MRSA Control in Care Homes

Methicillin-Resistant Staphylococcus Aureus (MRSA) is an anitbiotic-resistant bacterium that was first described in 1961 and continues to make news as a dangerous, sometimes fatal disease for hospital patients, as well as being a major source of illness acquired in care homes. However, according to a new review, few studies have looked at how to prevent its spread among elderly residents.

The bacteria are carried on the skin of about 30% of healthy individuals. In this setting the bacteria usually cause no symptoms, but when the skin is damaged, even with a minor injury such as a scratch, the bacteria can cause a wide range of problems.

MRSA spreads easily—most commonly via the hands of healthcare workers—and first line antibiotics, like penicillin, are ineffective against the organism. Nursing and care home residents are particularly vulnerable because infection with the bug tends to increase with advancing age. Couple this with the close living proximity, multiple medications, pressure sores and catheters commonly found in care homes and it is clear that they are ideal places for breeding and spreading MRSA. However, care homes have been short-changed in the medical literature on prevention, despite studies repeatedly reporting that residents are at higher risk.

There has been much debate about how to control the transmission of MRSA. While there is general consensus that more appropriate use of antibiotics would help, it is also recognised that infection control is vital. Lack of effective infection control is still a serious problem in UK care homes and the elimination of infection risk, whether to carers, patients or healthcare professionals, is regarded as a priority. Healthcare workers are responsible and accountable for reducing infection risk and therefore require the knowledge and skills required to prevent and control infection.

6 factors for effective MRSA infection control

1. Hand hygiene

• Perform hand hygiene using hand sanitizers such as Hibiscrub or Purell immediately after touching blood, bodily fluids, secretions, excretions and contaminated items, whether or not gloves are worn.
• Perform hand hygiene immediately after gloves are removed, between patient contacts, and when otherwise indicated to avoid transfer of micro organisms to other patients or environments.
• When hands are visibly soiled with blood or other body fluids, wash hands with soap and water.
• It may be necessary to perform hand hygiene between tasks and procedures on the same patient to prevent cross-contamination of different body sites.

2. Gloving

• Wear gloves (clean, non-sterile latex, vinyl or nitrile gloves are adequate) when it can be reasonably anticipated that contact with blood or other potentially infectious materials, mucous membranes, non-intact skin, or potentially contaminated intact skin (e.g of a patient incontinent of stool or urine) could occur.
• Remove gloves after contact with a patient and/or the surrounding environment (including medical equipment) using proper technique to prevent hand contamination.
• Do not wear the same pair of gloves for the care of more than one patient.
• Do not wash gloves for the purpose of re-use since this practice has been associated with transmission of pathogens.

3. Mouth, nose, eye protection

Use PPE to protect the mucous membranes of the eyes, nose and mouth during procedures and patient-care activities that are likely to generate splashes or sprays of blood, body fluids, secretions and excretions. Select masks, goggles, face shields and combinations of each according to the need anticipated by the task performed.

4. Gowning

Wear a gown or apron, that is appropriate to the task, to protect skin and prevent soiling or contamination of clothing during procedures and patient care activities when contact with blood, body fluids, secretions, or excretions is anticipated.

5. Appropriate handling of equipment & instruments

• Handle used patient care equipment soiled with blood, body fluids, secretions and excretions in a manner that prevents skin exposure, contamination of clothing, and transfer of micro organisms to other patients and environments.

• Ensure that reusable equipment is not used for the care of another patient until it has been appropriately cleaned and reprocessed and that single use items are properly discarded.
• Clean and disinfect surfaces (antibacterial wipes are useful for this) that are likely to be contaminated with pathogens, including those that are in close proximity to the patient (e.g. bed rails, over bed tables) and frequently touched surfaces in the patient care environment (e.g. door knobs, surfaces in and surrounding toilets in patients rooms) on a more frequent schedule compared to that for other surfaces (e.g. horizontal surfaces in waiting rooms).

6. Appropriate handling of laundry

Handle, transport, and process used linen, in something like a Dissolvo or Totally Soluble laundry sack, to avoid contamination of air, surfaces and persons.

If you'd like to print out this information for display in your care or nursing home, then go to the PDF version of the MRSA page.