MRSA
Patients at high risk of MRSA carriage:
- Patients who are known to have previously been MRSA positive
- Frequent admissions to any healthcare facility
- Transfers from other hospitals, in the UK or abroad
- Residents in residential care facilities
- Those who have had any hospital admission within the previous 6 months
Screening
The following groups require a screen for MRSA when admitted as an emergency (within 24 hours of admission) or are to be admitted electively for a planned procedure or series of treatments:
- All patients (adult and children) admitted to high-risk specialties, defined as:
- Vascular
- Renal unit/dialysis
- Cardiothoracic Surgery
- Haematology/Oncology/Bone Marrow Transplantation
- Head and Neck cancer surgery patients
- Transplantation Surgery
- Orthopaedics/Trauma
- All Intensive Care Units (Adult/Paediatrics ICUs, CTCCU, Neonatal ICU, High Dependency Units, Coronary Care Unit)
- All patients currently receiving chemotherapy or radiotherapy or has undergone it in the last 12 weeks prior to admission
- Patients admitted from other healthcare settings, including other hospitals, nursing, and residential homes
- Patients admitted from outside the UK
- All patients previously identified as MRSA colonised or infected
- All patients with a planned procedure involving device implantation e.g., Hickman lines, implantable cardiac device, mesh implant, breast implant (this list is NOT exhaustive).
How to carry out an MRSA screen
Five sweeps per nostril (1 swab for both nostrils) with a purple topped bacterial swab. Additional swabs are required when the following is present:
- Devices (in situ more than 24 hours) e.g., PEG, catheter sites, IV sites (if VIP score is more than 1), tracheostomy (1 swab per site).
- Areas of abnormal skin, e.g., eczema, psoriasis, pressure ulcers, pre-existing wounds (greater than 24 hours old).
Treatment of MRSA infections
IV vancomycin is the mainstay of treatment for MRSA infections (NOT colonisation).
Alternative treatment including oral options should be discussed with Microbiology/ID.
MRSA patients need to be isolated, with contact precautions. For decolonisation advice see MRSA decolonisation guidance and use MRSA decolonisation EPR PowerPlan to prescribe decolonisation.
See Infection Control website for policies on MRSA screening, isolation and decolonisation.