National Infection Prevention and Control Manual for England (v1.1) (updated April 2024)
Prevention and Control of Infection in Care Homes: An Information Resource (2013), DHSC
HSG220 Health and Safety in Care Homes (2nd edition) (2014), HSE.

Specialist advice and support will be obtained from the local public health protection team.

Policy on Preventing MRSA

In nursing or residential care homes, 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, and a thorough cleaning of the environment and equipment are sufficient to control the spread of the bacteria.

Therefore, in {{org_field_name}}:

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 home’s handwashing policy at all times — scrupulous handwashing before and after any contact with people and before and after any procedure is considered by the home to be 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
all cuts, sores and wounds should be covered with suitable impermeable dressings
blood and body fluid spills should be dealt with immediately according to the home’s infection control policy
clinical waste should be disposed of according to the home’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
clothes and bedding should be machine washed in accordance with the home’s infection control and laundry policies
people 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 should be offered a private single room but may share a room so long as neither they nor the person with whom they are sharing has open sores or wounds, drips or catheters
they may join other people in communal areas such as sitting or dining rooms, so long as any sores or wounds are covered with an appropriate dressing, which is regularly changed as clinically indicated in their plan of care
they may receive visitors and go out of the home, for example, to see their family or friends, and should not be discouraged from normal social contact; friends or family need not take any special precautions when visiting
they should not be isolated (according to DHSC guidelines, the isolation of colonised people in nursing homes 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 individuals with MRSA
staff should carry out any clinical procedures and dressings on a person with MRSA in the individual’s own room.

When admitting a new person receiving care or when transferring people from the home to hospital or from hospital to the home:

the home should always ask in the initial assessment of a potential resident if there is any record that they are 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
the home should always inform a hospital if a person from the home who is due to go into 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 home is agreeable
the home should seek and follow expert infection control advice from the local public health protection team for any individual with MRSA who has a post-operative wound or a drip or catheter.

Local health protection team contact details are as follows:

______________________

Reporting

MRSA is not a notifiable infection under RIDDOR which obliges the home 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. The home should therefore liase 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}}

Reviewed on: {{last_update_date}}

Next Review Date: {{next_review_date}}

CH210. MRSA in Care Homes