Recommendations for Care of Patients Colonised with MRSA in Community Units

Before hospital discharge

• There is no indication for routine screening prior to transfer to home or to a community unit
• The staff of the receiving community facility and the GP should be informed before transfer of a patient who is MRSA positive
• Carriage of MRSA is not a contraindication to the transfer of a patient to a nursing or convalescent home.

Care in the Community Unit

Good Hygiene

• The resident with MRSA should be encouraged to practice good hygiene and be assisted with this if their physical or mental condition makes this difficult.

Isolation

• Isolation is not required as this may adversely affect rehabilitation of the resident.
• However, if there is a reason to think that the resident is shedding large numbers of bacteria (eg large wounds not contained by dressings, a tracheotomy with frequent coughing), or have been implicated in the development of infection in other residents, segregation may be necessary (see below).
• In addition, residents colonized or infected with MRSA should not be placed in rooms with debilitated, non-ambulatory residents at greater risk of becoming colonized or infected, if single rooms are available or if cohorting of patients with MRSA is possible.
• Residential institutions should seek the advice of local Community/Public Health infection control prior to isolating residents.

Participation in social or therapeutic group facilities

• Residents of community facilities colonised with MRSA should not be restricted from participation in social or therapeutic group facilities within the residence, if wounds are covered.

Screening

• Residential institutions should seek the advice of local Community/Public Health infection control before embarking on screening for MRSA. MRSA carriers will not normally require special treatment after discharge from hospital.
• If a treatment course still needs to be completed on particular circumstances the infection control team should advise on this.

Patients with MRSA and skin ulceration or indwelling urinary catheters

• A colonised resident who has open lesions should be in a single room if available and if this will not adversely affect the resident's rehabilitation.
• The colonised resident may join other residents for social activities in the sitting room, dining room and other communal areas providing their sores or wounds are kept covered with an appropriate dressing, preferably impermeable.
• Equipment with which the MRSA colonised resident has been in contact, such as a commode, should be cleaned with detergent and hot water. Chemical disinfection is not required.
• Cutlery, crockery, and healthcare-risk waste should be dealt with as per normal routine. No additional measures are required.
• Clothes and bedding should be machine-washed, preferably on a hot wash setting, or drycleaned if unsuitable for machine washing.

Care of deceased residents

• All lesions in deceased residents should be covered with impermeable dressings.
• Body bags are not necessary
• There is negligible risk to relatives, mortuary staff, or undertakers as long as standard infection control precautions are followed.

Course of action if there is spread of MRSA infection in a community unit

• It is important that community residential facilities have appropriate infection control arrangements for the management of a growing infection problem, such as MRSA.
• Isolation of patients/residents is generally not required, other than in exceptional circumstances.

Further information is available in:

• Prevention and Control Methicillin-Resistant Staphylococcus aureus (MRSA) National Clinical Guideline

Created: August 2006

Last reviewed: 5 April 2018