Meticillin- Resistant Staphylococcus aureus (MRSA) Policy

Meticillin- Resistant Staphylococcus aureus (MRSA) Policy Policy Number / Version: Ratified by: 7.16 v2 Trust Board Date ratified: 31 st March 2009 Name of originator/author: Name of responsible committee/individual: Date issued: 31 st March 2009 Review date: March 2011 Date of first issue January 2007 Target audience: Infection Prevention and Control Team Director of Infection Prevention and Control All PCT employed Staff and others working on behalf of the Trust Page 1 of 23

Contents Responsibilities................ 3 What is MRSA.................. 3 How is MRSA spread................ 5 Control Measures................ 6 Specimen Collection................ 9 Treatment.................. 11 Screening.................. 11 Day Cases.................. 13 Respite Admissions................ 13 Appendices Appendix l: Topical Regimen............ 15 Appendix ll: Day Case Admissions.......... 17 Appendix lll: Inpatient Admissions.......... 18 Appendix lv: Equality Impact Assessment Tool...... 19 Appendix V: Consultation and Ratification Schedule...... 20 References.................. 21 Bibliography.................. 22 Page 2 of 23

Introduction The term the Trust used throughout this document refers to NHS Stoke on Trent and Stoke on Trent Community Health services. This policy should be read in conjunction with the Trust s Specimen management (7.14), Hand Hygiene (7.3) and Standard Precautions (7.4) policies located in the Trust Infection Control Policy Manual. Please also refer to the Trust s staff information leaflets on MRSA and Standard Precautions. Aim of the Policy The recommendations outlined in this policy aim to minimise the acquisition and spread of MRSA by assisting staff working in community hospitals, community and primary care settings. The policy will achieve these aims by ensuring that staff working with patients in any of the above settings will have knowledge and be competent in delivering care which includes the application of Standard Principles of Infection Prevention and Control. It is not possible to always know who may have an infection, therefore a standardised proactive approach to all patients and situations is required. The Trust Expectations and Responsibilities The Trust will provide a Meticillin-Resistant Staphylococcus aureus (MRSA) policy, and training in infection control and sample collection. It is expected that all staff have an understanding of, and apply the Standard Principles of Infection Prevention and Control takeing appropriate measures to minimise the risk of infection at all times. This will be a requirement in all job descriptions. (Department of Health, 2008) Staff Responsibilities Service leads, team leaders, matrons, and ward managers, must ensure that all staff are familiar with the MRSA policy through infection control induction undertaken in the area of practice. Staff must be seen to adhere to and apply the policy at all times. Service leads, team leaders, matrons and ward managers must ensure that staff are released from the clinical area to attend training and updates in infection control. Colleagues working within clinical teams are encouraged to contact the Infection Prevention and Control team for specialist advice associated with individual cases of MRSA. What is MRSA? Staphylococcus aureus is a bacterium found in 20-30% of the noses of healthy people and is commonly found on people s skin, these individual are said to be colonised (see below). Staphylococcus aureus resistant to the antibiotic meticillin (Flucloxacillin) are referred to as meticillin-resistant Staphylococcus aureus or MRSA. Many Page 3 of 23

