Mrsa suppression risk assessment tool may 201

Risk Assessment Tool for the use of MRSA suppression therapy in
Primary Care.
Staphylococcus aureus is a common coloniser of human skin and mucosa, but can cause disease, particularly if there is an opportunity for the bacteria to enter the body. Meticillin-resistant S. aureus (MRSA) are a type of S. aureus resistant to antibiotics such as Flucloxacillin that are normally used to treat S. aureus infections. Most patients who are colonised with MRSA do not go on to develop an infection, but colonisation is a known risk factor. A systematic review found that MRSA colonisation was associated with a four-fold increased risk of infection compared with MSSA (Meticillin-sensitive S. aureus)colonisation1 . MRSA is not confined to a hospital setting. MRSA infected patients who are discharged from hospital may continue to carry MRSA even after their infection has resolved. Similarly patients may become colonised with MRSA during a hospital stay, a condition that may persist after discharge.2 Overall there has been a 59% decrease in the number of MRSA (bacteraemia) episodes reported during the surveillance period in England between October 2007 & December 2009. Across all patients, the average age ranges from 65 to 71 years3. In Cornwall significant work has been undertaken to review the risk factors involved in cases of MRSA bacteraemia. A risk assessment tool was developed for use with patients on the district nursing caseload. Patients with a number of risk factors were offered screening and, if positive, suppression therapy. The tool below has adapted the same risk factors but altered the perspective to allow risk assessment of known positive patients to inform the decision to offer suppression therapy. Mupirocin resistance is associated with exposure to Mupirocin in the previous year4 and therefore prescription of suppression therapy should follow risk assessment. Safdar N, Bradley EA. The risk of infection after nasal colonization with Staphylococcus aureus. Am J Med 2008;121:310–315 International Scientific Forum on Home Hygiene, 2006 Health Protection Agency Quarterly Surveillance report. June 2010. ., . Risk factors associated with mupirocin resistance in meticillin-resistant Staphylococcus aureus. Journal of Hospital Infection. Nov;76(3):206-10. Epub 2010 Sep 16. Lisa Johnson Nurse Consultant DIPC May 2011 RISK ASSESMENT WHEN MRSA POSITIVE RESULT RECEIVED
Refer to MRSA information in prescribing guidelines for future antimicrobial prescribing. Conduct this risk assessment even for known positive patients unless
recent risk assessment noted on file.

Yes – Prescribe suppression and repeat screening if required by
Q1) Is the patient the admitting team.
booked for
No – go to Q2
 Suppression is indicated for the 5 days leading up to Q2) Is the patient
 The rationale is to reduce risk of transmission to other inpatients and reduce risk of infection to the positive patient by suppressing carriage prior to admission.  Suppression should have been supplied/prescribed by the  Prescribe suppression if none supplied (Covered by No – go to Q3
Q3) Is the patient
 Risk assessment should already be complete.  Suppression prescription may be requested by nurse No – review risk factors below
Lisa Johnson Nurse Consultant DIPC May 2011 MRSA positive
Patients with 4 or
more risk factors
should be
considered for
Discussion with a Microbiologist or Infection Prevention Nurse Consultant may be necessary. Microbiology
Acute settings
Community Settings
Lead Nurse Cornwall Community Health Services (DNs, Podiatry, Community Lisa Johnson Nurse Consultant DIPC May 2011


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