MRSA stands for Methicillin-Resistant Staphylococcus aureus.
Staphylococcus aureus (S. aureus) is a common germ/bug (bacteria), that 3 in 10 of us carry naturally. There are other types of bacteria in the Staphylococcus family, and we all carry at least one of the types on our skin at times, or throughout our lives. Staphylococci, as a group, are the most common cause of wound and skin infections. Some people carry S. aureus in their noses and on their skin. This is normal and does not require treatment. However some patients in hospital, who have MRSA on their skin, do sometimes require treatment.
MRSA is a particular type of S. aureus that has developed resistance to methicillin, a type of penicillin, as well as many other types of antibiotics. 'Resistance' means that it is not killed by the antibiotic. Similar infections occur whether a type of S.aureus is resistant to antibiotics or not. Most of the time MRSA just sits on the skin without causing a problem but if it enters the body through an open wound for example it may cause an infection.
The following points make patients vulnerable to any infections:
• their underlying condition
• the number of operations they’ve had
• the presence of open wounds
• how frequently they’ve used antibiotics
MRSA is sometimes referred to in the media as a superbug. However, a full explanation of MRSA is seldom given and the consequences are often exaggerated. Many people carry MRSA on their skin and lead full and normal lives.
3. What is the difference between colonisation and infection with MRSA?
MRSA colonisation means that the bacteria is simply “sitting on the skin” (in any site) but is causing no harm to the person.
In an MRSA infection, the bacteria are causing signs of infection, for example, fever and/or pus discharging from a wound. These patients will usually be given appropriate treatment for the infection.
Health-care associated infections (and hospital-acquired infections) are infections that arise as a result of a patient's treatment, which can be a stay in hospital. Some people come into hospital with infections they have got in the community.
Some patients get MRSA because of the treatments they receive for their primary illness, others acquire it in the same way as they do other infections.
Infections can be spread via the hands (touch) and from the environment. Therefore, good standards of cleanliness and hygiene from everyone are required to limit the spread of MRSA.
MRSA is not a problem to fit and healthy people. People staying in hospital and people receiving treatment and undergoing investigations are, however, more vulnerable. People who have long-term skin lesions (such as leg ulcers), long-term urinary catheters and those receiving frequent courses of antibiotics are also more at risk.
Patients can carry varieties of S. aureus on their skin without it causing any problems or symptoms of illness.
In hospital, routine specimens (including swabs) are taken to look for germs, and MRSA might be found as part of this procedure. We know that some patients are more vulnerable to MRSA, and might take more swabs more often from them. Swabs can take many days to process so we might not find out until you have been in hospital for some time or even after you have returned home.
If MRSA is found, your medical team is informed of the results and will prescribe treatment if necessary.
If you are discharged home from hospital before the results of swabs are available, your general practitioner (GP) will be informed and advised of any precautions or treatment necessary.
You will be notified if your doctors consider it useful to take further swabs (including after you have left hospital). It might be useful to know if you still have the MRSA, for example if you have further surgery planned.
Patients who are clinically unwell with an MRSA infection are treated with antibiotics. There are a number of antibiotics that can be used to treat MRSA infections and the medical team will discuss with the microbiologist which type is most suited to you. The duration of antibiotic therapy will depend on the patient’s condition. Some patients might receive skin treatment (soaps and creams, not tablets) at the same time as antibiotic therapy taken by mouth or tube.
When you are first found to have MRSA, eradication treatment is usually given - as long as your underlying condition does not preclude it.
Sometimes, carriers of MRSA are treated more than once, for example: before they have surgery.
There are problems with repeatedly treating patients with MRSA because resistance to some of the treatments can occur. The Infection Control Nurse can advise medical and nursing staff about appropriate eradication treatment.
10. Can I pass MRSA on to my friends and relatives?
If you have MRSA, you are not a risk to your healthy relatives or friends. You can continue to live a normal life and maintain your usual relationship with your partner. Good hygiene and cleaning procedures in your household are enough to lower the risk of possible spread.
People who have open wounds or eczema are more vulnerable to infection from you because their skin is not intact. If you are concerned, ask your doctor for advice.
11. Will having MRSA affect the care and treatment I get in hospital?
If you are found to have MRSA, your planned investigations and treatment will continue as normal. We might start to use barrier precautions, depending on the nature of the treatment you require.
If I have MRSA, can I use the physiotherapy, rehabilitation or day care facilities?
If it is required, people who have MRSA are able to use the rehabilitation and physiotherapy facilities.
Even if you have MRSA, we encourage you to continue seeing your usual visitors.
We recommend that all visitors wash their hands when they leave all wards and side-rooms.
If visitors are assisting with your physical care, it might be advisable for them to wear aprons and gloves - depending on what tasks they are performing. If you or your visitors have any concerns, please ask ward staff for further explanation and reassurance.
Barrier nursing is used to help prevent the spread infections in hospital. It can be used for MRSA but also to prevent other infections such as varicella zoster virus (causing shingles and chickenpox).