commonly prescribed antibiotics including penicillin, flucloxacillin, coamoxiclav, cephalosporins, erythromycin, and ciprofloxacin are no longer effective in treating MRSA. What is colonisation? Colonisation with MRSA occurs when the micro-organism is present e.g. in the nose (anterior nares), skin folds, the axillae (armpit), groin or perineum, without any signs of infection. The bacterium may also colonise indwelling devices, such as indwelling urinary catheters and Percutanious Endoscopic Gastrostomy (P.E.G) tubes. Chronic wounds such as pressure sores, and leg ulcers may also be colonised without causing any invasive infection. The wound may continue to heal while colonised with MRSA. Healthy people are unaffected by colonisation with MRSA and may be unaware of its presence, however should a person develop an infection it may be that the colonising strain is responsible for the problem. What is infection? Infection occurs when the micro-organism (MRSA) enters the body and causes a host (person) response, such as pain, pyrexia, inflammation, or tissue damage. MRSA has the potential to cause a range of infections including minor skin infections, surgical site infections and bacteraemia. The severity of the infection will vary depending on a number of factors including the individual s general health and the area of the body infected. The impact of MRSA in the community Patients who are colonised with MRSA will not be aware of its presence, a proportion however may develop an infection which requires treatment. MRSA may be no more dangerous or virulent than meticillin-sensitive Staphylococcus aureus (MSSA), but is more difficult to treat and continues to evolve into new potentially dangerous strains. Panton Valentine Leukocidin (PVL) Staphylococcus aureus PVL is a toxin produced by some strains of Staphylococcus aureus, it can be produced by both MRSA and MSSA. This is commonly associated with previously healthy people living in the community particularly children and young adults who have not had prior contact with the healthcare system. PVL toxin producing strains may cause skin infections, but have been associated with life threatening conditions such as necrotising pneumonia. Patients presenting with recurrent skin infections such as cellulites, boils, and abscesses should be reassessed by the GP or clinician responsible for the patient. Page 4 of 23

MRSA in Hospitals In UK hospitals, approximately 40-50% of all S.aureus strains from clinical specimens are MRSA positive. MRSA is therefore endemic in the hospital setting and may be a risk to vulnerable or debilitated older patients particularly those in the acute stages of illness, post surgical patients and those patients with indwelling medical devices such as vascular or urinary catheters and enteral feeding tubes. MRSA does not usually pose a risk to health care workers unless they have risk factors for infection, for example they may be immunocompromised. However Staff working within clinical teams should report dermatological problems to the Occupational Health Department. The family and friends of affected patients should be encouraged to undertake thorough hand hygiene, they do not need to take any special precautions and should not be discouraged from normal social contact or from contributing to care packages. How is MRSA Spread? Endogenous (Spread from one part of the body to another in the same person) A patient colonised with MRSA may transfer the bacteria from one part of the body to another through touch. Exogenous (Spread from person to person) This may occur via the following routes - Directly, during healthcare treatment. Indirectly via communal shared equipment or the environment. Patients with MRSA may contaminate objects and the environment through aerosols or skin scales which may transfer to other patients either directly or via staff hands. Patients may also acquire antibiotic resistant strains as a result of antibiotic exposure. Commonly antibiotics to which MRSA is resistant provide a selective advantage over sensitive organisms on skin and mucosal surfaces. Who is at risk? Patients with the following are at greatest risk of infectiono Intravenous devices o Surgical wounds o Chronic wounds e.g. pressure sores, leg ulcers o Repeated hospital admissions o Immunocompromised o Complex medical conditions o Multiple courses of antibiotics o Indwelling medical devices e.g. lines, catheters, and enteral feeding tubes Page 5 of 23

Control Measures Antibiotics & Topical Treatment Prudent use of antibiotics is essential. Careful consideration should be given to the need for antibiotics, which should only be prescribed when a patient s condition indicates infection. All antimicrobial prescribing should be in accordance with the Trusts antimicrobial prescribing guidelines. Where the clinical situation requires variation from the guidelines, advice from a Consultant Microbiologist should be sought. Always refer to laboratory sensitivities and document the reason for prescribing. Antibiotics should be given at the correct dosage and for an appropriate duration. The duration and stop date should be recorded on the prescription chart. Clear reasons for antibiotic prescribing must be documented. Glycopeptide antibiotics such as Vancomycin and Teicoplanin should be used selectively. Glycopeptide resistant organisms could threaten the future use of these antibiotics. Topical therapy for superficial infections must never be used without advice from a member of the infection control team. Hand Hygiene Hand hygiene is possibly the single most important measure in preventing the spread of infection. Hands must be decontaminated with alcohol hand rub before and after every patient contact or episode of care (NICE 2003). Visibly soiled hands must be washed with soap and water using the recommended six stage technique. (Please refer to the Trust s Hand Hygiene Policy) In situations where there are out breaks of diarrhoeal infection, hand washing with soap and water must be the first line of defence. (NPSA 2008) An intact skin provides an effective bacterial and waterproof barrier. An aqueous based hand cream should be used regularly to keep the skin moist and supple. Staff must ensure cuts or grazes are covered with a waterproof dressing prior to commencing that period of duty. Dermatological conditions such as eczema or psoriasis must be reported to the Occupational Health Department for advice on appropriate management. Patients, visitors, relatives and carers must be encouraged to undertake hand hygiene and to assist in the prevention and control of infection. Page 6 of 23

