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MRSA in Care Homes Policy

This home agency believes that adherence to strict guidelines on infection control is of paramount importance in ensuring the safety of both service users and staff.

Aim

The aim of the home agency is to prevent the spread of MRSA amongst service users, visitors and staff.

Goals

The goals of the home agency are to ensure that:

• service users, their families and staff working at the home for the agency are as safe as possible from MRSA
• all staff at the home agency are aware of the causes of the spread of MRSA and are trained to avoid these
• service users 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.

Legal Considerations and Statutory Guidance

The home agency should adhere to the following infection control legislation:

• the Health and Safety at Work, etc Act 1974 and the Public Health Infectious Diseases Regulations 1988 which place a duty on the home agency to prevent the spread of infection
• the Control of Substances Hazardous to Health Regulations 2002 (COSHH) which place a duty upon employers to control dangerous substances in the workplace
• the Reporting of Incidents, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR) which place a duty on the home agency to report outbreaks of certain diseases as well as accidents such as needle-stick accidents.

Policy Background

MRSA, or Methicillin Resistant Staphylococcus Aureus 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.

Policy on Preventing MRSA

In nursing or residential care homes healthcare organisations MRSA carriers should not be a hazard to staff or other service users and, according to Department of Health guidelines, the implementation of sound infection control techniques, especially rigorous attention to hand washing, 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 agency’s hand washing policy at all times — scrupulous hand washing before and after any contact with service users who use the services and before and after any procedure is considered by the home to be, ensuring that their hands are thoroughly washed and dried on arrival and before leaving a service user’s home, between seeing each and every service user 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, hand washing 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 service users
• cuts, sores and wounds on staff and service users on staff and people who use the services should be covered with suitable impermeable dressings
• blood and body fluid spills should be dealt with immediately according to the home’s agency’s infection control policy
• clinical waste should be disposed of according to the home’s 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
• clothes and bedding should be machine washed in accordance with the home’s infection control and laundry policies
• service users 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 consultant in communicable disease control
• if a service user’s wound gets worse or does not respond to treatment, then the service user’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 service user 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 residents 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 Department of Health guidelines, the isolation of colonised service users in nursing homes organisations is not necessary and may adversely affect the service user’s quality of life)
• staff with eczema or psoriasis should not perform intimate nursing care on service users with MRSA
• staff should carry out any clinical procedures and dressings on a resident with MRSA in the resident’s own room.

When admitting a new service user arranging care  for a new service user or when transferring service users from the home to hospital or from hospital to the home to or from hospital:

• the home the relevant care manager should always ask in the initial assessment of a potential service user 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, colonization with MRSA should never be reason for refusing a place to a potential service user, for preventing discharge from hospital or for any other form of discrimination
• the home domiciliary care staff should always inform a hospital if a service user from the home that they care for who is due to go into admitted to hospital is known to be infected with or colonised with MRSA
• service users 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 agency is agreeable
• the home domiciliary care staff should seek and follow expert infection control advice from the consultant in communicable disease control nurse in any case where support is required and for any service user with MRSA who has a post-operative wound or a drip or catheter.

Contact details for the local Consultant in Communicable Disease Control (CCDC), Communicable Disease Team or Communicable Disease Control Nurse are as follows:

______________________

______________________

______________________

Reporting

MRSA is not a notifiable infection under The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR) which obliges the home agency to report the outbreak of notifiable diseases to the Health and Safety Executive. The presence of MRSA in a service user can only be ascertained by the laboratory investigation of swabs and any positive result will be notified to the service user’s GP. The home Domiciliary care managers 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 service user’s plan of care and to ensure that everybody involved in the care of the service user is informed.

In the event of a positive MRSA result from the laboratory ________________________ is responsible for liasing with the GP, the CCDC (where relevant) and other members of the healthcare team involved.

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.

_____________________ is responsible for organising and co-ordinating training.

Further Information

Information sources used in the preparation of this policy include:

• MRSA — What Nursing and Residential Homes Need to Know, Department of Health guidance.
• Hospital Infection Control: Guidance on the Control of Infection in Hospitals, HSG(95)10 — available free from the Health Publications Unit.

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