The Discovery Of Penicillin

Alexander Fleming fortuitously discovered the antibacterial properties of a Penicillium mould in 1928. During the Second World War much use was made of penicillin in the treatment of battle wounds. Between the years of 1943 and 1955, when he died, Fleming received around 172 honours from all over the world.

Penicillin transformed the treatment of many infections. One such infection was Staphylococcus aureus.

Fleming, in his acceptance speech for The Nobel Prize in Physiology or Medicine, gave the portentous warning that using penicillin inappropriately might lead to the development of resistance. Sure enough, resistance to penicillin of strains of Staphylococcus aureus became a major problem in hospitals in the 1950s. This resistance was caused by the selection of strains of staphylococcus that could produce the enzyme penicillinase (a drug destroying enzyme). These penicillin resistant Staphylococcus stimulated interest in developing semi synthetic penicillins able to withstand the enzyme. The first of these, produced in 1959, was methicillin.

Resistance to methicillin of Staphylococcus aureus was detected within a year of the antibiotic appearing on the market.

Hospital-acquired MRSA refers to occurences on the MRSA infection that have been contracted within a healthcare setting. People in hospital are already suffering from a weakened immune system and are particularly vulnerable to MRSA infection.

Controversy surrounding the lack of hygiene in hospitals has brought attention to the heightened risks of catching MRSA whilst being an in-patient. Medical equipment such as catheters can harbour bacteria. Additionally, regular use of antibiotics has, in part, contributed to Staphylococcus aureus becoming Methicillin-resistant, hence MRSA.

Staphylococci can grow as biofilms, which are specialized communities of bacteria that are highly resistant to antibiotics and immune responses. They are remarkably adhesive and can grow on many surfaces, including implanted medical devices such as pacemakers, heart valve replacements and artificial joints. Preventing or inhibiting the growth of such biofilms would dramatically reduce the incidence of staph infections.

A MRSA screening is a process whose purpose is to detect the presence of the MRSA bacteria in patients. MRSA screenings are used primarily on colonised patients and on infected patients after they have been treated, to determine whether any resistant bacteria remains.

At a community level, MRSA screening may help to identify the source of a MRSA outbreak, and at a national level it can help to identify genetic characteristics of a MRSA strain.

MRSA Culture

The most commonly used test to identify MRSA colonisation is the culture. A swab is taken from the patient and is then cultured. Swabs are usually taken from the nose, though they can also be collected from wound sites or skin lesions on people with known MRSA infections. The culture is a definitive test and usually takes one to two days to complete.

When Are MRSA Screenings Performed?

A MRSA screening may be requested when a doctor, health department, researcher or hospital wants to evaluate MRSA colonisation in a patient, family member or group of people within the community. Certain populations in a community whose members have close contact may be tested for MRSA when an increased number of infections occur within their group. Example of these populations include football teams, residents of nursing homes and health care workers. Sometimes patients who have previously been treated for MRSA will be screened to determine whether the bacteria is still present.

MRSA Screening On Admission To Hospital

To cut down the number of hospital acquired MRSA infections, some hospitals have introduced a screening process that takes place when patients are admitted. Additionally, healthcare workers and family members of carriers may also be screened for MRSA.

It can all begin with something so simple such as a shaving cut. The MRSA organism may have been living on that person for some time, with no symptoms being demonstrated. However, once that shaving cut appears, the bacteria can enter the bloodstream. Then MRSA becomes much more serious.

The MRSA Superbug Enters the Bloodstream

Once SA bacteria is able to enter the bloodstream, almost any part of the body can be affected. The bacteria can cause:

• Septicaemia (blood poisoning) – the type of MRSA infection with the highest death rate;
• Lung infection (pneumonia);
• Septic shock;
• Bone marrow infection (osteomyelitis);
• Inflammation of the tissues that surround the brain and spinal cord (meningitis);
• Infection of the heart lining (endocarditis)
• Severe joint problems (septic arthritis);
• Internal abscesses.

At this stage MRSA can become fatal in about 10 – 20% of cases. Incidence of MRSA, although declining slightly according to government statistics, have increased substantially over the past decade. In 1993, the superbug caused 51 deaths. In 2005, the figure was 1,629.

Why the MRSA Superbug is so Dangerous

The MRSA superbug is able to survive treatment by antibiotics such as methicillin and penicillin. This becomes particularly dangerous in the case of hospital MRSA, because it affects patients with already compromised immune systems. Patients from intensive care units, burns units, surgical and orthopaedic wards are particularly at risk.