Personal Protective Equipment Personal protective equipment (PPE) must be worn whenever there is contact or potential contact with blood, body fluids, secretions and excretions and must be disposed of immediately after use. (Please refer to the Trust s Personal Protective Equipment Policy 7.5). Glove use does not remove the need for hand hygiene. Gowns, masks or visors are not required for routine treatments. Indwelling Devices Indwelling devices should only be used when absolutely necessary and removed as soon as possible. The reason for insertion of an indwelling device such as a urinary catheter, enteral feeding tube, or peripheral intravenous cannulae must be clearly documented and subject to daily review in a hospital setting and an agreed date in a primary care setting. Peripheral intravenous cannulae (PIC) Over 60% of blood stream infections are introduced by intravenous lines (Survive Sepsis 2007 www.survivesepsis.org ) In order to minimise the risk of infection, peripheral intravenous cannualae must be inserted by staff who have undertaken training and assessed as competent. Trust PIC documentation uses a traffic light system for recording inflammation or infection. PIC s must be inspected at each drug round and the documentation completed. The PIC will be kept in place for the minimum possible time and changed every 72-96 hours irrespective of the presence of infection. High Impact Intervention No 2(HII No 2) When being used for continuous infusion the delivery set will be changed immediately after use with blood or blood products and every 72 hours when used with all other products. The date and time of insertion and removal must be documented in the clinical records. Cleanliness and the Clinical Environment The clinical environment must reflect Department of Health (2006) standards for cleanliness. The area must be visibly clean with no blood or body substances, dust, dirt, debris or spillages. Roles and responsibilities relating to cleaning, particularly patient equipment, should be clearly defined. All communal equipment must be cleaned following each and every episode of use, in accordance with manufacturer s instructions and to NHS Standards of Cleanliness (DoH 2006). The item should be visibly clean Page 7 of 23

with no blood or body substances, dust, dirt, debris, spillages or adhesive tape. Patient equipment, such as wheelchairs, should be selected for ease of cleaning and must be decontaminated before use with other patients. Equipment in direct contact with the patients skin such as hoist slings, glide sheets and cushions should be patient specific. Linen Care should be taken to minimise dust dispersal when making beds and used linen should immediately be placed into a skip or bag at the bedside. There is no need to treat linen as infected unless it is contaminated with blood or body fluids. The linen room door must be kept closed to minimise potential contamination from airborne particles. Patient Isolation The decision on where to nurse the patient will depend on the holistic assessment undertaken on admission. This should include a professional judgement of patient need with consideration of patient safety, privacy and dignity and the identified or potential risk to other patients within that area. (Refer to 7.6 Isolation Policy for advice on Deprivation of Liberties) Patients with a productive MRSA chest infection, an exfoliating skin condition (e.g. eczema or psoriasis), large open exudating wounds, or organisms resistant to Gentamicin, should be nursed in an isolation/ side room. If a side room is not available then MRSA patients should be cohorted within specific bays. Transportation The risk of cross infection in an ambulance is minimal, consequently MRSA carriers do not require any special precautions when being transported by ambulance unless specific risk factors have been identified by the infection control or clinical team caring for the patient. Ambulance staff or their families are not at risk by transporting MRSA patients. Appointments in out patient or specialist departments The presence of MRSA should not affect appointments or treatment in other departments. Standard Principles of Infection prevention must be applied and the department notified of the details or information specific to the patient. Wound Care Page 8 of 23

