What is MRSA?

MRSA is short for Methicillin-resistant Staphylococcus aureus. S. aureus is a bacterium (bug or germ) that about 30 per cent of us carry on our skin or in our nose without knowing about it. This is called ‘colonisation’.

The inside of our nose and other moist areas of skin are mostly likely to be colonised by MRSA.
Most types (strains) of S. aureus do not cause any problems and if they do, are easily treated using standard antibiotic medicines. However, there are some types of S. aureus that cannot be treated with standard antibiotic medicines. This is because the bacterium has ‘got used to’ the standard medicines and changed itself so that the medicines do not work as well any more. This is called ‘resistance’.
There are other types of bacteria that are resistant to antibiotic medicines, but MRSA is the most well known type.

How serious is MRSA?
MRSA is not a stronger or more infectious type of bacteria than others. It is only different because the standard antibiotic medicines do not work against it. This means that non-standard antibiotic medicines are needed to treat the infection.

How does someone get colonised with MRSA?
MRSA is mainly spread by direct skin-to-skin contact, although it can also be spread through dusty and dirty equipment and surroundings. If someone who is colonised with MRSA touches the skin of a person who is not colonised, this can transfer the bacteria from one to the other.
In a lot of cases, when we test someone for MRSA we find that they are already colonised with the germ.
Being colonised with MRSA may not cause any problems if a person is well, but they could still pass it on to other people. This is why hand washing is so important. You can stop MRSA spreading just by washing hands before and after contact.

How does someone get infected with MRSA?
MRSA does not cause any problems when a person is well, but it can cause problems when someone has had an operation or any other treatment that breaks the skin. This allows the MRSA germs to get inside the body, where they could cause an infection or problems with wound healing. As MRSA is spread by direct skin-to-skin contact, it can be passed on through unwashed hands and then spread into the wound site.

How is it diagnosed?
There is no way of telling whether someone has MRSA or not just by looking. The most reliable way of diagnosing MRSA is to take a swab (like a cotton bud) of the inside of their nose and throat or their skin.
At the Royal National Orthopaedic Hospital (RNOH), all patients admitted as an inpatient using swabs. The swab is sent to the hospital laboratory to see whether the MRSA germ grows or not. If it does, this shows that the person is colonised with MRSA.

What happens if MRSA positive?
If a patient is colonised with MRSA, we will nurse him or her in a separate room with a closing door if possible. If there are no single rooms available, the patient will share a room with other children with MRSA.

Our domestic staff will clean the room thoroughly twice a day or more. Use of an antiseptic shampoo or body wash and a nasal ointment will be recommended for patients who are colonised MRSA. If an MRSA infection is elsewhere, the patient may need antibiotics given directly into a vein (intravenous infusion).

Do we need to take any precautions at home?
No, there are no additional things you need to do. We always recommend good basic hygiene, such as hand washing before eating and after going to the toilet, and using separate towels. There is usually no need to inform anyone that you have MRSA unless you will be in contact with someone who works in a hospital or is currently attending hospital as a patient.

Can MRSA come back once it’s been treated?
Yes. We know that if someone is colonised with MRSA and has the germs on his or her skin, they can move to an operation wound, for example. Equally, if a person’s wound has the MRSA germ, this can move to another area of skin. This happens during everyday life activities, such as moving around, washing or eating, and is a normal occurrence.

Treatment can reduce the number of MRSA bacteria to a level where it is difficult to detect through swabbing.

MRSA is easily transferred from person to person, so if you come into contact with someone else with MRSA, they can get the germs again, even after treatment.

When will I be free from MRSA?
At RNOH we declare a patient ree from MRSA following three complete clear screens.

What is RNOH doing to prevent MRSA spreading?
RNOH has been working hard for the past years to reduce the spread of MRSA. We aim to screen every patient that is admitted against MRSA so that we can nurse them in a separate room or with other patients with MRSA.

We strongly encourage hand washing before and after patient contact, by providing alcohol hand rub (an alternative to soap and water) at the entrances to each ward. We encourage you to ask any member of staff who visits your child whether they have washed their hands.

Finally, we are working with our cleaning contractors to maintain the high levels of cleanliness in our wards and general areas but we need your help too. Please talk to us about how you can help us keep the hospital clean.

Understanding Clostridium difficile

What is Clostridium difficile?

Clostridium difficile is a germ that can be found in many places, including soil, water, and air. You may hear people call it “C. difficile” or “C-diff.”Certain types of C-diff germs create chemicals or “toxins.” Toxin producing C-diff germs can make some people sick.

How long is an episode?

An episode of CDI is 28 days, with day 1 being the date of specimen collection.

Q. What stools should be tested for CDI?

A. If a patient has diarrhoea (Bristol Stool Chart types 5-7) that is not clearly attributable to an underlying condition (e.g. inflammatory colitis, overflow) or therapy (e.g. laxatives, enteral feeding) then it is necessary to determine if this is due to C. difficile. The stool sample must take on the shape of the container and ideally be at least ¼ filled (to indicate the patient has diarrhoea) before it is sent to the laboratory for testing. If in doubt please seek advice for example from your microbiologist, Director of Infection Prevention and Control or your Infection Prevention and Control Team. All diarrhoeal samples from hospital patients aged >2 years and, as a minimum, all diarrhoeal samples from those aged >65 years in the community where clinically indicated, in particular for those aged <=65 years, should be tested for C. difficile.

In suspected cases of ‘silent CDI’ such as ileus, toxic megacolon or pseudomembranous colitis without diarrhoea, other diagnostic procedures, such as colonoscopy, white cell count (WCC), serum creatinine and abdominal computerised tomography (CT) scanning, may be required, potentially with referral to a gastroenterologist or gastrointestinal surgeon.

Do I need to report cases in patients aged under 2 years?

Cases in patients aged under 2 years need not be reported; however Trusts may use the system to record these cases if they so wish. These will be excluded from data for publication.

The frequency of diarrhoea varies in definitions of CDI. Usually, definitions cite the need for at least 3 episodes of diarrhoea, for at least 2 consecutive days. Such a stringent definition is appropriate for clinical trials, but less so in a setting where transmission of infection is a concern. In primary care (excluding institutions such as nursing homes), it is reasonable to use the more stringent definition of CDI; in practice, patients would very rarely consult their GP for diarrhoea comprising 1-2 episodes per day, unless perhaps this continued for several days. Conversely, in the healthcare setting, using a single episode of unexplained diarrhoea as the threshold to instigate testing and pre-emptive patient isolation is reasonable. Whichever the scenario, some flexibility is required to ensure that unexplained diarrhoea is appropriately investigated and managed, especially in high risk individuals.

Q. Do I need to report positive specimens that come from patients not located within a hospital at the time of testing, or taken on admission?
A. Yes, all cases of CDI that conform to the case definition must be reported, regardless of where or when the specimen was collected.

Q. Do I need to report positive specimens from Welsh patients diagnosed in English laboratories?
A. Yes, all cases of CDI that conform to the case definition must be reported even if they are from Welsh patients tested/diagnosed in an English laboratory

Q. Do I need to report positive specimens sent from the Independent Sector (private hospital)?
A. Yes, all cases of CDI that conform to the case definition must be reported, regardless of where the specimen originated from.

Q. Should positive specimens from the same patient and the same episode be reported?
A. No, only report a second positive from the same patient if it is defined as a new episode

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MRSA