Managing MRSA is a fact of life in aged care. Yes yes, methicillin-resistant Staphylococcus aureus (MRSA), not that old chestnut again! We discussed MRSA and Staph earlier this year in another blog post, so we know that you’re all up-to-date. We all know this bacterium lives harmlessly on the skin and in the nose. And as we all know, MRSA has become resistant to some of the commonly used antibiotics, such as flucloxacillin. Therefore we now have antimicrobial stewardship to manage this bacterium!

The routine use, of surveillance cultures, and antibacterials, in an attempt to permanently eradicate MRSA from nursing home residents has not been successful, and resistance has quickly emerged.

Bradley, S. F., Methicillin-Resistant Staphylococcus aureus in nursing homes. Epidemiology, prevention, and management.

Fortunately there’s more than one way to skin a cat (no disrespect to cat lovers!). Nursing homes should therefore consistently follow and utilise all the infection control practices available to disrupt transmission by direct or indirect contact. By doing this, they can prevent the potential spread of MRSA.

1.     Managing the patient

Managing a patient with MRSA involves careful handling to ensure that the bacterium is not spread. This means ensuring the correct handling and isolation of theManaging a patient with MRSA involves ensuring that the bacterium is not spread. This means correct handling and isolation of the patient. Effective practices in standard and transmission-based precautions; you just can’t get away from them, can you? And that is for a good reason. These precautions underpin day-to-day infection prevention and control and will stop more than just MRSA spreading.

Hand hygiene

Hand hygiene is probably the most important when it comes to transmission of micro-organisms. We should practice the 5 Moments of Hand Hygiene in a Hand hygiene is probably the most important factor when it comes to transmission of micro-organisms. We should practice the 5 Moments of Hand Hygiene in a clinical setting, but we need to educate our residents and visitors in practicing good hand hygiene as well. After all, we are all in this together! Hand hygiene supplies need to be readily accessible ‘at the point of care’: wherever a physical activity takes place that involves our hands. Don’t be frightened to use that ABHR either, as many times as you need to.

PPE

Our next layer of defence is the appropriate use of PPE. Ensure staff know when to apply it, what PPE to apply and how to don and doff without contaminating themselves. You may also need to educate visitors on putting on and taking off their PPE, depending on what is being used!

Additional precautions

Then there are the additional precautions (transmission-based precautions), used on top of standard precautions. These will probably be contact precautions for MRSA in wounds, or airborne precautions if the MRSA is in the respiratory tract. Respiratory hygiene/cough etiquette is another standard precaution that is used to stop the transmission of micro-organisms in the respiratory system. Help your residents by encouraging them to cover their coughs and sneezes and dispose of any tissue immediately in a nearby bin.

Isolation

RResidents should ideally be in a single room alone, or cohorted with another resident with a similar infection. If the MRSA is in a wound and the wound is covered, and the resident is able to effectively manage self-care, then they may be able to venture outside the room for appointments, and to receive visitors.

Ensuring the proper use of PPE and other precautions as appropriate will help stop the spread of MRSA.

2.     Managing the environment

The next management strategy is effective environmental infection prevention and control. Yes, cleaning! This means the environmental hygiene of work areas such as equipment and other frequently touched surfaces where MRSA contamination has possibly occurred.

Cleaning should be a two-step clean: detergent then disinfectant. Just as revision, you need to use detergents to remove soil, dust, dirt, organic matter and germs (like bacteria, viruses and fungi). Cleaning with detergent lifts the dirt and germs off of surfaces, which can then be rinsed with water. Cleaning with a detergent is necessary to remove dirt that can prevent disinfectants from working.

Once the surfaces are clean, it’s time to disinfect. Disinfectants are chemical products that are used to kill micro-organisms, such as MRSA. Make sure that you are using TGA-approved disinfecting agents that have been made up to the correct strength.

When these simple, and relatively inexpensive precautions are implemented, transmission can be disrupted, preventing the potential spread of MRSA.

Managing resistant organisms in aged care is difficult. You need to ensure efficient and effective cleaning, as well as appropriate patient management and education. You also need to ensure that your antimicrobial stewardship program is working as intended. If you need help with managing MRSA, antimicrobial stewardship, or environmental cleaning in your facility, contact Bug Control. From infection control policies and procedures to environmental cleaning audits, we can help you stop infections.