Wounds should be kept covered, ideally with an impermeable dressing which effectively contains any exudate. Used dressings and other waste contaminated with blood, body fluids, secretions and excretions should be disposed of immediately in accordance with the Trust s waste policy. Where possible wound dressings should be changed in a designated treatment/dressing room and not in the main ward. If this is not possible owing to the patients condition or the absence of facilities, dressings should take place when airborne contaminants from bed making and ward activity have had time to reduce. Specimen collection Swabs/specimens must only be taken when there are clinical signs of infection (for criteria see chart below). Indwelling devices (e.g. catheters and enteral feeding tubes) will quickly become colonised, therefore routine sampling is of little value and should be avoided. Repeat specimens are not necessary if a wound appears to be healing. A swab is only intended to support the clinical assessment and not replace it. Please refer to the Specimen policy before taking and sending specimens. Wound Infection Urinary Tract Infection Pyrexia > 38 C Pyrexia > 38 C Purulent discharge or exudate Cellulitis or inflammation Localised pain & swelling Deliberate opening of the wound for drainage Spontaneous dehiscence Dysuria Pubic or loin pain Urgency Frequency Haematuria Respiratory Infection Pyrexia > 38 C Mucopurulent sputum Increased sputum Chest signs Septicaemia Pyrexia > 38 C Temperature < 36 C Rigors Signs of shock Focus of infection elsewhere Page 9 of 23

Wound extension Offensive odour Discolouration Delayed healing If it is necessary to send a swab/specimen, the following information must be included on the request form. Patient name, unit number or NHS number and date of birth. Ward / department or location. Name of doctor responsible for medical care. Clinical diagnosis. Reason for sending the swab/specimen (signs and symptoms of infection), any underlying illness, and the (suspected) diagnosis (e.g. UTI, pneumonia, cellulitis, sepsis. The type of wound, for example post operative total hip replacement or chronic wound. The specific location the swab was taken from (e.g. pressure sore left heel or laceration right shin) and whether the wound is superficial or deep. Where possible specimens should be obtained and forwarded prior to commencing treatment. Details of any systemic or topical antibiotics already given. For further information on specimen taking please refer to the Trust Specimen Management Policy (7.14). Treatment Page 10 of 23

Remember Always treat the patient, not the laboratory result. Antibiotic treatment should only be given when there are signs and symptoms of an infection. The use of broad spectrum antibiotics should be avoided unless used as empirical treatment for a life threatening infection. (Stoke-on- Trent Primary Care Trust, et al (2007) Topical therapy, e.g. Mupirocin (Bactroban), for superficial MRSA infections should not be used as MRSA quickly becomes resistant to topical agents especially if the patient has an indwelling medical device. Where possible indwelling devices should be removed or changed when embarking on antimicrobial therapy for a patient with MRSA as they may encourage the selection of more resistant strains. Antibiotic sensitivities are available from the Microbiology Laboratory, Central Pathology Laboratory, University Hospital of North Staffordshire (UHNS). For further advice please contact the Consultant Microbiologist / Infection Control Doctor on 01782 554654 or page via the UHNS switchboard on 01782 554666. MRSA Bacteraemia s (Blood Stream Infections) Department of Health mandatory surveillance requires that all MRSA blood stream infections are reported as a serious untoward incident (SUI). An investigation must be undertaken including a route cause analysis of the circumstances associated with the bacteraemia. Screening and subsequent MRSA decolonisation Screening of staff The routine screening of staff is not currently recommended, but may be necessary under certain circumstances such as a staff member with persistent abscesses or during an outbreak of infection. The infection control team will provide advice in specific circumstances where this is deemed necessary. Screening of all patients who attend the emergency portals of UHNS is currently being undertaken. Any community hospital inpatients attending UHNS for surgical procedures, for example insertion of PEG tube will be screened in accordance with the University Hospital North Staffordshire protocol. Screening of all patients admitted from any source to a community hospital bed. Page 11 of 23