The Role of the Media and the MRSA Superbug

It is not the case that coverage of the MRSA superbug is simply ‘news hype’. Nevertheless, the media does not always present a balanced report and viewers do not necessarily remember the critical points. About 30% of the entire population are MRSA carriers of (or colonised with) SA bacteria. Most do not develop an infection and therefore most do not demonstrate any symptoms. The bacteria can be found everywhere – telephones at work, elevator buttons, office pc keyboards, clothing.

The media tend not to report on the relatively harmless community-acquired MRSA that affects younger and otherwise healthy people. MRSA rarely presents a danger to the general public but this does not seem to be the media interpretation. The media focuses on where the deaths are – hospital-acquired MRSA, ‘killer MRSA and VRSA’.

The ‘Killer’ MRSA Superbug

A rare mutation of CA-MRSA produces the lethal toxin panton–valentine leucocidim (PVL). PVL destroys white blood cells, destroying a person’s immune system and leaving it too weak to fight infection. Pneumonia, very high temperature and coughing up blood are all symptoms. Alarmingly, only a quarter of victims survive PVL if it spreads to the lungs.

The VRSA Superbug

VRSA is Vancomycin-resistant Staphylococcus aureus. It is a rare strain of MRSA that is resistant to Vancomycin, the drug of last resort. Vancomycin is used to treat MRSA when other drugs have failed (see  Vancomycin and MRSA). The unnecessary overuse of antibiotics over a number of years is believed to be responsible for the bacteria’s resistance. The presence of VRSA does not signal death however. Oral drugs such as Linezolid, Doxycycline or Minocycline can be used.

MRSA Superbug: In Summary

The MRSA superbug is very serious but news coverage tends to focus on the death-related incidents where the superbug has entered the bloodstream and does not always present a balanced picture. Most of the 30% of the population who are colonised with SA bacteria, will show no symptoms. News coverage focuses on hospital MRSA, ‘killer‘ MRSA and VRSA, the latter two being extremely rare. Despite public perception, MRSA can be serious but in the majority of cases, is by no means incurable.

Defining Community-Acquired MRSA

A community-acquired MRSA infection is an MRSA infection in an individual who has had:

• MRSA identified within 48 hours of admission to a hospital
• No history of hospitalisation, surgery, dialysis, or residence in a long-term care facility within 1 year of the MRSA culture date
• No permanent indwelling catheter or medical device
• No known prior positive culture for MRSA.

It should be noted that in practice it is difficult to separate true community-acquired MRSA from MRSA that people out in the community may have acquired from a healthcare setting, or from close contact with a person in a healthcare setting.

Community-Acquired MRSA – The Basics

MRSA infections are usually associated with hospitalisation or other healthcare-associated risk factors. More recently however, physicians and other healthcare providers have observed an increasing number of people with MRSA infections who seem to lack traditional healthcare-associated risk factors. It appears that these people have community-associated infections. Skin and soft tissue infections such as abscesses or cellulites are the most common kind of infection caused by Staphylococcus aureus.

The incidence of community acquired MRSA infections is greater amongst younger and healthier people compared with healthcare-associated MRSA. CA-MRSA bacteria is generally less problematic than healthcare-associated MRSA and is usually susceptible to more types of antibiotics.

Identifying Community-Acquired MRSA

CA-MRSA most often appears as a skin or soft-tissue infection. This could be a boil, pimple, or abscess, in an otherwise healthy person. The area in question often becomes red and swollen. It maybe painful and have pus or a discharge. A person should pay particular attention to any cuts and scrapes and hairy areas of the body, such as the back of the neck, groin, buttocks, armpits, and the inner thigh.

Although community-acquired MRSA is relatively harmless in some cases it has been associated with more serious conditions. CA-MRSA has been associated with necrotizing pneumonia and empyema; sepsis syndrome; musculoskeletal infections, such as pyomyositis and osteomyelitis; necrotizing fasciitis; purpura fulminans; and disseminated infection with septic emboli.

At its extreme community-acquired MRSA has resulted in death. Ten years ago four children in Minnesota and North Dakota were reported to have died from CA-MRSA infections. It should be stressed however; in the vast majority of cases CA-MRSA does not cause life-threatening conditions and can usually be dealt with speedily and effectively. Measures should be taken to prevent the spreading of CA-MRSA and therefore we must understand how it is passed from one individual to another.