In areas of the hospital where patients are having many invasive procedures, such as in intensive care and surgical and medical wards, we prefer patients with MRSA to be barrier nursed.
In barrier nursing conditions, doctors and other staff attending patients need to wear protective clothing (usually aprons and gloves) when they have physical contact with patients. Apart from these hygiene precautions, your treatment will not be affected.
Visitors should check with nursing staff before entering barrier rooms to ensure that there are no other problems they need to be aware of.
Once patients have had some MRSA-negative swabs, (usually three sets) we will usually bring them back onto the main ward. If you are being barrier nursed on one ward, you will normally need to be barrier nursed on other wards you are transferred to.
Sometimes, to prevent the spread of infection, we nurse patients who have similar infections together in bays of a ward. This group of patients is called a cohort. From time to time, we have MRSA cohorts but we can also have ones for other infections.
15. If I am nursed in a single room because of my MRSA, will this affect my treatment or care?
Patients who are being nursed in single rooms should not receive any less attention or care than those in the main ward bays. Some single rooms have the advantage of en-suite facilities and most patients are very comfortable in side-room accommodation.
16. If I have MRSA, am I a danger to staff and patients?
If you have MRSA, you are not a danger to other patients and staff. It is important, however, that everyone observes good hygiene especially staff who have a hands-on role with patients.
17. Can I go down to the hospital shops without endangering patients, visitors and staff?
MRSA is not a risk to healthy people so there is no danger when MRSA patients go to the concourse and shops. It is more important that patients who are going down to the shops are appropriately clothed and that they have no weeping wounds.
18. Will having MRSA stop me having further treatment including operations?
If you require surgery in the future, if is helpful to check if your MRSA is still present. Swabs can be taken by either your general practitioner's practice nurse or in a hospital clinic.
The presence of any infection can delay planned surgery (for example: if you have an 'ordinary' chest infection). Having an MRSA infection is no different to these situations and should not delay your surgery because topical treatments can be started before the surgery and antibiotic 'cover' treatment can be given when needed.
20. Will MRSA stop me doing any normal daily activities when I return home?
MRSA is not a cause for concern in the community. If you feel well enough, it is important that you continue your usual activities including swimming, socialising and shopping.
In most circumstances, having MRSA should not affect your ability to attend work or college. However, if you are working in a health-care setting, we recommend you seek further advice. For most other people, observing normal hygiene is sufficient and there is no need to tell employers or colleagues. If you are concerned, ask your GP or the Infection Control Nurse for advice.
23. If I become pregnant, is my baby at risk of MRSA and am I more likely to get infections during birth?
If you are pregnant, there are no additional risks from MRSA and this is similar for other infectious agents. If you are concerned, ask your doctor or midwife for advice.
Only staff involved in your health need to know that you have MRSA, including district nurses, your GP and nursing and medical staff, who are caring for you during your hospital visits or stays.
If you have had MRSA in the past, it would be helpful to tell doctors and nurses (both in the community and in hospital) because it might assist in planning your care.
25. Who has responsibility for MRSA at Addenbrooke’s Hospital?
The Chief Executive of the Trust has overall responsibility for MRSA in Addenbrooke’s Hospital. The Infection Control Team takes care of the day-to-day issues.
26. What is the role of Infection Control and infection control nurses?
When you are identified as having MRSA, your medical team will discuss this with you and you might be visited by an infection control nurse. They can answer any questions and provide further information about your MRSA. The written information includes how to contact the infection control nurses if you have any further questions. With your permission, they are also happy to speak to your relatives about your MRSA.
MRSA is widespread in most hospitals in the UK but some hospitals 'actively' look for MRSA and some do not. This is why some hospitals have higher numbers of reported cases than others. At Addenbrooke’s, we have policies to advise staff which patients to screen (routine testing) and how to manage the treatment of any patients found to be MRSA positive. There are many Infection Control Policies in place in the Trust including ones concerning hand washing. The MRSA policies at Addenbrooke’s are based on guidance from a national working group on MRSA.
The overuse of antibiotics worldwide has led to the emergence of many antibiotic-resistant bacteria, one of which is MRSA. The Department of Health has produced guidance to GPs and the public to discourage the use of antibiotics, unless they are clinically needed. Hospitals are also addressing this issue by adhering to local antibiotic policies and following national guidance.
We all are monitoring cleaning standards in hospitals, surgeries and other care facilities closely to ensure they are up to standard. We are also encouraging everyone to work together to decrease the risks of catching all types of infection, not just MRSA. The simplest way to do this is to wash your hands frequently and follow good hygiene precautions.
Antibiotics treat infections by killing the bacteria can cause them. Not all infections are caused by bacteria, for example antibiotics do not work against the virus infections that cause the common cold. We should not abuse the 'gift' of antibiotics by using them unnecessarily - overuse leads to antibiotic-resistance because the bacteria 'learn' to survive treatment with them.
Further information For further information about MRSA contact your ward staff or the Infection Control Nurse
Copies of our printed information are available on the Addenbrooke's website and from the Information Centre.