It is a requirement of the Department of Health Operational Guidance 2 (2008) to have screening and attempted decolonisation of all planned elective admissions by April 2009, and all emergency admissions within three years, as soon as is practical. All patients admitted to Stoke on Trent Community Health Services inpatient beds and planned day cases will be screened. The aim of universal screening is to identify those individuals who are colonised with MRSA. This will allow us to instigate the offer of appropriate and timely decolonisation. The purpose if this is to: Reduce the risk of the colonised individual developing an MRSA infection Reduce the risk of cross contamination to other patients. Reduce the level of contamination in the environment.(doh 2007) Screening for MRSA Swabs will taken from the Nose (Anterior nares), Groin area and any open lesions or invasive devises. A CSU will be obtained if a urinary catheter is present and a sputum specimen if the patient has a productive cough. A single pre-moistened swab inserted into the anterior nares to a depth of 1cm, rotated, then placed into the transport medium. The laboratory request card should be labelled clearly stating admission screening. The site of the swab must be clearly stated to avoid confusion or mishap when several swabs are taken. Action to be taken if screening is positive Patients who are colonised or infected should be informed of their condition and its implications. Information leaflets should be provided and staff should respond to queries in a timely manner. MRSA decolonisation MRSA decolonisation refers mainly to the use of topical agents such as nasal ointment (Mupirocin) and antiseptic body wash/shampoo to eradicate or reduce skin carriage. There is evidence that long term decolonisation is only 50-60% effective. However, as soon as the decolonisation regime is initiated the presence and shedding of MRSA are significantly reduced.(doh 2007). The success of the regime may depend upon the presence of wounds and indwelling devices such as catheters or enteral feeding tubes, which may act as an anchoring point for micro-organisms. University Hospital of North Staffordshire (UHNS) In the case of elective surgery the pre-assessment clinic will prescribe and make arrangements for the appropriate topical treatment. A follow up letter will be forwarded to the GP for the patients records. For patients who are admitted via emergency portals or as elective non surgical patients the ward Doctor or Nurse Prescriber will prescribe the regime. Ward nursing staff will administer the treatment or where possible assist the patient to self administer. All treatments will be recorded on the patients prescription chart. Page 12 of 23

Day Cases Using the guidance issued by the Chief Nursing Officer, (2008), the majority of adult day cases will not be exempt from screening. All day cases admitted for treatment which runs over several consecutive days will be screened on first attendance. All day cases whose treatment will require them to remain on the day unit for more than 4 hours will be screened. Repeat attendees will be screened on each admission. Day cases who meet the above criteria will be asked to commence antiseptic wash, usually Hibiscrub, on returning home after the first attendance. These patients will be issued with Hibiscrub only. The Trust s MRSA explanatory leaflet will be issued at the same time Day Cases Who Screen Positive. If the patient is not expected to attend again, his/her GP will be informed by letter of the result. A letter will be sent to the patient at the same time asking them to contact their GP. If required Mupirocin will be added to the prescription by the GP. (Please see appendix II) Patients who have undergone topical treatment may become recolonised with MRSA at a later date. Respite Admissions. Patients admitted on a regular programme of respite will be screened on every admission. Consent. Verbal consent is required for all specimen collection. Patients who screen positive must also consent to decolonisation. Patients should be provided with the Trust s explanatory leaflet and staff should take time to allay any fears the patient or carer may have. If further help or support is needed please contact the Infection Prevention and Control Nurses. Discharge of Patients Patients with MRSA can be discharged as soon as their condition allows and there is no indication for routine screening before discharge to the community including discharge to care homes (nursing and residential homes). The General Practitioner and other health care professionals involved in the patients care should be informed. If the patient is to be discharged to a care home, the home should be informed of the patient s MRSA status. MRSA is not a contraindication to the transfer of a patient to a care home. Page 13 of 23

MRSA carriers do not require special treatment or follow up after discharge. Patients receiving topical treatment should complete the course but there is no need for routine follow up swabs. Patients should be informed that MRSA does not represent a special risk to healthy relatives, carers or infants. There are no special requirements for handling laundry, personal linen, crockery and cutlery if the patient is colonised. If infection is present local protocols and policies should be followed for laundry handling. Care of the Deceased No additional precautions are required for performing last offices. Topical Regimen for the decolonisation of MRSA positive patients Appendix I Page 14 of 23

