A Patient's Guide to MRSA - Methicillin Resistant Staphylococcus Aureus

There are lots of micro-organisms (germs) on our skin. Most of them are harmless, some are beneficial but a very small proportion can potentially cause harm. Staphylococcus aureus is a common germ that is found on the skin (as a normal skin flora) and in the nostrils of about a third of healthy people.

There are other types of bacteria in the Staphylococcus family, and we all carry at least one of these types on our skin. It can cause harm if it enters the body, for example through cuts and other skin breaks. Methicillin is a type of penicillin, an antibiotic that is used to treat infections.

MRSA are types of Staphylococcus aureus that have developed resistance to methicillin and some other antibiotics used to treat common infections.

Some people carry MRSA on their skin or in their nostrils without any harm to them. They may not be aware of having MRSA because they have no symptoms and it does not harm them - this is called ‘colonisation’.

MRSA and other germs cause problems in hospitals. Complicated medical treatments, including operations and intravenous lines (drips), provide opportunities for germs to enter the body. MRSA and other types of Staphylococcus aureus can cause local skin infections such as boils and, in more vulnerable patients, they can cause more serious infections in wounds, bones, lungs and can result to bloodstream infections that will require more extensive treatment.

The following make patients vulnerable to infections:
• Their underlying medical condition
• The number of operations they have had
• The presence of open wounds
• How frequently they use antibiotics

MRSA colonisation means that the bacteria is simply sitting on the skin (or any body part) but is causing no harm to the person. MRSA infection means 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.

People who carry MRSA do not look or feel different from anyone else. The MRSA does not harm them and they have no symptoms of infection. When patients come into hospital, a nurse may take swabs for laboratory tests to check for MRSA.

Patients who have an infection may develop signs and symptoms, such as a high temperature or a fever. An infected wound may become red and sore and discharge pus. Many different germs can cause these signs and symptoms. Only laboratory tests can show whether MRSA or other germs are the cause of this infection.

The RNOH takes MRSA very seriously. All patients being prepared for or admitted for surgical procedures in RNOH are routinely tested by taking swabs from different parts of the patient’s body (mainly from nose, groin, wound or device sites) to check if MRSA is present and to ensure that others are protected from the bacteria. Patients found to have MRSA are treated and their care discussed to ensure that they can still have surgery or investigations even with MRSA.

Patients with MRSA colonisation are usually treated with chlorhexidine solution used as shampoo and body wash along with an antibiotic nasal ointment to reduce or remove MRSA from skin, nostrils, etc - this process is called MRSA decolonisation. If you are found to have MRSA colonisation before admission, we inform your GP and ask them to assist with the decolonisation. We may ask your GP via a letter to prescribe the MRSA decolonisation treatment if you are not admitted in hospital when diagnosed. A patient who has an MRSA infection is usually treated with an antibiotic.

Carriers of MRSA have it on their skin and they can transfer it to people and objects that they touch. Other people can then pick it up on their hands and pass it on to others.

Good hygiene measures reduce the risk of acquiring and spreading MRSA. Wash your hands thoroughly with soap and water before and after meals and also after using the toilet or bedpan. If your hands are visibly clean and free from dirt and sweat, you can also use alcohol hand gel. We take MRSA seriously so please ask any member of staff whether they 6 have cleaned their hands before touching you if you have not seen them do so. Staff will wear gloves and aprons when they care for a patient with an infection risk including MRSA. Patients who have MRSA may be moved to a room on their own or into a separate area for patients who have MRSA.

Patients who carry MRSA do not usually have to stay longer in hospital. Patients who have an MRSA infection or any other infection may have to stay in hospital until it shows signs of clearing up.

They may stay until they have completed their course of antibiotics or they may need to continue treatment when they go home.

A patient who has MRSA can go home or be cared for safely in a nursing home or residential home, using simple hygiene measures without the risk of it spreading to others in the family or care home. Please try not to worry if you have MRSA positive test result.

MRSA does not usually affect healthy people. It does not usually harm elderly people, pregnant women, children and babies. But it can affect people who have serious health problems and people who have chronic skin conditions or open wounds.

Visitors can reduce the risk of spreading MRSA to other people by:

• Cleaning their hands on arrival and at the end of their visit to the hospital wards using alcohol hand gel or soap and water
 • Not sitting on the patients beds
 • Taking advice from clinical staff if someone who has a long-term health problem wants to visit a patient who has MRSA.

If you have any questions or queries, please contact:

 Infection Prevention and Control Team Royal National Orthopaedic Hospital Stanmore Telephone: 020 8909 5625/5360