Infection Prevention and Control METICILLIN RESISTANT STAPHYLOCOCCUS AUREUS (MRSA) screening December 2009 Author: Ratifies: Review

w date: 2012 CONTENTS Page Introduction 1. Screening 1.1. Screen swabs/specimens 2.0 Screening regimens for different patient groups 2.1 Elective admissions 2.2 Emergency and other admissions 2.3 Patients not included in mandatory screening 2.4 High risk patient screening 3.0 When not to screen 4.0 MRSA M,C&S culture test 5.0 Rapid MRSA test by PCR 5.1 Objective 5.2 Inclusion criteria for rapid screening 5.3 Pathway 5.4 Inter-hospital transfers 6.0 Known MRSA positive patients 7.0 MRSA contact screening 8.0 Newly identified MRSA positive patients in-patients 8.1 Notification of positive MRSA status 8.2 Ward Doctor and Sister responsibilities 8.3 Nurse in Charge responsibilities 9 Newly identified MRSA positive patients pre admission/out-patients 10 VISA/GISA/GRSA contact screening 11 Pre-operative screening Elective orthopaedic ward admissions 12 Transfers to other healthcare settings 13 Discharge screening 14 ITU screening and decolonisation 15 Renal unit screening 15.1 Haemodialysis patients 15.2 Satellite units 16 Staff screening 16.1 Introduction 16.2 Pathway 16.3 H&WC policy 17 References 2 2 2 2 2 2 3 3 3 3 3 3 4 4 5 5 5 5 5 5 5 5 5 6 6 6 6 7 8 9 10 10 11 12 12 15 ICT Infection control committee

IPC Manual/IPC protocol for MRSA screening

Introduction The Health and Social care Act (2008) Code of Practice for the NHS on the prevention and control of healthcare associated infections and related guidance4 requires all NHS bodies to minimise the risk to patients. Screening for MRSA and active decolonisation is a prime consideration in meeting these standards. Department of Health guidance published on Dec 31st 2008 clarifies: - The planning requirements to support MRSA screening for all relevant patients from April 09; - The assurances needed by trusts to provide evidence of MRSA screening; - The roles of SHAs, PCTs, Monitor and DH in assuring and supporting the delivery of MRSA screening.
http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Dearcolleagueletters/DH_092844

The guidance updates existing guidance but does not replace it. It does not prescribe how the NHS should deliver the commitment, which is a matter for local determination. Existing guidance includes: - Screening for MRSA colonisation: a strategy for NHS Trusts: a summary of best practice (2006)
http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Professionalletters/Chiefmedicalofficerletters/DH_063138

MRSA screening - Operational guidance (July 2008)

http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Dearcolleagueletters/DH_086687

The commitment in the 2008/09 and subsequent 2009/10 Operating Frameworks to introduce MRSA screening state; Meeting the challenge of HCAI will require additional actions across the system from April 2009, all elective admissions must be screened for MSRA in line with Department of Health guidance extended to cover emergency admissions as soon as possible and definitely no later than 2011. The following trust policy statements implement the guidance and mandates listed above and are part of the trusts Managing patients with Meticillin resistant Staphylococcus aureus (MRSA) policy.

1. 1.1

Screening Screen swab/specimen requirements Nose swab, dip swab briefly into transport medium prior to taking swab from the anterior nares of both nostrils. Gently insert swab into anterior nares (just inside the nostril) perform circular movement x3 and repeat in other nostril. Perineum swab; ensure swab from perineum rather than groin. CSU if catheterised; IV infusion site swab; (including CVC site, or other invasive device site) Wound(s) swab; -Other i.e. eczematous skin lesions ( ref 1) Rapid MRSA testing by polymerase chain reaction, (PCR), requires nose and perineal swabs only. (see below for more details) using red swab packs.

2.

Screening regimens for different patient groups 2.1 Elective admissions. All elective admissions must be screened. Screening is preferable in pre-admission clinic or two weeks prior to admission to allow test results to confirm if MRSA is identified and appropriate decolonisation regimen to be commenced. The optimum time for those requiring decolonisation is for surgery to happen on day five of the decolonisation regimen. Screening is mandatory on admission day if no clear screen is available within the preceding week.
IPC Manual/IPC protocol for MRSA screening

Screens should be sent for culture, not rapid testing, unless surgery or treatment is planned within 24 hours, or the patient is in the high risk category below (2.4) 2.2 Emergency and all other admissions. (Please see exclusion list below) All emergency and other non-elective admissions must be screened on the day of admission. Screens should be sent for culture, not rapid testing, unless surgery or treatment is planned within one week, or the patient is in the high risk category below (2.4)

2.3

Patients not included in mandatory screening (unless high risk as per 2.4) Day case ophthalmology Day case dental Day case Endoscopy Minor dermatology procedures, eg, warts or other liquid nitrogen applications Children/paediatrics (unless in high risk group) Maternity/obstetrics except for elective caesareans ,ie, high risk of complications in the baby, e.g likely to need SCBU, NICU because of size or known complication risk factors.