Patients with extensive wounds and/or indwelling devices may be difficult to decolonise. If after 2 attempts the patient remains positive, advice from the Consultant Microbiologist should be sought. However it should be remembered that it will not be possible to decolonise every individual. Antiseptic Body Wash The treatment should be applied daily for five days.. Wet skin before application. Antiseptic wash should be applied neat as a liquid soap/shampoo. Using approximately 30mls of solution, apply to the skin using a disposable cloth Wash vigorously from head to toe paying particular attention to known carriage sites such as the axillae, groin, perineum and buttock areas. The solution should remain on the skin for at least one minute before being thoroughly rinsed (preferably in a shower if the patient s condition permits). Hair should be washed twice within the 5 day course of treatment if the patient s condition allows. (N.B. Hibiscrub can change the colour of hair dyes). Dry thoroughly using clean towels. Towels should be laundered daily and cloths discarded after use during the course of treatment. Clean clothing, bedding and towels should be provided after each body and hair wash during the course of treatment. If any treatment causes irritation, stop immediately and inform the patient s doctor. Mupirocin sensitive MRSA Apply Mupirocin (Bactroban) Nasal using a cotton wool bud to both nostrils 3 times per day for five days. The patient should be able to taste the Mupirocin in the throat afterwards. Hands must be washed using the recommended six stage hand hygiene technique and thoroughly dried before and after each application. Mupicocin resistant MRSA Apply Naseptin (Chlorhexidine 0.1%) cream to both nostrils four times a day for ten days in combination with antiseptic wash for five days Repeat screening swabs Following completion of the topical regime, two days must elapse before repeating screening swabs. If the screening swabs remain positive, a second course of treatment may be required. Repeat screening will not be required if the patient has been discharged. Page 15 of 23

Appendix II Work Flow for MRSA Screening and Decolonisation of Day Case Admissions. Patient admitted to day case unit Patient is admitted for single short procedure and will be discharged in under 4 hours. Patient is admitted for treatment over 4 or more consecutive days, OR treatment requires patients to remain on the unit for over 4 hours. NO SCREENING REQUIRED Gain consent for swab from nose, and any open lesions. Collect CSU if urinary catheter in situ. Collect sputum sample if patient presents with a productive cough Label all swabs clearly. Ensure label/card also clearly states MRSA screen including any CSU. Provide patient with MRSA screening and decolonisation information leaflet and 1 bottle of antiseptic wash solution. Explain use of wash solution and encourage patient and /or carer to read leaflet. Page 16 of 23

THE SCREENING RESULT WILL BE RECIEVED BY THE IPCN s VIA ICNET. (USUALLY WITHIN 48HOURS.) NEGATIVE POSITIVE NO FURTHER ACTION. It is safe for patient to continue washes for 5 days. No further contact will be made by Healthcare Team IPCN S WILL SEND STANDARD LETTER TO PATIENT GP, REQUESTING MUPIROCIN NASAL BE PRESCIBED FROM THE SURGERY. AT THE SAME TIME IPCN S WILL SEND STANDARD LETTER INFORMING PATIENT OF THE RESULT AND ASKING THEM TO CONTACT THEIR GP FOR FURTHER ADVICE Page 17 of 23

Appendix III Work Flow for MRSA Screening and Decolonisation of Inpatient Admissions. Anticipated length of stay is 7 days or less. Collect swabs from nose and perineum/groin, and any open lesions. CSU if indwelling catheter is present and sputum if patient has productive cough. Anticipated length of stay is more than 7 days Collect swabs from nose and perineum/groin, and any open lesions.csu if indwelling catheter is present and sputum if patient has productive cough. Commence antiseptic washes using decolonisation and await results. Commence antiseptic washes using decolonisation and await results. NEGATIVE NEGATIVE POSITIVE Discontinue antiseptic washes POSITIVE Discontinue antiseptic washes Add Mupirocin Nasal to the prescription. The treatment should be completed and may have to be completed at home Add Mupirocin Nasal to the prescription. When both treatments are complete re-screen and await results. If patient remain positive repeat decolonisation once more. If patient remains positive after 2 attempts contact IPCN s for further advice. Page 18 of 23

