MRSA and non-medical staff

Savvy_Sue

Well, as regulars to this board probably know I'm waiting for a hospital date, taking my mind off this with shopping (MSE style of course). However, every now and again something impinges on my consciousness, and the latest was a Radio 4 programme - 15 minutes, not indepth - talking about how long MRSA has been around for and how they've tried to deal with infections in the past.

Now at one point they said that it wasn't likely to be transmitted because the floors weren't cleaned properly, because patients aren't usually treated while lying on the floor! And they talked about nurses, doctors etc needing to wash their hands between each patient.

But nothing was said about the staff who bring the tea trolley round, or the volunteers with the WRVS trolley with papers etc. You know, the really important people. Even the chaplains, for goodness sake!

Is this something I should worry about? Or any precautions I should take? Or have I just stumbled on the major cause of MRSA which no-one else has yet thought about?

Glad

Medical staff are the main source of MRSA because they are the people who have been treating patients already infected, Ancillary staff such as nursing auxillaries (who would probably be serving tea/meals) and ward domestics (cleaning staff) should also have been instructed in the regular washing of hands, even chaplains should be up to date with this policy,
the people with sweet/paper trolleys shouldn't be a risk as they shouldn't have been in contact with infectious patients (who should be isolated) and really shouldn't have close contact with any patient,

you could minimise the risks by having visitors bring in reading material etc to save buying from the hosp,
don't let other patients sit on the end of your bed for chats or accept sweets/biscuits from them, don't let your visitors or others 'bed-hop' around the ward chatting,
all rooms in a hosp should now have a supply of antibacterial handrub or gel (in our hosp there is one on the end of every bed) and similar can be bought in chemists, squeeze a little on a tissue and wipe around loo seats and taps before using,

and finally you are completely within your rights to request a member of nursing/medical staff to wash their hands before they approach you,

personally I think this is a big factor in the spread of HAI's,
staff may wash hands after treating any patient but they then may inadvertantly have picked something up and then gone on to another patient, if we all washed our hands before we gave any treatment we would know we weren't spreading anything,

take care

mightymo_2

When my father-in-law was in hospital 18months ago, I noticed that alcohol handwashes were at the end of every bed and there were several on the ward walls. Every member of staff who entered father-in-laws room used the handwash before and after seeing to him. (And visitors were encouraged to use it too).

His room was cleaned thoroughly daily too. It was all very reassuring.

(By the way he didn't have a contagious condition!)

Galtizz

My Gran was in hospital 2 or 3 years ago and the ward became infected with what we now believe was MRSA (of course, it wasn't as well known then and they said it was a bad case of sickness and the runs - can't spell dir, dia, dihorea).

All none essential staff (including all visitors) were banned from the ward and there were signs up everywhere (including bright signs which said 'ward closed') and the doors were locked to stop people getting in by accident. The ward was closed for 2 weeks (over Xmas, which was nice :mad: ). I'm not sure how they controlled the food etc (don't think they were eating much). but I know that when the ward re-opened the nurses were all knackered because they had done something with the shifts so that they were monitoring which nurses were allowed to go on there and stopping them from going on any other wards.

When the ward did eventually re-open there were bowls of disinfectant everywhere, including just inside the doors of the ward. There were signs everywhere telling everyone to wash their hands, the nurses station was near the wall and they would ask 'have you washed your hands?' It was a really strict rule that everyone stuck to, even the tea ladies .

When my Gran was readmitted to the ward a few months later I noticed that they still had the disinfectant everywhere and they were still as strict so it must be an ongoing precaution in all hospitals now.

The one thing to remember is that the media really hypes everything up. I have nothing to do with hospitals so I don't know figures but I know it is not always fatal. My Gran was very elderly and had just had a stroke (so in a really high risk group) and she survived it. She said it was like a really horrible case of food poisioning but the worst bit for her was not being able to see her family over Christmas (As it happened this was also her last Xmas we would be able to able to spend with her as she died of another stroke in the following year) :rolleyes: :mad:

I don't mean this to be frightening in any way, just trying to say that they are really vigilant about hand washing etc. now and, even if you do have the quite rare (if you go by statistics) misfortune to get it on the ward, although it is a horrible, horrible thing to have it is rarely fatal and they do have really strict rules about it spreading around the hospital, so even if you do hear about somewhere in the hospital having it, it is doubtful it will spread.


Good luck with your hospital visit, I hope all goes well

Savvy_Sue

Galtizz wrote:

My Gran was in hospital 2 or 3 years ago and the ward became infected with what we now believe was MRSA (of course, it wasn't as well known then and they said it was a bad case of sickness and the runs - can't spell dir, dia, dihorea).

Sounds more like one of the Noro viruses which are D&V, it's rampant locally, I know they've closed wards at all 3 local hospitals which may explain why I haven't yet had the phone call to give me a date which I'm supposed to have by the end of March. Still, we've got another week / 3 workings days and I'm in no hurry! Nor is the colleague who's going to cover my work ...

Anyway, that is sad not having visitors over Christmas. My bro was in isolation one Christmas: we were allowed to visit but had to put apron and gloves on when we went in and weren't allowed to take out anything which went in (so my mum left some knitting with him 'cos she couldn't sit and talk to him without any knitting!)