2.4 High risk patient screening, The following patients require rapid screening to ensure they are MRSA clear due to the higher risks for MRSA acquisition in the following circumstances: - transfers from another ward, - transfers into and from ITU, - transfers from other hospitals, - transfers from nursing/residential homes Culture is sufficient for patients who have been in any hospital within the last 12 months, but are not already know to be colonised with MRSA 3 When not to screen During topical decolonisation regimen and for 2 days after. During treatment, and for 2 days after completing treatment, with antibiotics to which the MRSA is sensitive: (Excepting routine periodic ITU screening) Glycopeptides Teicoplanin or Vancomycin. Linezolid. Rifampicin, Fucidin, Trimethoprim and Doxycycline. 4 MRSA M,C&S culture test All MRSA screens should be sent for culture (M,C&S) unless surgery or treatment is planned within 24 hours, or the patient is in the high risk category below (4.2.4)

Rapid MRSA testing by PCR. Rapid testing is specifically for timely reporting where there is a high risk of colonisation. Routine MRSA screening should still be done by culture (MC&S). Sending routine screens for rapid testing that are not necessary delays urgent test result reporting. 5.1 Objectives Increase availability of side rooms Reduce risk for contacts Reduce bed blocking caused by waiting for MRSA screen results in contacts
IPC Manual/IPC protocol for MRSA screening

Improve evidence that patients are admitted with MRSA Improve flexibility for inter hospital transfers particularly emergency tertiary referrals and transplants. 5.2 Inclusion criteria for rapid screening

The following patients must be screened. All ITU patients on admission to ITU All renal patients on admission to a renal bed, not regular dialysis attenders who have their own screening schedule. All patients from care homes on admission All inter hospital transfers on admission All patients who are contacts of a newly identified MRSA positive patient sharing the same bay. Patients who are known MRSA positive in the past who are waiting for a third clear screen. 5.3 Pathway

The infection prevention and control nurses keep a central list of patients who are being screened. Testing will take place at 09.30 and 14.00 on weekdays and 09.30 on weekends/bank holidays. Identify why the patient requires a screen, e.g from St Elsewhere. Using the MRSA Rapid Screen Pack, take nose & perineal swabs (wounds, sputum etc will not be part of rapid testing but will be processed as clinical samples/swabs as usual). Tick the appropriate box on the pack form indicating the reason for the rapid testing and request on Cerner as usual. If rapid testing is wanted on a patient not in one of the categories on the pack form, this request should be discussed with an IPC nurse. Inform infection control team on bleeps 2039 or 1576 within hours and extension 35216 during the week (leave a message on the answer phone). From 4pm Friday until 8.30 am Monday contact site manager on bleep 1112. Deliver the swabs to fridge on microbiology corridor as usual. For rapid testing on nose and perineal swabs, request MRSA screen as usual on the request form in the red swab, rapid screening pack, and write RAPID TESTING on form. If other swabs/samples are being sent, please request separately on Cerner as they will not be part of rapid testing scheme. If more than one patient requires a screen e.g. in contact bay please batch swabs together, this will ensure they go on the same run of testing. Positive tests for newly identified MRSA patients will be phoned to the ward. A first positive PCR result (or Reactive report) will be reported to the ward, with appropriate actions discussed, but confirmation is required by a second PCR result, or a positive culture. For all other results for rapid MRSA testing, wards will need to request by ringing extension 35216, or the microbiologist on call out of hours. Allow at least 2 hours from the time the test is run. Results may take some time to appear on the computer, so please confirm all rapid testing results in this way.

