MRSA screening
MRSA Screening Operational Guidance 2-Gateway Reference 11123
In compliance with the above directive of the Department of Health, Interhealth Care Services UK Limited confirms that:
1. Our MRSA policy /screening protocol is published and available below.
2. We are entirely compliant with this policy.
3. We have all relative evidence to validate statement 2 above.
4. We are compliant with local MRSA policy: This has been validated by Ms. Cathy Maddaford, (Director of Patient Safety, Governance and Performance,) NHS Western Cheshire and Mrs. Pam Broadhead, (Head of Independent Sector Contracts,) NHS Western Cheshire (please also see confirmation letter below)
Anne Males
Registered Manager.
Interhealth Care Services UK Ltd MRSA screening protocol for Elective Surgery
The transmission of MRSA and the risk of MRSA infection (including MRSA bacteraemia) can only be addressed effectively if measures are taken to identify MRSA carriers as potential sources and if they are treated to reduce the risk of transmission. This requires screening of patient populations for MRSA carriage before admission to identify carriers and implement a decolonisation regimen.
The normal habitat of Staphylococcus aureus, including MRSA, is human skin, particularly in the:
- Anterior nares (nose)
- Groin
Pre-operative patients in surgical specialties where the impact of MRSA infection can be particularly serious eg elective orthopaedics are the most frequent targets for this screen.
The purpose is to prevent the patient becoming infected by their own MRSA and also prevent the risk of transmission to other vulnerable patients. The incidence of infection is low in these patients, but the effect of MRSA infection when it occurs can be devastating.
All patients should have an MRSA screen at their first preoperative assessment. An explanation of why the screen is being undertaken must be discussed with the patient along with patient information sheet.
If a patient is found to be MRSA positive he/she will undergo decolonisation treatment prescribed by the patient’s GP.
Pre admission MRSA screens have a life of 2 months. Any patient where it is longer than 2 months since they had an MRSA screen must be rescreened. However, some discretion and latitude is allowed as it would appear unfair to cancel a patients’ surgery because the MRSA screen is 2 – 3 days out of date. If the screen is out of date it is at the surgeons’ discretion as to whether they want to proceed to operate.
There are occasions where our patients currently are health care workers in another healthcare facility. It is not the intention of the C&MNHSTC to dictate when a patient who is pre operative can work, and when they cannot. However, the patient must be advised that if they work in an area that has a high prevalence of MRSA it would be wise for them to attempt to arrange their duty roster so they are off duty in the days leading up to their surgery. The healthcare worker patient should be brought back to the C&MNHSTC 72 hours prior to their operation to have a MRSA screen. A risk assessment of the health care worker should be undertaken.
If a patient, for whatever reason, is admitted into another hospital and has an overnight stay in that hospital, in the timeframe from having the pre admission swabs taken at the pre assessment clinic, and being admitted for surgery at the C&MNHSTC, must be rescreened. It is imperative that patients are informed of this at the pre assessment clinic and encouraged to inform the treatment centre of any hospital admission.
Screening method
Specimens for MRSA are processed at the Warrington and Halton Hospitals NHS Foundation Trust. The sites for MRSA screening are as follows;
- Nose (1 swab for both anterior nares)
- Groin ( 1 swab for left and right groin)
- Any open wounds
- A CSU if the patient has an indwelling urinary catheter.
Specimens are ‘pooled’ once they reach the laboratory and therefore it is impossible to tell which clinical site the positive result came from. It is therefore imperative that all sites are included in the decontamination protocol.
Process following confirmation of a patients positive result
Once the centre is informed of a positive result the infection control nurse (or a designated deputy in their absence) will ensure that the patient receives a decontamination protocol. This is achieved in conjunction with the GP. The Infection Control Nurse will
- Telephone the patient and inform them that their swabs have come back as MRSA positive. A full explanation and reassurance is given to the patient and they are informed that there surgery, and any clinic appointments have been suspended.
- FAX a prescription request through to the patients GP
- Send a detailed letter to the patient confirming that they are MRSA positive and giving detailed instructions on the decontamination process. The patient is also supplied with a Health Protection Agency MRSA leaflet
- Send a detailed letter to the GP confirming the MRSA results and giving detailed instruction on the decontamination process
- Complete an amendment to the patient journey form and send it to scheduling detailing the reason for suspension
- Place a clinical alert on compucare
- Complete an MRSA communication sheet Eradication treatment/ MRSA Protocol
Eradication treatment / MRSA Protocol
The MRSA treatment protocol is as follows (Coia et al 2006):
Week 1 and 2
- Bactroban nasal 2% in paraffin (3g) applied 3 times a day to the anterior nares for 5 days (there should be no more than 2 courses of bactroban nasal). The patient should be able to taste the bactroban in the back of their throat if it has been applied correctly.
- Chlorhexidine Gluconate 4% applied neat to the body paying special attention to the skin folds, groin, axilla and perineal areas. Left to dry for 1 minutes then washed off with clean water. It is preferable that this should be done in the shower, or strip wash rather than a bath. This should be done daily for 5 days
- Chlorhexidine Gluconate 4% to hair as a shampoo at least 2 times per week.
'Protocol' should stop after 5 days, then reswab 2 days later. A modified 'protocol' is then recommenced.
Week 3 and thereafter
- Chlorhexidine gluconate 4% applied neat to the body paying special attention to the skin folds, groin, axilla and perineal areas. Left to dry for 1 minutes then washed off with clean water. It is preferable that this should be done in the shower, or strip wash rather than a bath. This should be done daily for 5 days
- Chlorhexidine gluconate 4% to hair as a shampoo at least 2 times per week. Protocol should stop after 5 days, then reswab 2 days later. 'Protocol' is then recommenced and continues on the 5 on 2 off then re-swab programme until 3 negative screens have been obtained.
