Superbugs, which are resistant to many antibiotics, have had a high media profile for at least the last 10 years. In the UK, they became a political issue too. In the run-up to the 2005 general election, the management of superbug MRSA – a specific strain of methicillin-resistant Staphylococcus aureus bacterium – was a key policy battleground, following alarming headlines about epidemic-level rates and closed hospital wards.
The emergence of the superbugs has been attributed to the overuse of antibiotics for non-serious conditions; this is a global public health problem. The widespread coverage of MRSA in the UK was instrumental in the fight to control it, by forcing individuals and healthcare providers to change their behaviour to prevent an outbreak happening in the first place. Rates have been falling year-on-year for over a decade, but MRSA remains a concern. It begun as a hospital-acquired infection – commonly attacking patients recovering from surgery – but it is now often community-acquired. Care homes, where a number of vulnerable people live together in an enclosed space, provide an environment where MRSA could strike with calamitous results. A 2013 report named care homes as the place where the second highest number and percentage of all deaths involving MRSA occurred, after NHS hospitals.
Transmission is often from skin-to-skin contact or via contaminated objects, such as towels and bed linen, as well as surfaces like floors and door handles. People with existing serious health conditions are most at risk of MRSA, along with the elderly, especially if they are post-op and have an open wound. In the care home environment, with vulnerable residents plus a steady stream of visitors, the conditions are ripe for bacteria to spread easily. It is important for managers to think about their staff too; anyone working in a healthcare facility for an extended amount of time is also at risk of an infection like MRSA.
If it infects the skin, initial presentation is often small, red bumps or boils, maybe an abscess. Additional symptoms can include a high fever, or a general sense of feeling unwell. Although some of the early signs do not always mean that MRSA is present, medical advice should be sought so a GP can conduct a swab test. If the infection goes deeper, there may be swelling and a discharge of pus from the bumps or boils. The worse case scenario is when the bacteria has become virulent and invasive. The individual affected may become sore, dizzy or confused. Implications of invasive MRSA include sepsis, endocarditis and pneumonia, all of which can be fatal. Any form of MRSA can make an existing health condition worse.
Care home managers should take steps to protect both residents and staff from MRSA, without creating a sense of alarm. A sensible approach to identify and mitigate the risk of an outbreak will keep people safe. Encourage a communicative atmosphere. If staff, residents or visitors have concerns about an unclean bathroom, or inadequate hand washing facilities, they should be able to report it and have the issue resolved promptly. Good hand washing with effective products and using the right technique will always be on the frontline of defence against any infection. Remind visitors to wash their hands when they arrive and leave. Residents should routinely wash their hands before and after eating, as well as after using the bathroom. Both residents and staff should be discouraged from sharing products and personal items that come into direct contact with the skin too, such as towels and cosmetics. Frequent baths and/or showers as well as keeping fingernails short and clean will help.
Safe and effective wound care protocols should be refreshed and retaught frequently to ensure that all members of staff know exactly how to treat even minor cuts and burns. This may include the wearing of personal protective equipment, like gloves; they should always cover any wounds of their own too.
Effective cleaning means keeping all surfaces dry and as germ free as possible on a daily basis, consolidated by regular intensive cleans. Choose hard-working products for your housekeeping team, such as the Steri-7 Xtra range from Initial Medical. Not only will the concentrate solution, sprays and wipes eradicate 99.9999% of bacteria, spores, fungi, yeasts and viruses, but they will also offer protection for up to 72 hours after use.
There has been positive progress in the management of MRSA. But despite a calming of the media storm around deadly superbugs, care home managers are advised to maintain a zero-tolerance approach to MRSA. Good hygiene protocols, well-trained and knowledgeable staff who adhere to best practice guidelines, and the use of high-quality products will mean that an outbreak of MRSA will be an exceptional event that could not have been prevented. While scientists look for ways to solve the worldwide problem of antibiotic resistance, let us focus on the people in our local communities and make keeping them safe from superbugs our ongoing priority.
For further information please visit www.initial.co.uk/medical or Tel: 0870 850 4045
Author: Rebecca Waters, Category Manager, Initial Medical
Rebecca has worked in the Healthcare sector for the past 13 years and was a Research Chemist with Bayer Cropscience prior to joining Rentokil Initial in 2003. She keeps up to date on all developments within the clinical waste management industry and is an active member of the CIWM, SMDSA and BDIA.