IPC Manual/IPC protocol for MRSA screening

5.4 Inter-hospital transfers If there are no available side rooms and the patient has no other infectious organism then patients from external hospitals may be admitted to open bays and screened on admission. Providing they are isolated immediately if a positive result is received the bay will NOT become a contact bay. 6 Known MRSA positive patients Screen on admission and discuss further screening frequency with infection prevention and control team. Once a patient has 3 clear complete sets of screens, each set 1 week apart, isolation may be discontinued in liaison with the IPC team. 7 MRSA contact screening All patients who are contacts of known MRSA patients. ONE complete set of swabs as described above is needed for clearance. This may be by PCR. 8 Newly identified MRSA positive patients- in-patients 8.1. Notification of positive MRSA status A microbiologist, or member of the IPC team will notify the appropriate ward doctor and the nurse in charge of the ward of a newly identified patient with MRSA. 8.2. The ward doctor and ward sister/charge nurse are responsible for : a) Informing all staff who are involved in patient care: nurses, doctors, nursing and medical students, therapists; b) Informing the patient of MRSA status and what this means to them individually with regard to isolation, treatment (or not), family, discharge planning and any other relevant issue as raised by the patient. The IPC patient liaison nurse will be able to provide advice and facilitate this. c) Explaining isolation procedures to portering, domestic and works department staff who have contact with the patient of isolation precautions. d) Commencing topical decolonisation once agreed with IPC team. e) The doctor should review any antibiotic therapy and modify as necessary following discussion with a microbiologist. 8.3. The nurse in charge is responsible for: a) Ensuring isolation of positive patients in liaison with the bed manager, site manager and infection prevention and control. b) Arranging rapid screening (PCR) of direct contacts i.e. other patients in the same bay. c) Arranging terminal clean and curtain change of the patients bed space. 9 Newly identified MRSA positive patients- pre-admission/out-patients Out-patients and pre-admission patients identified with MRSA must be informed by the staff who arranged for the screening to occur. The IPC patient liaison nurse will also be available to assist with notification and to discuss on a case-by-case basis. Decolonisation packs must be given as above, preferably pre-admission, or where this is not possible, on admission. 10 Vancomycin or glycopeptide intermediate or resistant Staphylococcus aureus. (VRSA/GRSA or VISA/GISA) contact screening. Vancomycin, or glycopeptide resistance indicates a broader antibiotic resistance pattern than MRSA. For this reason, enhanced screening is needed for contacts of known GRSA patients. A screen for know GRSA patients includes:
IPC Manual/IPC protocol for MRSA screening

Nose Axilla Perineum Skin lesions Wounds/ invasive device sites. NB, Staff screening for GISA/GRSA discussed in staff screening section (Section 9) Pre-operative screening. - Preferably in pre-assessment clinic, or at least one week prior to admission for elective surgical admissions, - On admission for emergencies - Prior to surgery for any patient who is scheduled for surgery but is already an in-patient. Ideally screening of all elective surgical admissions would reduce the risk of MRSA infection in post-operative wounds. This may be by PCR if surgery is imminent, or by culture for a surgery date one week or more in the future. Patients should not be screened if they are on topical decolonisation protocol. The elective orthopaedic ward MRSA positive patients are not to be admitted, or managed on the elective orthopaedic ward. There are two wards for orthopaedic care in the trust, allowing for an elective ward where patients are screened pre-admission. Transfers to other NHS bodies or to other healthcare facilities, including nursing and residential care homes. Screening prior to discharge is not routine. However, the infectious status of any patient must be declared before transfer to any NHS or other healthcare facility, including MRSA status, in order for the receiving trust to prepare adequate isolation or infection control precautions. This should be documented on transfer documents as well as any verbal hand-over.

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12

There are sometimes concerns from nursing and residential homes about accepting patients back from the trust once they have been identified with MRSA. The following Department of Health guidance is very clear: There is no justification for discriminating against people who have MRSA by refusing them admission to a nursing or residential home or by treating them differently from other residents http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/D H_4009587 Although private homes may refuse any patient according to their own policies, NHS homes must be guided by department of health policy. Difficulties with individual homes should be discussed with the Health Protection Agency: REACTIVE DESK Health Protection Agency Centre for Infections

61 Colindale Avenue, London, NW9 5EQ Tel 020 8200 4400 Fax 020 8200 7868
13 Discharge screening Discharge screening of MRSA patients should only be done: i. If a known MRSA patient has not been screened within the last week. ii. If the hospital, nursing or residential home requests it prior to transfer.
IPC Manual/IPC protocol for MRSA screening

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Intensive therapy unit / critical care Admissions

