Page updated 30 April 2007
Management of Patients Found to have MRSA
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What do I do if a patient is found to be colonised MRSA?
- Remember the importance of regular hand hygiene in preventing infection
- Use alcohol gel (or alcoholic chlorhexidine hand rub), or perform clinical hand washing before and after attending to the patient
- Wear an apron if there is a likelihood of clothing / uniform becoming contaminated by a procedure
- Wear gloves if there is a risk of hands becoming contaminated by the procedure
- Source Isolate patients with infected wounds and particularly with respiratory tract colonisation in a single room (or designated area within a ward). Isolate other colonised patients if possible, especially on high risk units (e.g. surgical and orthopaedic wards)
- If nursed on the open ward, keep infected patients separate from those for elective surgery. Cohort nurse if several patients are involved. Use team nursing to keep activities for those colonised separate from non-colonised patients. Preferably one nurse should look after the infected and no other patients.
- Inform the Infection Control Team if a patient known to be colonised with MRSA is admitted to the ward. The ICT can help to make decisions about the need for isolation, cohort nursing and eradication.
- Visitors need not wear protective clothing, but should wash their hands in chlorhexidine gluconate or equivalent or rub their hands with alcohol gel, when leaving the patient. They should be asked not to perform tasks for other patients in the ward.
- Admit patients known to be carrying MRSA into Source Isolation if colonised in the lower respiratory tract or purulent wound(s).
- The patient must not be transferred anywhere (except home) without informing receiving ward/unit.
How do I follow up patients colonised with MRSA?
- Infectious patient(s) (eg colonised in purulent wounds or lower respiratory tract), if not to be sent home promptly, should remain in isolation until discharged.
- If wounds heal, then the patient may be re-screened in appropriate sites.
- Perform a risk assessment before letting a patient out of Source Isolation.
- On re-admission, patients known to have had MRSA should be assumed to be carriers. If screened, many patients will be found to be negative because carriage disappears with time, though rarely in those with chronically open wounds. Even if found to be negative on screening, MRSA carriage can reappear especially if the patient is given antibiotics.
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