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MRSA IN PRACTICE
By the late Mr Nicholas J. Mills, M.A., Vet.M.B., M.R.C.V.S, Q.D.R.
BMF advisor and friend
Senior Partner, Cinque Ports Veterinary Associates, Cranbrook Road, Hawkhurst, Kent
Petplan were one of the major sponsors of the 1st International Conference on MRSA in
Animals which was held between 19th and 21st June 2006 at Liverpool University
Veterinary School and the major findings are summarised below.
Background:
MRSA (Methicillin Resistant Staphylococcus Aureus) is now recognised as a worldwide
problem in companion animals, horses and farm animals and whilst it has not reached the
major problem that it has in human hospitals, veterinary surgeons now need to recognise
that some of the animals they treat may be carriers or infected with MRSA and this needs
consideration for both treatment regimes and in recognising the risk of transfer to other
animals and to veterinary staff.
Certain countries, notably the Netherlands and Scandinavia, have controlled MRSA
infection in human hospitals effectively. Unfortunately, the UK has a poor record in its
human hospitals as regards MRSA. UK veterinary practices now have the opportunity to
use “best practice” to control MRSA.
MRSA – Method of Infection:
Animals usually acquire MRSA from humans and can act as reservoirs of infection for
humans who are in contact.
MRSA can be spread by direct contact or indirectly (normally due to poor hygiene).
MRSA is of little risk to healthy individuals but is of concern to:
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Immuno-compromised patients.
Long-term in-patients and those undergoing major surgery.
Patients with catheters and implants.
Patients with open wounds.
Measures to Prevent the spread of MRSA:
As MRSA can survive for up to twelve months in hospital dust top quality hygiene is the
key to success here requiring:
1. Conscientious hand washing.
2. Disinfection of surfaces and equipment between patients.
3. At a time when most veterinary practices have computers in the consulting rooms
and reception, waterproof keyboards or keyboard covers should be used.
4. Wearing protective uniforms that can ideally be laundered regularly on site.
5. Wearing disposables e.g.
 Disposable gloves.
 Disposable aprons.
 Disposable masks etc.
6. Cover all wounds with barrier dressings.
7. Thoroughly clean cages daily and between patients.
8. The highest standards of aseptic technique in the operating theatre:
 Sterilisation of equipment.
 Minimise theatre staff.
 Use sterile gowns, hats, masks and drapes.
9. Handle clinical waste sensibly and carefully with sealed bags of appropriate
strength and colour.
10. The rational and conscientious use of antibiotics is important.
It is extremely sensible for a practice to have a specific member of staff (normally the
head nurse) to be in charge of these control measures (echoing the belated return of
“matron” to the NHS wards).
Identification of MRSA Infected Patients:
MRSA infection should be suspected in:
 Patients from known MRSA positive households.
 Patients belonging to healthcare workers.
 Patients with non-healing wounds and likely staphylococcal infection.
Hospitalisation:
If a known MRSA patient needs to be hospitalised they should be moved directly into the
consulting room, (which should be cleaned and disinfected after use).
The MRSA patient should be isolated from other patients as direct spread can be up to
four metres and mechanical spread is also possible.
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Stethoscopes, pens, thermometers etc should be used with the infected patient only and
then thoroughly disinfected.
Barrier nursing techniques and conscientious hand and forearm washing should be used.
Surgery:
Before surgery on an MRSA positive patient it may be possible to decontaminate the
patient by using an antibacterial shampoo, bathing the surgical sites with alcohol and
even using nasal mupirocin to reduce the risk of MRSA colonising the surgical site. The
MRSA positive patients should be discharged from the veterinary practice environment
as soon as possible.
MRSA in Horses:
MRSA can colonise horses without producing clinical signs and whilst the infection is
still uncommon the fact that MRSA can spread from horse to human and visa versa is of
considerable concern.
Staff Screening for MRSA:
Staff screening can help if MRSA becomes an endemic problem in a practice but the
surveillance of staff carries with it issues of confidentiality and stigmatisation.
MRSA Treatment:
MRSA infections can often be successfully treated. The choice of antibiotic should be
based on the results of culture using appropriate antibiotics at appropriate concentrations.
MRSA infection is not synonymous with death and most cases can be successfully
treated.
The Use of Modern Silver Wound Dressings in the Control of MRSA:
The latest silver wound dressings such as “Aquacel AG ™Convatec” can be particularly
useful in the control of MRSA and the silver ion release allows for a very rapid
destruction of bacteria which lasts for a prolonged time of action.
Legal Issues:
Veterinary staff should be told about MRSA positive cases as soon as it is known and all
reasonable precautions taken. Immuno-suppressed staff should not nurse MRSA positive
animals.
SUMMARY:
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MRSA represents a moderately significant problem in veterinary practice at present but
with the potential to become an enormous problem.
Petplan were pleased to sponsor the 1st International Conference on MRSA in animals
and would like to thank the organisers and Liverpool Vet School for a most practically
useful and thought-provoking conference.
References:
Proceedings of the 1st International Conference on MRSA in animals 19/21st June 2006,
University of Liverpool.
With special thanks to Dr Tim Nuttall, David Lloyd, J. Scott Wesse
and to The Bella Moss Foundation.
Photogaphs by Tom Mills
[email protected]
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