MRSA (methicillin resistant staphylococcus aureus)

What is methicillin resistant Staphylococcus aureus?

Staphylococcus aureus (staph) is a bacteria (germ) that commonly live on peoples skin, in their mouth or in their nose without causing illness. The term used to describe this is ‘colonisation’. However, like many organisms, staph can cause infection if it gets into the body via a scratch, cut, surgery or invasive medical procedure.

Some strains of staph are resistant to the antibiotic called methicillin, and to other antibiotics. These staph are known as methicillin resistant Staphylococcus aureus (MRSA). Some people call MRSA "golden staph".

MRSA infections can occur among people in hospitals and other healthcare facilities, like residential aged care. A healthcare-associated MRSA (HA-MRSA) is an infection associated with having any surgery, procedure or device inserted whilst in hospital. However, some MRSA strains spread readily between people in the community, and these are known as community acquired MRSA (CA-MRSA) infections. CA-MRSA strains are often quite different to MRSA strains associated with hospitals and may cause infections in people who are otherwise healthy who have not been in hospital or had a medical procedure.

How do you get MRSA?

MRSA is usually spread from person-to-person through direct contact with another person who is colonised or infected with MRSA.

It may also spread by having contact with items contaminated by a person with MRSA such as:

• towels
• wound dressings
• door handles, taps and other surfaces.

MRSA is not usually spread through the air. Most people do not become infected if they pick up MRSA on their skin.

In hospital, some people have an increased risk of getting an MRSA infection, such as those:

• with certain health conditions e.g. cancer, diabetes, and obesity
• on medications that suppress your immune system, such as steroids
• who smoke
• with poor skin integrity e.g. eczema and psoriasis
• from a nursing home
• being treated with antibiotics.

In the community, anyone can be affected however the people at greatest risk of getting an MRSA infection are often found living in crowded conditions or in environments where frequent skin contact occurs, such as schools, dormitories, childcare centres, and gymnasiums. People with other medical conditions including diabetes, dermatitis or who are immunosuppressed are also at increased risk.

What are the signs and symptoms of MRSA infection?

The symptoms that develop with MRSA infection are common signs of local skin infection, such as:

• redness
• swelling
• pain
• heat
• the presence of pus.

MRSA infections can cause:

• infections of the surface of the skin such as boils and impetigo (school sores)
• infections under the skin that can be tender and increase in size (abscesses and cellulitis)
• infections of the bone, lungs and other parts of the body.

In some cases, MRSA can enter the blood, from either an existing infection such as a wound or abscess or from a medical device such as an intravenous catheter (IV). Typically, signs and symptoms can include high fever, shaking and low blood pressure. This can be a life-threatening illness and requires urgent medical treatment.

What are healthcare facilities doing to prevent spread?

Infection prevention and control (IPC) measures are actions taken at healthcare facilities to prevent or stop diseases from spreading. Healthcare facilities use the same IPC measures for patients colonised or infected to help prevent spread of MRSA to others.

If you are colonised or infected with MRSA, you will still receive the same level of care in hospital. Healthcare providers can help stop it from spreading with these actions:

• performing frequent handwashing or use an alcohol-based hand rub when providing care to you
• a sign maybe placed on your door to remind others of the precautions they need to follow, for example, to wear a gown and gloves when providing care
• you may be cared for in a single room with your own bathroom 
• frequent cleaning and disinfection of your room, bathroom and medical equipment
• ensuring visitors clean hands with alcohol-based hand rub or soap and water.

For patients living in settings like nursing homes, long-term measures are taken based on the facility's policy.

Screening

Screening patients for MRSA is an important way to prevent or stop outbreaks in healthcare facilities and keep patients safe. Patients who are colonised with MRSA may not know it because they do not have any symptoms.

If someone has a history of being in a hospital overseas or outside of Western Australia (WA) in the last 12 months or residential care facility, a specimen to look for MRSA (swab from your nose and throat and/or any wounds/lesions on your skin) will be collected when you are admitted to hospital. Screening results for MRSA are used to help guide infection prevention and control strategies in healthcare facilities, which helps prevent it from spreading.

Notification

MRSA is a notifiable condition in WA. This means healthcare providers and laboratories must inform the Department of Health of your diagnosis. Notification is confidential.

If you test positive for MRSA an alert will be placed in your medical record to let your healthcare provider know you have MRSA. This alert can be seen in all public hospitals in WA. Should you go to a private hospital, or another healthcare provider e.g. your local doctor, you need to tell them you have MRSA.

Can MRSA infections treated?

MRSA infections are treated with antibiotics. Your doctor should take a swab of the infected site to make sure the right antibiotics are given.

The period of colonisation of MRSA on your body varies and depends on several factors, such as your overall health and whether you need to continue taking antibiotics or skin antiseptics for any reason. Because of this, you may be screened when admitted to hospital again to see if you are still carrying MRSA. If MRSA is not found you may be cleared and the alert on your medical record removed.

There is no vaccination available to prevent you from acquiring MRSA.

Decolonisation treatment

Your healthcare provider may talk to you about decolonisation. This is when topical treatments are used to try and get rid of the MRSA you are carrying.

The treatment involves the use of antiseptic body washes and a nasal ointment for 5 days.

After you have finished the treatment, swabs to test for MRSA should be taken to check if you are still carrying the bacteria.

What will happen when I go home?

There is no need to take additional precautions at home, but it is important that you and your family members continue to practice good hygiene to prevent the spread of MRSA to other people:

• always wash your hands with soap and water:
  • after going to the toilet
  • before preparing meals and eating food
  • before and after touching any wounds or lesions or medical devices you may have.
• use your own towels and face cloths and do not share them
• do not share grooming items, such as brushes, nail scissors, or razors
• cover any skin wounds if possible.

No special cleaning is required in your home and your clothing may be laundered as usual, along with the rest of the household laundry. All eating utensils and dishes can be washed in the normal way. You can return to work.

Remember

• Staphylococcus aureus (staph) is a common bacteria (germ) in Australia.
• Strains of staph that are resistant to the antibiotic called methicillin are called methicillin resistant Staphylococcus aureus (MRSA)
• MRSA is treatable.
• MRSA can spread from person to person through contact with infected people or colonised people .
• Hand hygiene is a simple but very effective measure that stops the spread of germs.
• Remember to tell your healthcare provider you have MRSA.

More information

• If you are in hospital, you can ask to speak to the infection prevention control nurse.
• See your doctor.Ring healthdirect on 1800 022 222.

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This publication is provided for education and information purposes only. It is not a substitute for professional medical care. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your healthcare professional. Readers should note that over time currency and completeness of the information may change. All users should seek advice from a qualified healthcare professional for a diagnosis and answers to their medical questions.