Evaluation article: Care for the patient with MRSA and C. difficile

Published: Friday, 13 June 2014

Find out how to reduce the risk of MRSA and C. difficile infection in your care setting.

What is MRSA?

Meticillin Resistant Staphylococcus Aureus (MRSA) is a strain of bacteria that has become resistant to specific antibiotics. Staphylococcus Aureus is a bacterium found on the skin or in the nose and throat of many individuals and usually presents no problems. Such bacteria, however, are the most common cause of skin and wound infections. Infections caused by the resistant strains (MRSA) are no different from those caused by ordinary strains; they just become more difficult to treat. Occasionally they may be responsible for more serious infections and those undergoing major surgery or who require intensive care may be most at risk.

People who have MRSA on their bodies but who are unharmed by it are described as being colonised.

What are the symptoms?

MRSA causes problems when it enters the body. This is more likely to cause problems in people who are already unwell. The symptoms of an MRSA infection will depend on what part of the body is infected. MRSA can infect a range of body tissues and organs. Most Staphylococcus Aureus skin infections cause boils, abscesses, carbuncles and cellulitis. MRSA can also infect wounds, which become red, swollen and tender with yellow pus seeping from them.

How is MRSA diagnosed?

People who have MRSA do not look or feel different from other people. Swabs can be taken and sent to a laboratory to confirm whether an individual has MRSA and then a doctor can decide on the most
appropriate treatment.

How is MRSA spread?

MRSA can be acquired anywhere, whether it is in hospital or in the community. It is spread mainly on the hands of carers during direct contact with infected sites. The organisms remain on the hands of carers and are passed on from one person to another if the carer does not wash their hands.

What precautions must be taken for MRSA?

There are a number of precautions that can be taken to prevent the spread of MRSA to others.

  • Hand washing is the single most important measure in preventing the spread of MRSA. Hands should be washed following ‘hands on’ care of those infected with MRSA and also following any bed-making or handling used linen or equipment. Hands should be washed with soap under running water and dried on disposable paper towels. Alcohol gel is a useful hand rub for killing bacteria related to MRSA.
  • Appropriate protective equipment such as aprons should be used when carrying out ‘hands on’ care or when there is a possibility of being contaminated from linen or equipment. Gloves should be used while in contact with the MRSA area, or when handling dressings or emptying catheter bags. Hands must be washed after removing and disposing of gloves.
  • Any wounds, cuts or abrasions should be covered with a dressing.

Single room occupancy in either the hospital or care setting is preferred but not essential. Individuals do not need to be isolated, nor is it necessary to limit their visitors if they are residing in the hospital or a care setting. Visitors should be encouraged to wear appropriate protective equipment depending on the individual situation and they should wash their hands using the hand washing technique.

Routine daily damp cleaning of the individual’s room will also help to reduce the spread of infection.

Appropriate treatment should be given to treat the infection. Any individual who is moving in or out of care settings should ensure any infected wounds are covered and that the person in charge is aware of them so that appropriate measures can be put in place.

What is C. difficile?

Clostridium Difficile (C. difficile) is a bacterium that is found in many people’s bowels. It does not usually have a harmful effect as it is controlled by other bacteria. However, when some antibiotics are being taken the bacteria that usually stop C. difficile causing any problems are destroyed. As a result the individual may suffer from C. difficile disease.

What are the symptoms?

Some people who do not have symptoms may still have C. difficile in their stool samples; however this may be a result of individuals already having C. difficile in their bowel. The main symptoms of those with C. difficile disease include diarrhoea, abdominal pain, fever, feeling sick and loss of appetite.

Once the individual has been clear from diarrhoea for 48 hours they can be considered clear of symptoms, but C. difficile will remain in the bowel and may appear in stools for up to eight weeks after the patient has been clear of symptoms.

How is C. difficile diagnosed?

Doctors may not be able to diagnose C. difficile infections by symptoms alone, as many different conditions cause similar symptoms. Diarrhoea is often a side-effect of taking antibiotics, so does not necessarily mean the individual has C. difficile.

A stool sample grade 6–7 (according to the Bristol Stool Chart) can be taken by a healthcare worker, which will be sent to a laboratory to see whether it contains C. difficile toxins.

How is C. difficile spread?

C. difficile infection is usually spread on the hands of healthcare workers and other people who come into contact with infected people or with an environment contaminated with bacteria or spores.

What precautions can be taken for C. difficile?

There are a number of precautions that can be taken to prevent the spread of C. difficile.

  • Hand washing is once again the single most important measure in preventing the spread of C. difficile. Hands should be washed following ‘hands on’ care of those infected with C. difficile and handling any soiled linen or equipment. Hands should be washed under running water and dried on disposable paper towels. It is worth noting that alcohol gel does not kill the C. difficile spores.
  • Those infected with C. difficile must ensure that they wash their hands after using the toilet and before eating.
  • Appropriate protective equipment should be worn such as gloves and aprons when dealing with any soiled items. Hands should be washed after removing gloves and aprons.
  • Those infected with C. difficile should be cared for in a single room, ideally with an en-suite bathroom. If this is not possible they should have a commode for personal use.
  • All equipment potentially soiled, including touch points, should be cleaned with a sodium hypochlorite solution made up to 1000 parts per million. It is worth noting that C. difficile can survive for long periods of time outside of the body by creating spores.
  • In any care setting linen should be placed in a water soluble bag and washed immediately on a sluice cycle at the highest temperature possible for the linen.

A GP should ensure that any medication being taken is reviewed.

Toolkit

Use the following items in the toolkit to put the ideas in the article into practice:

 

About the author

Suzanne Averill, MSc, RGN, Nurse consultant, Global Infection Prevention, has previously worked for the Health Protection Agency as the International Lead and in commissioning as Head of Infection Control. 

This article was first published in the January 2012 issue of Quality & Compliance Magazine.

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