Name of originator/author: Kris Khambhaita

Position: Lead Nurse Infection Prevention & Control

Policy Lead: Lead Nurse Infection Prevention & Control

Directorate: Provider Services

Date issued: March 2009

Version: 1

Approved by: Infection Prevention & Control Committee (Chair’s Action)

Review date: January 2011

Target audience: NHS Haringey in-patient ward area

HPP 230 – Policy

MRSA ADMISSION SCREENING POLICY

staff

1. Introduction

The purpose of this policy is to assist NHS Haringey in meeting their legal obligations regards screening and treating of MRSA colonisation and to ensure that every member of staff is aware of their individual responsibility in relation to the prevention and control of MRSA colonisation and infection.

The Department of Health (DH) recent guidance for NHS Trusts has identified that by 31st March 2009 all elective admissions should be routinely screened prior to admission with the exclusion of:

Day case ophthalmology Day cases dental Day case endoscopy Minor dermatology procedures (e.g. warts or other liquid nitrogen

applications) Children/paediatrics Maternity/obstetrics, except for elective caesareans and any high risk

cases (i.e. high risk of complications in the mother and/or potential complications in the baby (e.g. likely to need SCBU, NICU because of size or known complications or risk factors)

Mental Health Patients

The rationale for admission screening is aimed at not only reducing the risk to the individual patient but trying to reduce the burden of MRSA carriage in the general population. The identification of MRSA carriers enables the application of the MRSA decolonisation or suppression protocol immediately following detection and the use of appropriate systemic antimicrobials.

2. Scope

This policy is an addition to all other existing infection control policy documents of NHS Haringey (formally known as HTPCT).

This policy applies to all patients admitted into Green Trees Rehabilitation Unit and should be adhered to by all staff caring for in-patients admitted into Chestnut Ward.

Staffs of NHS Haringey, when working on the sites that have a service level agreement with other provider services are required to follow the local trust Infection Control Policy where they are practicing.

The contents of this document should be regarded as a guide to best practice, but they cannot cover all eventualities and may need to be

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modified in certain circumstances. Practitioners are urged to seek further advice when necessary

This policy will provide a basis for audit and will be subject to regular review. The next planned review will be completed by January 2011.

3. Accountability and Responsibility

The philosophy of this policy is to encourage individual responsibility by every member of staff. All staff should participate in the prevention and control of infection ensuring that there are effective arrangements in place for the prevention and control of infections.

Chief Executive

The Chief Executive has ultimate responsibility to ensure the control of infection is addressed according to department of health directives. This responsibility is delegated to the Director of Infection Control and Prevention. The Trust board is responsible for ensuring that a robust system is in place and there is a clear line of accountability. Director of Infection Prevention and Control and reports directly to the Chief Executive on infection control matters.

Lead Nurse Infection Prevention & Control

Is the lead person responsible for the provision of an effective infection control service to the Trust; is responsible for preparation and implementation of infection control policies and guidelines and is responsible for giving expert advice and training related to all Infection Control practice. Is responsible for ensuring this policy is raised and reviewed at the Infection Prevention and Control Committee to ensure evidence based guidelines are available for all staff, and is also responsible for working with the Director of Infection Prevention and Control to develop organisational strategy for Infection Control.

Heads of Services, Departments / Team Leads / Service Managers

Are responsible for ensuring that their staff will be familiar with the policy and that the management of patients with infectious diseases is carried out in their areas in accordance with legislation, Trust policy and best practice.

All Clinical Staff

All clinical staff must ensure they have read and understood the policy and incorporate the guidance to help reduce the risk of health care associated infections.

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Non-Clinical Staff

Non-Clinical staff should ensure that they are familiar with the policy and be aware of their role in the prevention of health care associated infection in their working environment.

4. MRSA colonisation and infection

MRSA stands for Meticillin-resistant Staphylococcus aureus. Meticillin is a marker which indicates resistance to all beta-lactamase antibiotics. MRSA can be carried as an asymptomatic colonisation of normal skin sites, (e.g., nose, perineum, axilla,) or abnormal sites such as leg ulcers and eczema. Infections vary in severity and patients particularly at risk from infection are surgical patients; intensive care patients; immunocompromised patients; patients with open wounds or intra- vascular devices. Both colonised and infected patients must be viewed as potential sources of infection.

5. Rationale for Screening

Screening is the testing of patients for the presence of MRSA on the most common body sites known to be colonised on or before admission to hospital. MRSA screening is the microbiological testing of a sample taken from the potential carriage sites of a patient on or before admission. It is the process by which patients who are colonised with MRSA is identified.

6. Screening protocol

All patients admitted to ward must have a full MRSA Admission Screen within 48 hours of admission

Full MRSA Screen consists of

SITES OF SWABS:

1. NOSE – 1 swab for both nostrils

2. PERINEUM

3. EXTRA SWABS TO BE TAKEN

Any boils, wounds or burns

Any recent scars/operation sites

Sites of skin complaints, such as eczema or psoriasis

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CSU if catheterised

MRSA Admission Screening Swabbing Guide

Nose Perineum

Use one swab for both nostrils

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Perineum

Hold the swab handle between thumb and forefinger. To avoid contamination do not hold the swab too close to the swab bud.