The Spreading of Community-Acquired MRSA

CA-MRSA infections can be spread by contact with infected skin or personal items that have been in contact with infected skin such as towels, bandages, or razors. The bacteria get into the skin through cuts. Bacteria are more likely to spread where there is close contact between people. Outbreaks have been reported in football, wrestling, rugby, soccer, fencing, canoeing, prison inmates, and the military. There have also been CA-MRSA cases in tattoo recipients.

Community-Acquired MRSA: In Summary

A clear distinction is made between CA-MRSA and healthcare-associated MRSA. However, ensuring that CA-MRSA patients really do not have any link to a healthcare setting is often quite difficult.

CA-MRSA tends to affect a different section of the population – younger and healthier people compared to hospital MRSA. In most cases, CA-MRSA is also easier to treat.

Care should be taken in environments where there is close contact between people to prevent the spread of CA-MRSA. It should be stressed however, it is very rare for CA-MRSA to result in a serious or life threatening health condition.

A Pregnant Woman Who Is An MRSA Carrier

There is no risk to an unborn baby if a pregnant woman is a carrier of MRSA bacteria and does not have an infection.

A Pregnant Woman With An MRSA Infection

There is an extremely small chance that if a pregnant woman becomes infected with MRSA, it could pass onto the unborn baby.

A Pregnant Woman With An MRSA Infection and Childbirth

The risk increases slightly once an MRSA infected pregnant woman goes into childbirth (vaginal birth). There is a small chance that the infection could be passed onto the baby at this stage. However, it must be stressed that the likelihood of this happening remains minimal.

Pregnant women and new mothers should avoid all people known to be infected with MRSA. The possibility that a mother will pass MRSA onto her unborn or newborn baby is low. However, every effort should be made to avoid this risk.

A Pregnant Woman with an MRSA Infection – Harmful or Harmless to a Baby?

There is no substantial evidence to suggest that a pregnant woman with an MRSA infection is more likely to experience a miscarriage. Furthermore, a pregnant woman with an MRSA infection is no more likely to give birth to a baby with a birth defect than a pregnant woman with no MRSA infection. However, it should be stressed that treating an MRSA infection at the earliest possible stage will help towards a healthier pregnancy.

Safe Treatment Of A Pregnant Woman with an MRSA Infection

Treating pregnant women with an MRSA infection is safe for both the mother and baby. There are a number of antibiotics that can be used to treat an MRSA skin infection.

Taking a Course of Antibiotics for an MRSA Infection and Breastfeeding

New mothers can breastfeed whilst on a course of antibiotics to treat an MRSA infection. There are no problems occurring for the majority of breastfed babies whilst their mothers are taking antibiotics. However, it should be noted that some babies might develop an allergy to the antibiotics. In this case a different antibiotic can be prescribed to treat the skin infection.

Passing on an MRSA Infection whilst Breastfeeding

It is possible for an infection to spread from mother to baby when breastfeeding. Whether breastfeeding or not, a baby’s bottles, storage containers and anything else used for or by the baby must be thoroughly washed and sterilised to reduce the risk of passing on an MRSA infection.

Avoiding Someone with an MRSA Infection During Pregnancy

Should the father of the baby, any family member or friend develop an MRSA infection, a pregnant woman is advised to avoid contact.
There are a number of steps that can be taken to reduce the risk of contracting an MRSA infection:

• A pregnant woman should wash her hands with soap and water after direct contact with anyone who has a skin infection;
• A pregnant woman should not share towels, soap, razors (or any other item used to maintain personal hygiene) with someone who is MRSA infected;
• If a pregnant woman needs to wash clothing or bedding used by someone who has an MRSA infection, gloves should be worn;
• A pregnant woman should never touch a person’s sores, cuts or bandages especially if they have an MRSA infection.

Pregnancy and Infected Wounds

If a baby comes into contact with their mothers infected wound or any pus that has originated from that wound, MRSA bacteria can be spread to the child. It is therefore essential that a pregnant woman covers her wounds with bandages to prevent the baby from touching the wound or discharge from it. Furthermore, if the baby comes into contact with clothing or bedding that was previously in contact with the infected area, an infection can be passed on.

