MRSA
What is MRSA?
MRSA stands for Methicillin-Resistant Staphylococcus aureus. Staphylococcus Aureus bacteria are found on the skin of many people. These people are referred to as ‘carriers’. The bacteria can infect the skin by way of a cut or abrasion, thus allowing them to cause boils or abscesses. When the bacteria enter the bloodstream a more serious infection can occur, such as septicaemia or pneumonia. This happens more often when a person is immunosurpressed i.e. they are susceptible host or following a break in the body’s outer defences. e.g following surgery or cannula insertion. Many strains of Staphylococcus (SA) exist and those sensitive to methicillin (an antibiotic) are called methicillin sensitive Staphylococcus Aureus (MSSA) and can cause infections but can be easier to treat as some strains may be resistant to 5 or more antibiotics. Historically so called healthcare associated strains of MRSA (HCA-MRSA) were the major cause for concern, being responsible for the deaths of many hospital patients. Due to increased prevention measures, mortality due to MRSA in U.K. hospitals seems to be decreasing however there is now also concern over so called community acquired strains (CA-MRSA) which seem to be emerging.
How is MRSA spread?
MRSA is an opportunistic organism spread by person-to-person contact. This is usually by direct skin-to-skin contact. In a healthcare setting, spread can also occur when contact is made with items touched by an MRSA colonised person, for example blood pressure cuffs, bedding or dressings. The environmental areas/surfaces close to people confined to bed are the most likely to be contaminated although other surfaces, e.g. keyboards or remote controls can also be sources. However most service users do not become ill they only become colonised, which means they could pass the bacteria onto a more susceptible person.
How is MRSA prevented?
MRSA infections can be prevented by staff adhering to good hygiene practices. Hand washing is essential to reduce the chances of passing bacteria from person to person. Service users should also be encouraged to wash their hands after contact with the environment of others or shared spaces. Cleanliness of bedding and the regular cleaning of healthcare settings must be a high priority.
Clostridium Difficile
What is Clostridium difficile (C. diff)?
Clostridium difficile bacteria are found in the intestines (gut) of 3% of adults and 60% of babies and children. In both adults and children the bacteria rarely cause any problems as the normal ‘good’ bacteria keep them under control.
C.diff can produce two types of toxins and can cause a wide range of problems including mild to severe (bloody) diarrhoea, colitis and in some cases it can be fatal. Newer strains of the bacterium are capable of producing more toxins than original strains and are resistant to a greater range of antibiotics.
How is Clostridium difficile spread?
Clostridium difficle is spread from person to person, normally from spores found in diarrhoea which can contaminate the environment and are difficult to destroy. This includes having direct contact with healthcare staff/infected service users or the items used by them, for example bedpans, toilets.
How is Clostridium difficile prevented?
Clostridium difficile is prevented by good hygiene practices such as effective hand washing before, during and after dealing with an infected service user coupled with thorough environmental cleaning and the careful prescribing of antibiotics .
All hand contact surfaces and toilets should be cleaned using a 1% hypochlorite solution at least twice daily. Disposable gloves and aprons should be used and hands washed after removal.
Alcohol Solutions, Gels and Foams depending on their formulation may be ineffective or less effective compared to hand washing in removing spores of C.diff. Where possible infected service users should be isolated.
E.Coli 0157
What is E.Coli 0157?
E.Coli is the abbreviated name of the bacterium called Escherichia coli which is normally found in the large intestine of mammals and birds. Certain strains are known as shigatoxin-producing E.Coli (STEC), including E.Coli 0157, these produce toxins which causes illnesses ranging from mild diarrhoea through to very severe inflammation of the gut. Complications of infection can cause kidney failure especially in young children.
How is E.Coli spread?
E.Coli 0157 can be spread by eating infected food. Other means of spread include contact with people who have the illness, through inadequate hand washing after using the toilet and/or before food handling particularly in households, nurseries and infant schools. Contact with articles contaminated by manure and eating unwashed vegetables which may have been contaminated by manure can also spread the illness.
How is E.Coli 0157 prevented?
E.Coli 0157 is prevented by thoroughly washing hands after using the toilet, handling raw meat, before meals and after contact with animals. Food should be handled and prepared in a safe and hygienic manner. All fruit and vegetables should be washed under running potable water before use. Personal hygiene should be observed, especially effective hand washing. If in contact with an infected service user, all dirty clothes, bedding and towels should be machine – washed on a hot cycle. Toilet seats, bowls, flush handles, taps and wash – hand basins should be cleaned with detergent and hot water. This wash should be followed by disinfectant.
ESBL producing E.coli.
ESBL stands for extended spectrum beta lactamase producing E.Coli. These strains produce an enzyme (beta lactamase) which makes them more resistant to antibiotics and thus more difficult to treat, i.e. if they cause a urinary tract infection. Typically they are more likely to cause problems in the sick, elderly or people already on antibiotics or with reduced resistance. ESBL producing strains are not like the food poisoning ones but are a cause for concern in healthcare establishments. Standard infection control procedures including hand hygiene, patient isolation, environmental cleaning and careful antibiotic prescribing are all important in control.
