Download MRSA Primary Care Policy - NHS Durham Dales, Easington and

Policy for the Management of
Meticillin Resistant Staphylococcus Aureus (MRSA)
Positive Patients Within Primary Care v5
IC04
Version Number:
5
Issue Date:
January 2014
Review Date:
January 2017
Sponsoring Directors:
Directors of Nursing
NHS North Durham, NHS Darlington, Durham Dales,
Easington
and
Sedgefield
(DDES)
Clinical
Commissioning Groups (CCGs)
Prepared By:
Lead Infection Prevention and Control Nurse
Consultation Process:
Members of Health and Social Care Health Care
Associated Infection (HCAI) Assurance Group
Document History
Version Date
2
Sept 2006
3
Nov 2008
4
Nov 2010
5
Jan 2014
Significant Changes
*
*
* None
* None
POLICY VALIDATION STATEMENT
This policy is due for review on the latest date shown about.
After this date, policy and process documents may become invalid.
Policy users should ensure that they are consulting the current valid version of the
documentation.
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EQUALITY IMPACT ASSESSMENT STATEMENT
Audit Assessment
Date
Result
Risk Audit
14.01.2014
Risks identified and risk assessment included
at Appendix 1
Equality Audit
14.01.2014
No or very low potential for discrimination
Human Rights Audit
14.01.2014
No breach of Human Rights
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POLICY FOR THE MANAGEMENT OF METICILLIN RESISTANT
STAPHYLOCOCCUS AUREUS (MRSA) POSITIVE PATIENTS WITHIN PRIMARY
CARE
CONTENTS
Section
Title
Page
1
Introduction
4
2
Definitions
4
3
Management of Meticillin Resistant Staphylococcus
Aureus (MRSA) Positive Patients Within Primary/
Community Care
5
4
Duties and Responsibilities
7
5
Implementation
9
6
Training Implications
9
7
Documentation
9
8
Monitoring, Review and Archiving
10
9
Equality Impact Assessment Statement
11
Non-Compliance
14
Appendices
1
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POLICY FOR THE MANAGEMENT OF
METICILLIN RESISTANT STAPHYLOCOCCUS AUREUS
(MRSA) POSITIVE PATIENTS WITHIN
PRIMARY/COMMUNITY CARE
1
Introduction
NHS North Durham, NHS Darlington and NHS DDES CCGs aspire to the
highest standard of corporate behaviour and clinical competence, to ensure
that safe, fair and equitable procedures are applied to all organizational
transactions, including relationships with patients, their carers, public, staff,
stakeholders and the use of public resources. In order to provide clear and
consistent guidance, NHS North Durham, NHS Darlington and NHS DDES
CCGs will develop documents to fulfil all statutory, organizational and best
practice requirements and support the principles of equal opportunity for all.
The aim of this policy is to provide a framework for the safe management pf
Meticillin Resistant Staphylococcus Aureus (MRSA) Positive Patients within
Primary Care.
This policy is in line with national guidance from the Department of Health
(DH).
1.1
Status
This policy is an Infection Control policy.
1.2
Purpose and Scope
To provide optimum care and management of patients colonised or infected
with MRSA and to minimise the risk of spread to other patients and health
care workers.
This policy applies to all health care workers working within NHS North
Durham, NHS Darlington and NHS DDES CCGs.
2
Definitions
MRSA – Meticillin Resistant Staphylococcus Aureus. The name given to
strains of staphylococcus aureus that are resistant to Meticillin.
Meticillin – an antibiotic that is not used clinically, but Meticillin Resistant
Staphylococcus is often resistant to other commonly used antibiotics.
Colonised – the presence of a bacteria but the patient shows no clinical signs
of infection.
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Infected – patient showing clinical signs of infection
3
The Management of Meticillin Resistant
Staphylococcus Aureus (MRSA) Positive Patients
within Primary Care
Staphylococcus aureus (S. aureus) is carried in a number of sites on the body
eg nose and perineum. These areas are called carriage sites. Up to 30% of
the population are nasal carriers at any one time. Staphylococcus aureus is
usually a commensal, neither benefiting nor harming the host.
However, if it gains access to tissues beneath the skin or mucosa it may
cause infections eg abscesses, wound/chest infections. It may, rarely, cause
severe systemic infections.
MRSA is the name given to strains of S.aureus that are resistant to Meticillin.
Meticillin is an antibiotic that is not used clinically but Meticillin Resistant S.
aureus is often resistant to other commonly used antibiotics. Like Sensitive S.
aureus, MRSA may colonise or cause an infection. An infection is suspected
when MRSA is isolated and the patient shows clinical signs of infection.
Colonisation is suspected when MRSA is isolated but the patient shows no
clinical signs of infection.
There is no evidence that MRSA causes more severe infections than other
strains of S.aureus, but treatment is often more difficult.
3.1
Management of patients within primary care
Patients who are colonised or infected with MRSA should not be prevented
from visiting their GP surgery.
3.1.1 Protective Clothing
Disposable plastic aprons must be worn for activities involving direct patient
contact. Gloves must be worn by staff for direct patient contact, or for contact
with secretions and handling of infected/soiled dressings. Within general