In Summary, there is no cause for alarm when dealing with pregnancy and an MRSA infection. There are a number of measures that can be taken to minimise risks and ultimately, an MRSA infection should not impact on a normal healthy pregnancy.

Here is a brief MRSA information pack.

What is MRSA?

Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterium that causes difficult to treat infections. It is a more resistant variation of Staphylococcus aureus (SA).

Where is MRSA Found?

About 30% of people in the UK carry MRSA in their nose or on their skin. It does not become a problem unless it enters the body.

Symptoms of MRSA

In the first instance boils, abscesses, sties, carbuncles and impetigo may develop. Once MRSA enters the blood stream Septicaemia, septic shock, lung infection and infection of the heart lining can occur.

The Spreading of MRSA

MRSA can be spread via the hands (skin-to-skin contact), by sneezing or by touching shared equipment that is also used by someone with MRSA.

Information About Hospital Acquired MRSA

Hospital Acquired MRSA strikes around 100,000 people every year, which is about 44% of all cases. This costs the NHS £1 billion annually. Government statistics point to an increase in hospital MRSA of 60% over the past decade. The Office For National Statistics found that MRSA deaths are around 1,650 (recorded in 2005 and 2006).

The Spreading of Hospital MRSA

Inadequate cleaning and hygiene procedures by hospital staff are the main cause of MRSA in hospitals. This is the means by which MRSA bacteria can transfer from patient to patient. Healthcare workers may pick up the bacteria on their clothes or on their hands. Hospital equipment also may not be adequately cleaned.

Community Acquired MRSA (CA-MRSA)

Carriers of CA-MRSA do not necessarily demonstrate symptoms of MRSA. Strains of Staphylococcus aureus (SA) are unable to colonise their hosts for long periods of time before causing infections. CA-MRSA is relatively harmless and if symptoms do occur it may be in the form of boils or minor infections.

‘Killer’ MRSA

In contrast ‘Killer’ MRSA destroys the immune system. It is a rare mutation of MRSA. Symptoms may include pneumonia, very high temperatures and coughing up blood. If it spreads to the lungs only a quarter of victims survive.

Vancomycin-resistant Staphylococcus aureus (VRSA)

VRSA is a rare strain of MRSA that is resistant to Vancomycin. Vancomycin is the drug of last resort and is used when all other drugs have failed to treat MRSA.

Efforts To Combat MRSA

The Labour government have launched a programme that will see hospitals ‘deep cleaned’. However, we have been taking measures to combat MRSA for some time.

In the 1990’s, the NHS was isolating all patients with MRSA and screening all staff. If staff were carrying MRSA, then they would be removed from work until they had undergone eradication therapy.

Since 2004, the ‘clean your hands’ campaign has led to alcohol-based hand rubs being placed at the entrance to wards and near all beds. Staff and visitors are encouraged to wash their hands regularly.

The number of cleaners in the NHS fell from 100,000 in 1984 to 55,000 in 2004. This trend must be reversed if the battle with MRSA is to be won. Furthermore, the contractual arrangements made with the private sector responsible for cleaning hospitals should be reassessed.

The reintroduction of matrons, continuous MRSA education programmes directed at hospital staff and new powers given to hospital nurses to ensure that visitors wash their hands regularly are crucial if we are to be successful in combating MRSA.

Guidelines To Understanding and Combating MRSA

MRSA (Methicillin-resistant Staphylococcus aureus) is a bacterium that causes difficult to treat infections. It is a more resistant variation of Staphylococcus aureus (SA).

Being Colonised With SA

About one third of the population are carriers of SA bacteria but show no symptoms. These people are said to be colonised.

Developing an SA Infection

Anybody colonised with SA can potentially develop an SA infection later in life. This happens when SA bacteria enters the body via a wound or cut. This is particularly dangerous if it enters the body of someone with a weak immune system.

Hospital-Acquired MRSA (HA-MRSA)

Hospitalised patients often have weaker immune systems. This makes an infection more likely. Furthermore, medical equipment such as catheters can harbour bacteria. Regular use of antibiotics has, in part, contributed to Staphylococcus aureus becoming Methicillin-resistant, hence MRSA. According to government figures, cases of hospital MRSA have increased by 600% over the past decade in England and Wales.

Community-Acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA)

This strain is relatively harmless and may cause boils or minor infections. Outbreaks of CA-MRSA are most common among children, military personnel and people living in other crowded environments such as prisons. Poor hygiene and cuts on the skin will certainly make infection more likely.