And thanks Glad for the reassurance: you just worry about these things being passed on before staff realise a patient is infected. Seems very mean not to offer biccies round to everyone but if I'm not going to accept them from other people I shall have to set a good example

mentaljessie

As somebody who works in a hospital it's normally the visitors who get a little huffy at having to glove and gown up when visiting an infected ward. People seem to forget we joe public have MRSA on our bodies (in particular up our noses). We often have patients bought with MRSA it's not possible to isolate these cases as we don't know these patients have MRSA until it's too late.

chugalug

As far as I know we all carry impetigo on our skin and up our noses too its just that it doesnt often break out but when it does boy do we suffer. When I worked in nursing homes we often has patients return from hospital with MRSA - dont know if that would be allowed now. They were always isolated and you had to put on disposable aprons and gloves before entering their room and obviously take them off and bag them up when leaving. Not one home I worked in had the infection spread. I think you just have to be cautious about physical contact and make sure everyone washes their hands constantly.

Glad

I've not heard or read that impetigo is carried by everyone,

however MRSA is probably carried with no ill effects by a large pecentage of the population, people in ill health or with open wounds are most susceptible to it, which is why there is a greater risk in hospitals. Patients with MRSA are nursed in open wards as long as the site of the infection is covered ie a wound with a dressing on, but this is why it is important not to have physical contact with other patients.

the ward where Galtizz' gran was probably had an outbreak of [font=Verdana, Helvetica]Clostridium difficile, C. Diff is a bacteria often present in the gut with no ill effects, but when the normal flora of the gut is altered [eg by prolonged use of antibiotics, which kill off good bacteria as well as bad] the C.Diff can flourish and cause horrific diarrhoea and/or vomiting, as C.Diff is [/font]a spore forming bacteria, patients need to be isolated, this was a big problem in Hospitals a few years ago, but is now less of a problem, partly due to not misusing antibiotics,
in our hospital patients on long-term antibiotics are often prescribed Yakult 'friendly bacteria' drinks.

the last 'Infection Control' seminar I attended also recommended these, but the drink type not the yoghurts, so now if any family member is on antibiotics my get well pressie is a weeks supply of Yakult

Savvy_Sue

glad wrote:

I've not heard or read that impetigo is carried by everyone,

but it's certainly true that some people are a lot more prone to breaking out in it than others - middle son seems to get that or ringworm or other nasties on a regular basis while the rest of us stay clear! I discovered the latest patch when he finally agreed to a haircut and there it was, under the thatch ... Just glad I was shearing him with the clippers rather than sending him to the barbers!

glad wrote:

the last 'Infection Control' seminar I attended also recommended these, but the drink type not the yoghurts, so now if any family member is on antibiotics my get well pressie is a weeks supply of Yakult

which leads me to my next question: I usually have one of these friendly drinks each morning (not Yakult though, think it tastes vile!) so presumably there won't be any objection to my DH bringing me one in every day so my gut stays happy? I also need my high dose Vitamin E but I'll clear that with the nurses first ...

Glad

Savvy_Sue wrote:

but it's certainly true that some people are a lot more prone to breaking out in it than others - middle son seems to get that or ringworm or other nasties on a regular basis while the rest of us stay clear! I discovered the latest patch when he finally agreed to a haircut and there it was, under the thatch ... Just glad I was shearing him with the clippers rather than sending him to the barbers!

funnily enough after writing this I took a closer look at sore on son's ear and it's Impetigo so been down to GP for some antibiotic cream, which is needed to clear up impetigo

Savvy_Sue wrote:

which leads me to my next question: I usually have one of these friendly drinks each morning (not Yakult though, think it tastes vile!) so presumably there won't be any objection to my DH bringing me one in every day so my gut stays happy? I also need my high dose Vitamin E but I'll clear that with the nurses first ...

Hospital should have no probs with you having these brought in, we used to keep them in ward fridges for patients but that has all stopped now due to HAI,

Sterling_geezer

Interesting discussion on MRSA.

Thought I would add my 2 pence worth...

I am sure we all know by now that MRSA stands for Methicillin Resistant Staphylococcus aureus. Funny name really because methicillin is never used as a medicine. Its a lab based diagnosis but its important because if a bug is resistant to Methicillin it is resistant to all Penicillin based medication (which is a lot!)

Staph. aureus is commonly carried on peoples skin and up their noses, it doesn't do any harm (quite a few people have the bacteria that can cause meningitis up their nose aswell!). However, it can sometimes develop a strain that is a problem and can overgrow. This causes the skin infection impetigo - easily treated with antiseptic creams (try and avoid antibiotic creams if its a small infection- I'll come on to this in a minute).

Staph infections are usually treated with Flucloxacillin containing medicines. However with more and more antibiotics being dished out there is a growing risk that S.aureus will become resistant to them ( i.e. turn into MRSA). There is a public perception that sore throats, coughs, ear infections, minor chest infections all should have antibiotics to treat them. This is simply not true, countless medical trials show that in the vast majority of these illness they get better by themself. Of course GPs are also partly to blame for dishing out the antibiotics.

So what happens is that we have a population in the community taking antibiotics when they don't need to. Over time this forces bacteria to develop resistance. Not a problem for minor illnesses as they get better by themselves. But develop a serious one and you are in trouble.

Of course people should see the GP if they are unwell, but they shouldn't come in demanding antibiotics which don't help, make you ill, and can make the bacteria resistant. Amazingly people still request them even when they are told all these things. Oh and in case you are wondering its not a cost cutting thing as the most commonly used antibiotics cost pennies.

So this population of people now carrying resistant bugs get unwell and need to be taken to hospital. Thus transferring the bugs to anyone they come into contact with. Washing hands helps but doesn't entirely remove the risk of transmission. Unless the antibiotic prescribing rate drops MRSA will continue to be a problem. MRSA will lose its resistance if the antibiotics that helped create it are dramatically cut back.

I am not so sure that there is a clear cut association with cleanliness and MRSA rates. I think a lot of it is politics using bad science to push a point. I could go on but I'll let someone else add their two pence as i think I got my moneys worth!