Known MRSA patients requiring a critical care bed should be transferred to Intensive Therapy Unit Level 4 rather than to Intensive Therapy Unit Level 3. All patients with a known infectious or transmissible organism will have effective infection control measures put in place. A risk assessment may also be needed to prioritise the use of isolation facilities for patients with the most virulent or transmissible organisms first. It is understood that there are limited isolation facilities and sometimes clinical need means that isolation of patients with infectious/transmissible organisms may not occur. A risk assessment should be performed and documented by the critical care unit in these cases. All MRSA positive patients leaving the unit transfer to isolation side rooms or identified MRSA cohorts in non-endemic wards. Transfers out of Intensive Therapy Unit Level 4 not known to be colonised with MRSA or other resistant organisms: go to side rooms on non-endemic wards. go to any appropriate bed on endemic wards if they have no known resistant organism /infection (not 5 bed bay). On transfer to endemic ward open bays, rapid MRSA testing must be done immediately. When Intensive Therapy Unit Level 3 does not have MRSA patients, all transfers out can go to any appropriate bed on the receiving ward. When Intensive Therapy Unit Level 3 does have MRSA patients, transfers out are as follows: Known MRSA patients go to a side room or designated cohort in endemic and non- endemic wards. Those not known to be MRSA go to a side room on non-endemic wards or Go to any appropriate bed on endemic wards if they have no known resistant organism / infection (not 5 bed bay).

ITU MRSA Screening and topical decolonization programme - This protocol applies to ITU only Screen all patients on admission to ITU for MRSA. (Nose, perineum, CSU, wounds, and IV cannula sites and sputum / endotracheal aspirate.) Isolate known positive MRSA patients. MRSA positive patients on ITU3 to be transferred to ITU4. Initiate decolonization regimen for MRSA positive patients Mupirocin in paraffin base t.d.s. to both nostrils. (Hibitane used if isolate is resistant to mupirocin or if mupirocin is unavailable) Chlorhexidine mouthwash 0.2% q.d.s applied as mouth care using pink sponges from oral care pack Chlorhexidine 4% skin cleanser. Apply to wash cloth and use daily directly as skin wash / bed bath. Do not dilute. Chlorhexidine 4% skin cleanser used as shampoo every 2-3 days. Continue protocol for 2 weeks or until patient leaves ITU, whichever is sooner. Following completion of protocol discuss with the Infection Prevention and Control Team. Contact bleep 1576, 2039, or 1991. Document reasons for not using protocol
IPC Manual/IPC protocol for MRSA screening

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Renal unit

15.1

Staphylococcus aureus decolonisation in haemodialysis patients.

See over-page

IPC Manual/IPC protocol for MRSA screening

Staph aureus and MRSA decolonisation in haemodialysis and PD patients

When to send Dialysis Staph aureus screens: Access clinic and Low clearance clinic Patients likely to require dialysis within 6 months Before access procedure 10 South,10 East wards and renal outliers Patients admitted who are on dialysis Before insertion of line, graft making a fistula or fistuloplasty Before discharge to dialysis unit Dialysis units All patients every three months according to schedule New and old patients accepted to unit Before transfer to another dialysis unit PD patients Send on every attendance in hospital When to send an MRSA screen

Dialysis patients
Dialysis Staph aureus screen sent from dialysis unit every 3 months according to rota

Insertion of dialysis lines and grafts and PD catheters

Has a Dialysis Staph aureus screen been sent in previous 3 months?

Access clinic and Low clearance clinic All new referrals When attending after a hospital admission 10 South, 10 East wards and renal outliers All admissions including transfers from other wards On discharge for patients attending dialysis units. Dialysis units New transfers in from other Trusts

Result = Staph aureus isolated Result = aureus No Staph

isolated

Result = No Staph aureus isolated

No

Yes

Do not give decolonisation

Give decolonisation for 5 days

Do not give decolonisation

Result = Staph aureus isolated

Result = No Staph aureus isolated

Staph aureus screen: Nose swab Give decolonisation for 5 days, starting day before insertion Do not give decolonisation MRSA screen: Nose swab Perineum swab IV line (exit) site swab Wound(s) swab (CSU if catheterised)

Rest 2 days Then repeat screen If Staph aureus isolated from repeat screen give one further course of decolonisation Send next dialysis Staph aureus screen according to rota

Rest 2 days Then repeat screen If Staph aureus isolated from repeat screen give one further course of decolonisation