Guidelines to Identifying the Symptoms of MRSA

MRSA may begin as a skin infection such as a boil or pimple. From this a furuncle or large boil may develop. A localised cellulitis (characterised by redness, swelling and pain) might appear on the skin. Impetigo, darkening, blistering or necrosis of the skin can develop.

If the infection proceeds to a person’s bloodstream it will produce bacteremia, which is the growth of bacteria in the blood stream. Fever, increased heart rate, increased respiratory rate, or hypotension can result in septic shock.

If MRSA is unchecked a person may develop pneumonia, infection of the heart valves, meningitis, spinal abscesses or necrosis of extensive areas of skin that can prove fatal. Infection of prosthetic devices used by a patient may also complicate the situation.

Guidelines to Preventing an MRSA Infection

MRSA bacteria are spread through skin-to-skin contact and by touching objects contaminated with the bacteria. To prevent infection, a person should:

• Wash their hands with soap and water. This is the most effective way to prevent the spreading of MRSA;
• Wash their hands for a minimum of twenty seconds and ideally dry them with a disposable towel;
• Use an alcohol sanitizer;
• Clean any cuts and cover them with a bandage;
• Never touch other peoples’ bandages or cuts;
• Not share personal hygiene items such as towels, clothing, soap bars and razors.

Guidelines to Treating an MRSA Infection

Antibiotics are commonly used to treat an SA skin infection. However, when the infection becomes resistant to the Methicillin antibiotic, the patient is said to be suffering from MRSA. There are, however, some antibiotics that can treat MRSA infections. Linezolid and Vancomycin, examples of drugs that still retain potency against MRSA, although, in a very small number of cases Vancomycin-resistant SA has developed (VRSA).

Guidelines to Combating MRSA – The Individual

Combating MRSA requires coordinated action. For members of the public visiting hospitals, the alcohol-based cleansers should be used before entering the ward, whilst in the patient’s room, and also when leaving the ward (as regularly as possible).
For healthcare workers, the alcohol based substances provided should be used in addition to regular hand washing. Healthcare workers not following this protocol should be reported to line managers.
Ultimately, not maintaining the highest standards of cleanliness is putting lives at risk.
Community-Associated

Testing For MRSA

A Methicillin-resistant Staphylococcus aureus (MRSA) screen is conducted to identify the presence of MRSA and no other pathogens. MRSA may be present in a colonised patient or in the wound site of a patient already treated for an MRSA infection.

The Culture

The culture is the most widely used form of testing to identify MRSA colonisation. A nasal swab is collected from the nostrils of an asymptomatic person and cultured. This means it is either put into a special nutrient broth or spread onto a nutrient gel. It is then incubated and examined for the growth of MRSA colonies. It is also possible to collect a swab from a wound site of a person previously treated for MRSA. That too would be cultured. Testing in this way can take up to two days but the results are definitive.

MRSA Testing – Results

A patient is a carrier of MRSA if the screen is positive.

MRSA remains if a wound site culture take from a person previously treated for MRSA is positive.

MRSA is either not present or not significantly present if the nasal screen or wound site culture is negative.

Testing High Risk Groups For MRSA

Currently universal testing for MRSA is not practised. Some hospitals have identified high-risk patients, who may be potential MRSA carriers and conducted MRSA screening in a bid to control the spread of MRSA. Healthcare workers and family members of carriers may be screened for MRSA. In nursing homes, for example, many people may be tested for MRSA so as to understand the extent of the spread of colonisation.

Screening for MRSA alone, however, cannot prevent its spreading. In a study conducted by Geneva University, 22,000 patients took part. Some patients were subject to testing for MRSA and some were not. Those patients found to be colonised by MRSA in the screening group were exposed to a range of measures such as isolation and decontamination. Interestingly, no significant difference between the numbers contracting MRSA, during their hospital stay, were found. So what is the solution to this?

Testing More Effectively

Testing for MRSA could be targeted better:

1. Surgical patients who undergo elective procedures, with a particularly high risk of MRSA infection, could be targeted. A patient could be screened for MRSA if undergoing a surgical procedure such as a prosthetic implant.
2. Transplantation, cardiothoracic, orthopaedic, intensive care, burns, trauma, vascular surgery and renal and referral centres are all areas with a high proportion of MRSA infection among colonised patients. If testing is specifically directed into these areas, screening will become increasingly effective.
3. Where there is a high risk of MRSA carriage, MRSA testing should be directed.