practice aprons and gloves must be disposed of as infectious hazardous
waste. Hazardous waste bins must be foot-operated and have a lid. See local
waste Policy.
3.1.2 Hand Hygiene
All healthcare workers must perform hand hygiene before and after each
patient or environmental contact and after disposal of Personal Protective
Equipment. Alcohol gel can be used as a rapid disinfectant between patient
contacts if hands are visibly clean. See Hand Hygiene Policy.
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3.1.3 Equipment
Equipment shared between patients (eg stethoscope, tourniquet) must be
thoroughly cleaned with an alcohol wipe before being used on another patient.
The examination couch should be covered with disposable paper towel and
changed between each patient, and the couch cleaned with detergent and
water after use.
Sheets and blankets should not be used within general practice unless they
are changed between each patient and industrial washing machine facilities
are available.
3.1.4 Communication
A verbal explanation accompanied by an information leaflet available from
Infection Control Nurses should be given to the patient. A leaflet can also be
given to relatives. The opportunity to speak to an Infection Control Nurse can
be offered if the health care worker is unable to answer any specific
questions.
3.1.5 Patient Screening
Routine screening is not required in the community. If a specific request is
made by a hospital Infection Control Nurse or microbiologist then the following
swabs should be taken:
Nose – Rotate swab around the anterior nares of each nostril using the same
swab for both nostrils.
Groin/perineum – 4 firm strokes over groin/perineum.
Nose and groin/perineal swabs should be sent with only one request card to
requesting hospital and labelled ‘MRSA screen’.
NB
Swabs for MRSA will be screened only for MRSA. If there are signs of
clinical infection at the site, a second swab should be taken for culture
and sensitivity and be sent with a separate request form.
3.1.6 Eradication Therapy
Should only be prescribed if clinically indicated, eg patient is being admitted to
hospital for surgery and it has been specifically requested, or the treatment
would reduce the risk of the patient becoming infected.
If a patient is positive for MRSA from any skin site, a daily antibacterial body
and hair wash with Octenisan is required for 5 consecutive days. Contact the
Infection Control Nurse if the patient has a skin condition before starting this
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treatment eg eczema. Octensian must be applied to moist skin and hair.
Manufactures’ guidance must be followed
Do not use flannels/face cloths – use disposable wipes. It is advisable that
patients should use separate towels from other people. Clean clothing should
be worn daily during treatment, where possible.
Nasal carriage – apply Mupirocin nasal ointment to anterior nares using a
cotton bud three times a day for five days. Recent studies have shown that
using a combination of interventions together gave better success rates
of decolonisation. It is therefore recommended that nasal Mupirocin
and Octenisan should be given at the same time. If there is carriage in
another site eg pressure sore, peg, wound - discuss with Infection Control
Nurses.
3.1.7 Treatment of Infections
Advice regarding specific anti-microbial therapy can be obtained from the
Consultant Microbiologists on the respective sites:
UHND
DMH & BAGH
Out of hours
0191 333 2333 Ext. 2430 or 2613
01325 380100 Ext. 3241 or via switchboard
Via switchboard at all sites including North Tees,
Hartlepool and Sunderland.
3.1.8 Confidentiality
MRSA is part of a patient’s diagnosis. Personnel who do not have access to
the patient’s medical/nursing notes should not be told the nature of the illness
but should be given specific infection control guidelines. Giving a diagnosis
inappropriately is a breach of confidentiality.
3.1.9 Staff Screening
This is NOT necessary, unless requested by the Infection Control Nurse or
Infection Control Doctor.
4
Duties and Responsibilities
4.1
Accountable Officer
The Accountable Officer has overall responsibility for the
strategic direction and operational management, including ensuring that CCG
process documents comply with all legal, statutory and good practice
guidance requirements.
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4.2
Director of Nursing
As the nominated director responsible for Infection Prevention and Control the
Director of Nursing has delegated responsibility for ensuring that
arrangements are in place to manage Infection Prevention and Control
including the risks from the safe management of Meticillin Resistant
Staphylococcus Aureus (MRSA) Positive Patients within Primary Care.
In addition the Director of Nursing is responsible for ensuring that the policy is
drafted, approved and disseminated in accordance with ‘Writing Policy
Documents’.
The necessary training and education needs and methods to implement this
document are identified and resourced. Mechanisms are in place for the
regular evaluation of the implementation and effectiveness of this document.
4.3
Lead infection prevention and control nurse
The Lead Infection Prevention and Control Nurse will:
4.4