Apply downward pressure while swabbing. Rotate the swab so that the entire swab surface is used to sample the test surface.

Add details of the swabs taken into specimen book, and document in patient’s medical notes.

7. Results

Check on computer or ask doctor for results 3 days after the screen swabs were sent to the laboratory for analysis.

Negative Results:

Document result in the patients medical notes; inform the patient and relatives / next of kin as appropriate. No further action required.

Positive Results:

(Inform doctor, if they are not aware). Inform Infection Control Team ext 5781

Inform patient and their next of kin; provide them with leaflets on MRSA and MRSA treatment

Place patient into isolation room (if required this depends on the site(s) where they are positive), put up door sign on the room

Start patient on nasal cream / ointment and skin treatment body wash for 5 days. Then ensure there is no treatment for 48 hours. Re-screen 48 hrs after completion of 5 day course.

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Management of MRSA eradication protocol

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Patient diagnosed colonised with MRSA

Inform doctor if not already aware

Inform Infection control team ext 5781, if no answer leave message

Inform patient and their next of kin, provide leaflet on MRSA

Place into isolation if required (depends on site(s) of positive result)

Place door signs

Document into medical notes

Start patient on nasal and skin treatment (doctor to prescribe) for 5 days – re-screen

48 hrs after completion.

Refer to swabbing guide if needed

Await result

Continue treatment cycle two, 5 days on two days off and re-screen

Discontinue treatment consider patient negative

Negative result Positive result

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Continuous skin treatment maximum for one month if no skin irritation (maximum 4 cycles of 5

days on two days off) after this call Infection Control Team for advice

ext 5781

Inform doctor if not already aware Inform Infection control team ext

5781, if no answer leave message Inform patient and their next of kin De-isolate patient if applicable Remove door signs, terminal clean

room area Document into medical notes

Negative result Positive result

MRSA Colonisation eradication Nursing Care Plan

Patient Name………………………………………………………..........................................................Hospital Number ……………………………………

Date of Birth…………………

PROBLEM: MRSA colonisation (Insert sites)

AIM: To eradicate MRSA and prevent colonization/cross infection or further spread of infection

Care plan discontinuation date:

DATE Actions Care delivered bySign & Print name

Designation

Review date

Doctor and Infection Control Team notifiedInform patient and give information sheet, place into isolation (if required, depend on site(s) positive), place door signs upInformed patient relativesEradication protocol: nasal ointment applied to inner surface of each nostril TDS 5/7 DATE COMMENCED:Daily body washing ideally shower Once a day for 5 days. Date commenced:Repeat screening 2 days after stopping eradication protocol, DATE swabs sent:After screening, restart body wash only Do not continue nasal treatment.If the results are negative stop protocol if results positive Discuss with Infection Control Team.Twice weekly hair wash using antimicrobial body wash. Daily changing of bedding, treat as infected linenDaily changing of clothes, treat as infected linen

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8. Compliance monitoring

Monitoring of compliance with admission screening will be presented at the monthly ward meetings, and is the responsibility of the ward manager to audit and feedback data to The Infection Control Team at least monthly. Quarterly surveillance reports feedback compliance and trends to senior management and Trust board.

Non-compliance issues will be addressed with relevant ward manager and clinical leads. The number of patients that should have been screened but were not will be sent monthly to ward manager to address and investigate reasons for non-compliance. Compliance with prescribing and 5 day completion of MRSA suppression protocol to MRSA positive patients forms part of an ongoing audit with the Infection Control team and the ward.

9. References

Anwar, R. Botchu, R. Viegas, M. Animashawun, Y. Shashidhara, S. Slater, G. J. R. (2006) Preoperative meticillin-resistant Staphylococcus aureus (MRSA) screening: An effective method to control MRSA infections on elective orthopaedics wards. Surgical Practice, vol 10, no 4, pp. 135-137(3)

Cookson, B. (1997) Controversies: Is it time to stop searching for MRSA? Screening is still important. British Medical Journal 314:664-665.

Department of Health (2006) Screening for Meticillin-resistant Staphylococcus aureus MRSA colonisation: A strategy for NHS Trusts – a summary of best practice. Saving Lives: a delivery programme to reduce HCAI including MRSA

Samad, A. Ghosh, S. Carbarns, N. (2002) Prevalence of Meticillin Resistant Staphylococcus Aureus (MRSA) colonization in surgical patients on admission to a Welsh hospital. British Journal of Surgery 89: Supplement 3.

Department of Health (2006) Screening for Meticillin-resistant staphylococcus aureus (MRSA) colonisation: A strategy for NHS Trusts: a summary of best practice. Available at http://www.dh/gov/assestRoot/04/14/08/04140848.dpf

Department of Health (2008) MRSA screening - operational guidance http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Dearcolleagueletters/DH_086687

Department of Health (2008) MRSA Screening - Operational Guidance 2http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Dearcolleagueletters/DH_092844

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