Appendix lv Equality Impact Assessment Tool 7.16 Meticillin Resistant Staphylococcus aureus (MRSA) Policy v2 To be completed and attached to any procedural document when submitted to the appropriate committee for consideration and approval. Yes/No Comments 1. Does the policy/guidance affect one group less or more favourably than another on the basis of: Race Ethnic origins (including gypsies and travellers) Nationality Gender Culture Religion or belief Sexual orientation including lesbian, gay and bisexual people No No No No No No No Age 2. Is there any evidence that some groups are affected differently? 3. If you have identified potential discrimination, are any exceptions valid, legal and/or justifiable? 4. Is the impact of the policy/guidance likely to be negative? No No No No 5. If so can the impact be avoided? N/A 6. What alternatives are there to achieving the policy/guidance without the impact? 7. Can we reduce the impact by taking different action? 8. Has the Mental Capacity Act been considered in the development of the policy? N/A N/A Yes If you have identified a potential discriminatory impact of this procedural document, please refer it to the Equality and Diversity Manager, together with any suggestions as to the action required to avoid/reduce this impact. For advice in respect of answering the above questions, please contact the Equality and Diversity Manager. Page 19 of 23

Appendix V CONSULTATION AND RATIFICATION SCHEDULE 7.16 Meticillin Resistant Staphylococcus aureus (MRSA) Policy Name and Title of Individual Community Infection Prevention and Control Nurses (IPCNs) - Julia Barcroft NHS North Staffs Christine Baldwin NHS North Staffs Kim Gunn NHS Stoke on Trent Anne Gething NHS Stoke on Trent Carol Lawton NHS Stoke on Trent Sue Williams - CHC Date Consulted 03.02.09 Name of Committee Date of Committee Infection Control Committee 16.01.09 Infection Control Committee Sub-Group 04.02.09 Infection Control Committee Sub-Group - email 09.02.09 Integrated Governance 25.02.09 VERSION CONTROL Policy Name: Version V1 V2 Valid From Jan 2007 March 2009 Valid To Jan 2009 March 2011 Document Path/Name N:\SHARED_RESOURCES\Policies_Guidelines_ Plans_&_Strategies\Stoke_on_Trent_PCT_Policies \Folder_7_Infection_Control\7.16_Meticillin_Resistant_ Staphylococcus_aureus_(MRSA)_Policy Page 20 of 23

References Beasly C & Florey D 2008 CNO s letter Operational guidance No2 MRSA Screening. www.doh.gov.uk Departmant of Health 2007 Saving Lives: reducing infection, delivering clean safe care. DH Publications. London Department of Health 2008 The Health Act 2006: Code of practice for the Prevention and Control of Healthcare Associated Infections (Revised January 2008) DH Publications. London National Institute for Clinical Excellence 2003 Infection Control. Prevention of healthcare-associated infection in primary and community care. Clinical Guideline 2 www.nice.org.uk National Patient Safety Agency 2008 Clean Hands Save Lives. Stoke-on-Trent PCT. 2007 Antimicrobial prescribing guidelines in general practice. Version 2 Bibliography Page 21 of 23

Association of Medical Microbiologists 1995 The facts about MRSA. Availab online at http://www.amm.co.uk/newamm/files/factsabout/fa_mrsa.htm Coia J.E., Duckworth G.J,. Edwards D.I,. Farrington., Fry. C., Humphreys.H., Mallaghan C., Tucker D.R., 2006 Guidelines for the control and prevention of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. Joint Working Party og the British Society of Antimicrobial Chemotherapy, The Hospital Infection Society and the Infection Control Nurses Association. The Journal of Hospital Infection. Vol 63 Supplement 1 S1-44 Department of Health 2001 National Standards of Cleanliness for the NHS. NHS Estates Royal College of Nursing 2005 Wipe it Out RCN Campaigne on MRSA Scottish Infection Standards & Strategy (SISS) Group of the Royal College of Physicians of Edinburgh and the Royal College of Physicians and Surgeons of Glasgow 2006 Guidance for the Hospital Management of Meticillin-Resistant Staphylococcus aureus. Page 22 of 23

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