generate and formulate this policy, identifying appropriate processes
for regular evaluation of, and the implementation and effectiveness of,
this policy;

notify the Policy Coordinator of any revisions to this document;

ensure the policy is taken to members of the Health and Social Care
HCAI Group for comment;

arrange for superseded version of this document to be retained in line
with national guidance.
All staff
All staff, including temporary and agency staff, are responsible for:

compliance with relevant process documents. Failure to comply may
result in disciplinary action being taken

co-operating with the development and implementation of policies and
procedures as part of their normal duties and responsibilities

identifying the need for a change in policy or procedure as a result of
becoming aware of changes in practice, changes to statutory
requirements, revised professional or clinical standards and
local/national directives, and advising their line manager accordingly

identifying training needs in respect of policies and procedures and
bringing them to the attention of their line manager

attending training/awareness sessions when provided
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5
Implementation
5.1
This policy will be available to all staff for the management of patients with
MRSA.
5.2
All managers are responsible for ensuring that relevant staff within their
departments have read and understood this document and are competent to
carry out their duties in accordance with the procedures described.
6
Training Implications
The sponsoring director will ensure that the necessary training or education
needs and methods required to implement the policy or procedure(s) are
identified and resourced or built into the delivery planning process. This may
include identification of external training providers or development of an
internal training process.
7
Documentation
7.1
Other related policy documents
Policy for General infection control precautions
Policy for decontamination of equipment
7.2
Legislation and statutory requirements
Health and Safety Executive (1974) Health and Safety at Work Etc. Act 1974.
7.3
Best practice documents
Coia, J.E. et al (2006) Guidelines for the control and prevention of meticillinresistant Staphylococcus aureus (MRSA) in healthcare facilities by the Joint
BSAC/HIS/ICNA Working Party on MRSA, Journal of Hospital Infection 63
Department of Health (2008) MRSA Separating Fact from Fiction, London, DH
7.4
References
Coia, J.E. et al (2006) Guidelines for the control and prevention of meticillinresistant Staphylococcus aureus (MRSA) in healthcare facilities by the Joint
BSAC/HIS/ICNA Working Party on MRSA, Journal of Hospital Infection 63
Department of Health (2010) The Health and Social Care Act 2008 Code of
Practice on the prevention and control of infections and related guidance.
London, DH
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Department of Health (2008) Going Further Faster II: Applying the learning to
reduce HCAI and improve cleanliness, London, DH
Department of Health (2008) MRSA Separating Fact from Fiction, London, DH
Health and Safety Executive (2002) Control of Substance Hazardous to
Health (COSHH) Regulations, London, HSE
Perry,C. (2008) Exploring the evidence for screening staff for MRSA. Nursing
Times, Vol.104, No 3
8
Monitoring, Review and Archiving
8.1
Monitoring
The Director of Nursing, as sponsor director, will agree with the Lead Infection
Prevention and Control Nurse a method for monitoring the dissemination and
implementation of this policy. Monitoring information will be recorded in the
policy database.
8.2
Review
8.2.1 The Director of Nursing will ensure that each policy document is reviewed in
accordance with the timescale specified at the time of approval. No policy or
procedure will remain operational for a period exceeding three years
without a review taking place.
8.2.2 Staff who become aware of changes in practice, changes to statutory
requirements, revised professional or clinical standards and local/national
directives that affect, or could potentially affect policy documents, should
advise the sponsoring director as soon as possible, via line management
arrangements. The sponsoring director will then consider the need to review
the policy or procedure outside of the agreed timescale for revision.
8.2.3 If the review results in changes to the document, then the initiator should
inform the policy manager who will renew the approval and re-issue under the
next ‘version’ number. If, however, the review confirms that no changes are
required, the title page should be renewed indicating the date of the review
and date for the next review and the title page only should be re-issued.
8.2.4 For ease of reference for reviewers or approval bodies, changes should be
noted in the ‘document history’ table on the front page of this document.
NB If the review consists of a change to an appendix or procedure document,
approval may be given by the sponsor director and a revised document may
be issued. Review to the main body of the policy must always follow the
original approval process.
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8.3
Archiving
The Policy Manager will ensure that archived copies of superseded policy
documents are retained in accordance with Records Management: NHS Code
of Practice 2008.
9
Equality Impact Assessment Statement
The tables below summarise reviews with respect to:



9.1
Strategic and operational risks, including risks to health and safety.
Current equality and diversity legislation.
Rights under the European Convention on Human Rights.
Risk Audit
Risk Audit for
RISK CATEGORIES
1
2
3
4
5
6
7
8
Risks relating to organisational objectives
Risks to patient experience/outcome
Risk to or from service/business interruption
Risks relating to staffing and competence
Financial risks
Risks to compliance with inspection/audit standards
General risks to organisational reputation
Specific health and safety (inc fire) risks to persons
(staff, patients, public, etc)
a
Location (access, environment, working
conditions)
b
Equipment (medical, electrical, other)
c
Hazardous substances
d
Lone working
e
Moving and handling
f
Potential to cause undue stress
g
Anti-social behaviour (violence, harassment,
theft)
Significant Risks
Identified Yes/No
Yes
Yes
No
Yes
No
Yes
Yes
No
No
No
No
No
No
OUTCOME (tick appropriate box)
ACTION
No significant risks
identified
Significant risks identified
Proceed with ratification process.
There is some doubt about
whether risks are significant
or relevant.
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Complete a full risk assessment form and
action plan for all risks identified. Include in
the Appendices – see Appendix 1.
Take further advice from appropriate
directorate or department. If unresolved,
refer to Governance and Assurance
Committee.
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9.2
Equality Audit
Equality Audit for
QUESTION
RESPONSE
What is the purpose of the proposed policy document
(or changes to policy document)?
Management of MRSA
positive patients within
primary/community care
Correct patient
management and safety
No
Who is intended to benefit, and how?
Will the proposals involve, or have consequences for,
the people the CCGs serve and employ?
Is there any reason to believe that people could be
affected differently by the proposals, for example in
terms of access to a service, or the ability to take
advantage of proposed opportunities?
Is there any evidence that any part of the proposals
could discriminate unlawfully, directly or indirectly,
against any section of the population?
Is the proposed policy likely to affect relations between
certain groups of people, for example because it is
seen as favouring a particular group or denying
opportunities to another?
Is the proposed policy likely to damage relations
between any particular group(s) of people and the
CCG?
No
No
No
No
OUTCOME (tick appropriate box)
Potential for discrimination
is very low or non-existent
Potential for discrimination
exists
There is doubt about the
potential for discrimination
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
Proceed with ratification process.
Amend the document as appropriate to
clarify exceptions or remove potential. If this
is not possible, take further advice from
Corporate Services Manager and/or the
Equality Lead Manager (HR Department)
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9.3
Human Rights Audit
Human Rights Audit for
QUESTION
RESPONSE
Does the policy document interfere with a Convention
right?
Could the actions described in the policy document
touch on one of the Convention rights?
Is there a victim?
Are there circumstances where the right can
legitimately be limited or interfered with?
Does the interference meet the general criteria
established by the Strasbourg authorities, ie:

The action is prescribed by law

It pursues a legitimate aim.

It is necessary in a democratic society.
No
No
No
No
No
OUTCOME (tick appropriate box)
No rights affected
Potential to affect a right
has been identified
There is doubt about the
potential to affect a right.
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
Proceed with ratification process.
Amend the document as appropriate to
clarify exceptions or remove potential. If this
is not possible, take further advice from
Corporate Services Manager/Legal Advisers.
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APPENDIX 1
There is a risk of non-compliance with all infection control policies which would in turn
increase the risk of patients acquiring healthcare associated infections (HCAI), the
organisation not achieving national targets on HCAI and not complying with inspection
audits.
These policies are designed to provide a framework to reduce those risks.
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