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

The Prevention of Methicillin-resistant Staphylococcus aureus
(MRSA)

Touch a person who carries the MRSA bacteria or touch something that an infected person has touched and MRSA may spread. That is how easy it is. To understand how to prevent MRSA we must first focus on how it is spread.

Spreading MRSA

The spread of MRSA can be linked to openings in the skin such as cuts or abrasions, contact with contaminated items and surfaces and close skin-to-skin contact, crowded living conditions, for example hospitals and poor hygiene. Of course some people are more at risk than others. In conjunction with understanding how MRSA is spread, we must know who is most at risk before we can attempt to role out prevention strategies.

People At Risk From MRSA

Those people at particular risk are hospitalised patients, people over the age of 65 and premature/newborn babies. It is important to note that for a nursing mother who has MRSA, some antibiotics can enter breast milk. The spread of MRSA is not however, inevitable. Efforts to prevent the spread can work at a number of levels. The strongest emphasis should be placed on individual responsibility.

MRSA Prevention and Individual Responsibility

• Wash hands thoroughly for at least 15 seconds and ideally, dry them with a disposable towel. Family and close contacts should be advised to wash their hands frequently.
• Carry a small bottle of hand sanitizer containing at least 60% alcohol and use it regularly.
• Cuts, abrasions and any other kind of wound should be cleaned and covered with sterile and dry bandages until they completely heal. Never touch other peoples’ wounds or bandages. We can prevent MRSA bacteria from spreading by covering infected sores (from which the pus may contain MRSA).
• Antibiotics should be taken exactly as prescribed by a doctor.
• Linens should be sanitized. Towels, bed linens, clothes and so forth, should be subjected to a hot water setting. A hot dryer is preferable to air-drying. This helps to kill bacteria.
• At the very beginning, if a skin infection requires treatment, the request should be made for MRSA testing. The quicker MRSA can be identified, the stronger our efforts to prevent it spreading.

There exists a common argument that only healthcare professionals need to know about an individual’s MRSA infection. This logic should be firmly re-examined. Perhaps the spread of MRSA could be in part, attributed to this thinking. A more open approach, informing school staff and any other individual who might come into contact and therefore be at risk, might prove more pragmatic if MRSA is to be prevented.

Preventing MRSA in Hospitals

The introduction of surveillance systems that track bacterial outbreaks and products such as antibiotic-coated catheters and gloves that release disinfectants may certainly help. Additionally, patients infected or colonised with MRSA should be placed in isolation. However, without the complete and absolute compliance of healthcare staff with procedures preventing the spread of MRSA, prevention efforts will be undermined.

Preventing MRSA – Healthcare Staff

The very highest standards of hygiene must be enforced.

• Healthcare workers must wash and dry their hands frequently and thoroughly.
• Healthcare workers must use the antiseptic solutions like alcohol rubs or gels provided.
• When changing dressings, handling needles, inserting an intravenous drip, or when having any kind of physical contact with open wounds, healthcare staff should be wearing disposable gloves.
• Healthcare staff have a responsibility to ensure that hospital surfaces are properly disinfected and any kind of non-compliance should be reported.
• We should consider the impact of continuous educational and training programmes (additional to that already in place) specifically on the prevention of MRSA. Furthermore, reintroducing hospital matrons might impact positively, preventing any slip in hygiene and cleanliness standards.

Preventing MRSA – Hospital Visiting

When visiting a patient in hospital, hands must be washed before and after visitation. Alcohol gels must be used regularly. No physical contact with a patient known to be infected with MRSA should be made (nor is it allowed). Furthermore, avoid wherever possible, physical contact with any of the objects inside the isolated room or a patient with MRSA.

Preventing MRSA – The Role of The Patient

Ideally, before a patient goes into hospital, the individual can be screened for MRSA, particularly if falling into a high risk group. A hospitalised patient can make the following efforts to prevent the spread of MRSA:

• Hands and body should always be clean and products, such as towels, never shared;
• Hands should be washed after using the toilet;
• Hands should be washed before eating a meal;
• Report any failure to maintain complete cleanliness and the highest standards of hygiene to hospital staff;
• Open wounds or damaged skin should never be touched;
• Never walk on hospital floors in bare feet.

MRSA can be prevented and does not have to spread at the rate we have recently witnessed. MRSA prevention measures should be taken at all levels if prevention strategies are to be successful and a reduction in infections realised.

New research has found a direct correlation between the amount of alcohol handwash supplied to a ward and reductions in the rate of hospital acuqired MRSA infections.

A study by University College London (UCL), in collaboration with the Health Protection Agency, London School of Hygiene and Tropical Medicine, and the Hand-Hygiene Liaison Group, discovered that rates of MRSA infection are cut by 1% with each extra millilitre of alcohol hand rub supplied per patient per day.

These findings are the results of an independent evaluation of the cleanyourhands campaign to boost hygiene on hospital wards and were presented at this year’s Federation of Infection Societies conference in Cardiff.

The National Patient Safety Agency started co-ordinating this campaign in 2004 and rolled it out to 187 acute NHS trusts in England and Wales.

Dr Sheldon Stone, lead author of the evaluation at UCL, said: “Our study shows that hand hygiene lowers hospital superbugs, and our message to healthcare workers is: ‘one ml. one percent’.

He added, “The findings also serve as a reminder that we should be washing our hands in the home and workplace. Winter is the season when colds and flus abound, and people can protect themselves and stop germs from spreading by frequently washing their hands.”

So, this research tells us what we knew already. Greater levels of hygiene reduce infection. Common sense really, isn’t it?