Tackling healthcare associated infections outside of hospital
MRSA Action UK presenting on Multi Agency Working

4th December 2008

The Improvement Foundation has designed an integrated programme of support to help tackle healthcare associated infections specifically in Care Homes, complementing the work already taking place locally and nationally in hospitals.  The programme is available for Primary Care Trusts, Local Authorities and individual Care Homes who are committed to tackling healthcare associated infections.  Each facility will identify local improvement teams which will include representative managers, nurses and other staff from each Care Home, residents, carers and relatives, local General Practitioners and community nursing teams.


MRSA Action UK has welcomed the opportunity to be part of this programme and the event in North Lincolnshire.  The breakout sessions were informative and provided opportunities for teams to work together to identify how their shared learning can help through working collaboratively to tackle the problem of healthcare infections within the care home setting.  MRSA Action UK's presentation considered the risk factors involved for people who move between the hospital and community setting, and how carers, whether formal or informal carers, need the support of the teams within the Primary Care Trust to help reduce the risks of infection.


-         Some of the main risk factors for the acquisition of MRSA include previous hospitalisation, intravascular lines, catheters, other indwelling devices, pressure sores, underlying disease and recent antibiotics.  Antibiotics can also cause Clostridium difficile


-         A patient who has had an infection or has been previously colonised with MRSA, will most likely have multiple vulnerabilities.  Diabetes, cancer, or other conditions can compromise their immune systems.  They may require wound care, help with urinary catheter care or enteral feeding.  A patient with mobility difficulties can be vulnerable to pressure sores which can become infected with MRSA or other bacteria


Speakers demonstrated that with extra care and support from the Primary Care Trust and other agencies infection is not inevitable.


MRSA Action UK outlined the new challenges arising from screening for MRSA and the work needed to support patients going into hospital.  If patients are found to be MRSA positive and decolonisation is required this may cause anxieties, and the decolonisation regime will need to be carried out effectively so that the patient will be able to have their surgery.  Support for informal carers at home and for staff in care homes will need to be available, and the community Infection Control Teams will need to respond to this new challenge.


When analysing healthcare infections in the community it is evident that two thirds of reported cases have had prior contact with hospitals.  There is already a policy of accepting the elderly in nursing homes and residential homes who have a healthcare associated infection, and there is evidence of colonisation from patient and client contact.  Key interventions for MRSA and Clostridium difficile were covered in the presentations and challenges identified.




Interventions required:






Hand hygiene





 - screening

 - decolonization


Indwelling devices






Are staff cleaning hands every time they should & doing it correctly?

How do you know?


Do staff understand colonisation, risks and what to do?



How are indwelling devices cared for


How are leg , pressure ulcers managed


Who is tracking antibiotic usage




Clostridium difficile


Interventions required:






Hand washing


Prompt Isolation



How clean is your equipment ?commodes toilets, bed areas?

What cleaning regimes are in place?

How do you care for patients with suspected infection?

Do staff understand the causes of infection, know what to do, have skills?

How do you know?



An assessment framework is being rolled out and staff in care homes will use this to identify the problems and find solutions.  The framework will enable measurement of outcomes with the aim of reducing infections and encouraging leadership from everyone.  There would be a zero tolerance to avoidable infections, with everyone playing their part.

A Selection of Speakers' presentations:


Healthcare Associated Infections:Theories, Enigmas and Practical Approaches

Bharat Patel Health Protection (HPA) Agency Consultant Microbiologist, HPA Regional Microbiology Network Healthcare associated infection lead for London


The National Picture

Caroline Trevithick

Department of Health


Hand Hygiene Compliance and Accountability

Ann McQueen

Hand Hygiene Co-ordinator

NHS Lothian

If you or someone you care about has been affected by a healthcare infection and you wish to discuss this with us, please contact us at info@mrsaactionuk.net