MRSA and Staph aureus decolonisation regimen MRSA and Staph aureus sensitive to mupirocin. Mupirocin in paraffin base t.d.s. to both nostrils for 5 days. Chlorhexidine mouthwash q.d.s. for 5 days. Chlorhexidine 4% skin wash / bed bath daily for 5 days. Regimen of Hibiscrub hairwash, rinse, normal shampoo, rinse. Twice during the 5 days Staph aureus resistant to mupirocin As above using hibitane instead of mupirocin If 2 or more courses of decolonisation have been given in previous 12 months then discuss with Vicky Pang HNT infection control Nurse 07799623159 or Infection Control x35216

IPC Manual/IPC protocol for MRSA screening

15.2

Renal dialysis satellite units. Units which do not have isolation facilities will transfer all MRSA patients to the Royal Free site for dialysis until screened clear of MRSA. Patients transferred to these units from the Royal Free Site should be screened prior to transfer or immediately on transfer if this cannot be arranged.

When units have non-isolated MRSA patients, all transfers to the Royal Free site must be screened and go to side rooms in non-endemic wards, side rooms or open bays in endemic wards, and be screened immediately.

16 16.1

Staff screening. Introduction Staff screening is co-ordinated by the Health and Work Centre (HWC) Staff screening is only indicated if the pattern of cross infection indicates transmission to diffuse areas of ward, rather than transmission limited to a bay and is instigated by the Infection Prevention and Control Team, usually following an Emergency Infection Prevention and Control Meeting. Staff contacts of known GRSA/GISA patients may have a more extended screening and decolonisation regimen, which will be managed on a case by case basis with discussion between HWC and microbiology consultant.

See 16.2 appendix A for Health and Work Centre policy,

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16.2

Staff screening/management pathway

STAFF SCREENING
First Screen - Nose -Skin lesions

Negative

Positive

No further action

- Topical decolonisation as per protocol for 5 days started immediately. - Refrain from work for first 48 hours of decolonisation. - Re-screen 2 days after finishing decolonisation.

Negative Screen

Positive Screen

-Repeat topical decolonisation for a further 5 days -Re-screen 2 days after finishing decolonisation. -Staff refrain from work until results of post decolonisation screen known.

Negative

Positive

- Screen nose, throat, skin lesions. Other sites if indicated. - Systemic treatment will be discussed by H&WC and IPCD. - Topical decolonisation will not be routinely repeated. - H&WC and IPC Doctor decide on case by case basis whether staff continue to refrain from work during this time.

Return to work Re-screen weekly until 3 negative screens. Negative Negative Positive Positive

Nil further action

Discuss case by case basis with H&WC and IPCT IPC MRSA screening policy

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16.3 Appendix A
Royal Free Hampstead NHS Trust Health and Work centre MRSA Policy Staphylococcus aureus (S. aureus) is a bacterium commonly colonising skin and mucous membranes. Many people live symptom free in the community with this organism. Most strains of S. Aureus are treatable with a wide range of antibiotics, including flucloxacillin and are know as MSSA. Some strains of S. aureus have become resistant to many antibiotics and are known as MRSA strains. MSSA and MRSA are equally pathogenic and have the potential to cause life threatening infections, such as bacteraemias in hospital patients who may be immunocompromised or have open wounds. The occurrence of invasive infection, especially in vulnerable patients, and limited options for treatment of MRSA means that a concentrated effort is made in the hospital environment to contain MRSA and prevent cross infection. MRSA is most commonly transmitted on the hands of health care workers and survives in dust. Transmission can be greatly reduced by adherence to basic infection control measures such as hand washing before and after contact with each patient and general environmental cleanliness. This is the procedure to be followed should the Infection Prevention and Control (IPC) Team ask for an MRSA screen of staff. Staff screening is only requested if the pattern of cross infection indicates transmission to diffuse areas of a ward, rather than transmission limited to a bay. Such screening is instigated by the IPC Team, usually following an Emergency IPC Meeting Screening IPC will tell H&WC (by telephone and email) and the ward manager if a staff screen is needed. The H&WCNA co-ordinating the screen must check that the ward staff have the correct forms for submitting swabs and know how to label the swabs correctly. The co-ordinating H&WCNA will ask the ward sister to compile a list of all staff that need screening including domestics, physios, OTs, doctors etc An H&WCNA will visit the ward/department and start the screening process. He/she will take nose swabs from all the staff involved and swabs from anyone with exposed skin lesions (eczema, wounds etc). As staff are swabbed, they will be logged on the list. A copy of the list must remain with the ward/department manager so that staff working shifts, weekends and those not available at time of visit by H&WCNA can be screened. A copy will also be kept in H&WC so that results can be logged and progress monitored. Staff are informed that H&WC do not routinely inform them of negative results in the event of a positive result, they will be contacted by an H&WCNA or if out of normal office hours, by the site manager. For those staff not available at the time of the H&WCNA visit, instructions are left with one or two nominated members of staff in order for them to complete the screen. Staff may also come to the H&WC unit for their swabs if they prefer. The ward/department manager is asked to keep H&WC informed of progress. It may be necessary for the H&WCNA to contact him/her on a regular basis to keep information up to date.