Patients having experienced a previous MRSA infection or colonisation should be screened.

Patients frequently readmitted to healthcare facilities and patients who were recently inpatients or residents at a hospital or healthcare facility, with a likely high prevalence of MRSA, should be screened.

It is argued that because the contamination of the hospital environment is a greater cause of infections than patients arriving at the hospital with MRSA, the targeting of screening is particularly important. So where are we currently in respect of testing for MRSA?

MRSA Testing – The Present Situation

In the UK, the Labour government has called on NHS hospitals to introduce screening for routine operations. However, this is just one part of its anti-infection strategy. The recruitment of additional infection control nurses and the deep cleaning of hospitals are included in the government’s approach. This task is made much more difficult when considering that the number of cleaners in the NHS has fallen from 100,000 in 1984 to 55,000 in 2004. A reversal in this trend is certainly expected if any ground is to be made in combating MRSA. The government is right, however, to be adopting a multi-faceted strategy because testing alone will not control MRSA.

Testing for MRSA plays an instrumental role in beginning to control its spread. Screening for MRSA can be made more effective by directing it towards higher risk groups; however, this must be done in conjunction with other measures. Whether this will significantly reduce the spread in the long-term, we do not know for sure, but certainly, it is a positive move in the right direction.

Being An MRSA Carrier

A Methicillin-resistant Staphylococcus aureus (MRSA) carrier is a person who has the MRSA bacteria living on their skin or in their nose but who does not demonstrate the symptoms of MRSA. Such people are often described as being colonised with MRSA.

Colonisation and MRSA Infection

It is particularly important when referring to an MRSA carrier that we distinguish between MRSA colonisation and MRSA infection. In the case of colonisation, and unlike infection, the bacteria causes no adverse effects in a person and it exists on their skin or in their nose but does nothing more. The patient might experience pus discharging from a wound for example. An appropriate treatment for the infection is usually required.

Being An MRSA Carrier – The Risks

MRSA carriers can lead a normal life. They do, however, have to be more diligent with personal hygiene. For example, when sneezing, carriers should always cover their nose with a tissue and wash their hands thoroughly and regularly. There exists minimal risk to a person who is a carrier providing that their skin is not broken. Should an open wound develop, the infection bacteria can enter the carrier’s body. In respect of others, carriers pose little threat to healthy people. A person with an open wound or eczema, however, because their skin is not intact, is more vulnerable to infection.

The Carrier and MRSA Spreading

Bacteria are spread from person to person by direct contact. A person with MRSA on their skin, especially on their hands, may touch another person and by doing so can spread MRSA. A person may have MRSA on their hands as a result of being a carrier or from touching another person who is a carrier or infected with MRSA. People with weak immune systems, and are living in hospitals, nursing homes and other healthcare centres, are most susceptible to MRSA infection.

The Carrier and MRSA Prevention

There are a number of measures a carrier can take to help prevent the spread of MRSA:

1. Carriers should wash their hands with soap and warm running water for at least 15 seconds and regularly;
2. Carriers should wash their body with antiseptic soap;
3. Carriers should never share personal hygiene items;
4. Carriers should disinfect the home, particularly the kitchen and the bathroom;
5. Carriers should wash linens and towels with bleach and dry their clothes in a dryer (to help kill bacteria);
6. Carriers should avoid if possible, and certainly be more careful around, people with weak immune systems and people with skin conditions or wounds that would make them more susceptible.

So how do you know if you are a carrier?

Knowing You Are An MRSA Carrier

Most people who are MRSA carriers don’t know it. If you experience repeated bouts of MRSA infections then you may be a carrier. If people you are in regular and close contact with experience MRSA infections, then you may be a carrier.

Decolonisation

Once a carrier not always a carrier. Following treatment for MRSA, a patient can completely cover themselves using Chlorhexidine or Hexachlorophene antiseptic soap, when showering. Additionally, Mupirocin can be applied to each nostril. There are other antibiotics that a doctor may prescribe with include Clindamycin or Levofloxacin. It is highly advisable that if decolonisation is to be effective, the whole family are involved. For an MRSA carrier, there are solutions to being colonised, but the most  important measure they can take is to ensure that high standards of personal hygiene are continually maintained.