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To take a nose swab, dip the swab into the transport medium and rotate the swab anti-clockwise five times in each nostril. The same swab is used for both nostrils. The swab is only rotated in the anterior nares, rather than higher into the nasal cavity. To take a swab from a skin lesion, dip the swab into the transport medium and pass gently over the lesion several times until exudate or shedding has been collected. Use a different swab for each lesion. All transport containers should be clearly marked with the site of the lesion.

Positive results Contacting Staff During Normal Office Hours (09.00 17.00, Monday to Friday excluding bank holidays) Positive results will be telephoned through to H&WC by Microbiology An H&WCNA will try to contact the member of staff directly in the event of a positive result. IPC and microbiology will not contact the staff member apart from exceptional circumstances. It may be necessary to contact staff at home or in the case of agency staff, via their agency. Every effort should be made to maintain confidentiality at all times. The staff member should be asked to attend H&WC as soon as possible. They must leave the workplace immediately. They should inform their manager that they will be away from work from work for 48 hours and this should be recorded as absence due to infection control rather than sickness absence.

Out of Normal Office Hours, Bank holidays and Weekends. The on-call Consultant Microbiologist should notify the site manager (or the most senior nurse on duty) that the member of staff should refrain form work and report to H&WC on Monday morning (or next working day) for further advice and management. To maintain confidentiality, the reason for this advice will not be disclosed by the Microbiologist to the site manager. The person notifying the member of staff (site manager or senior nurse) should advise them to contact the on-call Consultant Microbiologist to discuss the reason why they are being sent off duty. Microbiology should contact H&WC on Monday morning (or the next working day) and inform them of the member of staffs MRSA status. It is the responsibility of H&WC to arrange and oversee treatment of staff with MRSA, Decolonisation Treatment If their nose swab is positive to MRSA, they will be given a prescription for Mupiricin in Paraffin base, to both nostrils, three times a day for five days, Betadine/chlorhexadine gargle four times a day for five days Chorhexidine 4% skin wash/bath daily for five days Hibiscrub hairwash, rinse, normal shampoo, rinse. Twice during five days

If a skin lesion is infected, each case will be considered on an individual basis. This should be discussed with the H&WC and with one of the infection prevention and control doctors. On attending for prescriptions, staff should be given an advice sheet and any questions discussed. They will typically be off work for the first 48 hours of treatment. Allow two days following completion of this treatment before starting the post decolonisation screening programme. An appointment should be given to them when they come for their prescription.
IPC MRSA screening policy

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Post eradication treatment screening process The first post decolonisation swab must be taken in H&WC. Ideally, all three should be taken by an H&WCNA but if this is inconvenient for the staff member, they may arrange to have the swabs taken on the ward by the staff trained/designated to do so. Three post decolonisation treatment swabs are needed at weekly intervals. The H&WCNA coordinating the screen should remain in contact with the colonised staff member and remind them to attend for follow up swabs. If any of the post decolonisation treatment swabs are positive, further treatment will be needed and this should be discussed with one of the infection prevention and control consultants.

CJ/DM Dec 2004 Updated in conjunction with infection control and microbiology March 2005 Update August 2009

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17.

References Working Party Report - British Society for Antimicrobial Chemotherapy, the Hospital Infection Society and the Infection Control Nurses Association. Guidelines for the control and prevention of methicillin resistant Staphylococcus aureus (MRSA) in healthcare facilities. Journal of Hospital Infection (2006) 63S : S1-S44. DOH (1996) Chief Medical Officer. Methicillin Resistant Staphylococcus aureus in Community Settings.
3 2 1

NPSA Safer practice notice 15. Colour coding hospital cleaning materials and equipment,10 January 2007. Department of Health (2008) The Health and Social care Act. Code of Practice for the NHS on the prevention and control of healthcare associated infections and related guidance

IPC MRSA screening policy

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