Going into hospital

hospital

This information has been written to provide a guide for patients, carers and visitors about MRSA and other healthcare associated infections, and some of the questions you may have if you are going into hospital.

The information describes the measures that are being taken to help reduce the risks of getting an infection in hospital, and to suggest things that patients, visitors and staff can do to help to reduce the risks of getting an infection, or to stop the spread of infection. It is written as a general guide and may not be specific to your needs, it is always best to ask your doctor or the team at the hospital looking after you about what you need to do to prepare for your stay. Contact details for hospitals near you can be found on the NHS Choices website for England, NHS 24 Scotland, or NHS Direct Wales.

Content

What you can expect before you go into hospital, or if you are admitted as an emergency

Chances are you have come to our website because you are either going into hospital or visiting someone and want to understand more about MRSA or other healthcare associated infections. There are a lot of measures in place now to reduce the risks of acquiring infections and to stop their spread, including screening for MRSA, which may be done routinely prior to your surgery; your GP will be able to discuss this with you.

Typically, a nurse will take swabs as part of other checks, such as blood pressure and blood tests, leading up to your hospital stay. Nasal swabs and swabs from other parts of the body such as the groin, underarm and perineum are routinely taken to ensure you are not colonised (carrying MRSA on the skin and/or in the nose). If you are colonised ointments and antiseptic washes will be given to ensure the colonisation is reduced prior to any surgery. If you have questions about testing for MRSA visit our screening for MRSA page for more information

What is MRSA?

Staphylococcus aureus is a common bacteria (germ) that is found on the skin and in the nostrils of about a third of healthy people. It can cause harm if it enters the body, for example through cuts and sores.

Meticillin is a type of penicillin, and is used for testing purposes. MRSA stands for meticillin (M) resistant (R) Staphylococcus (S) aureus (A). MRSA is a type of Staphylococcus aureus that has developed resistance to all penicillin based antibiotics and some others that are used to treat common infections. Strains of MRSA were first found in the 1960s following the widespread use of antibiotics, and occur in many countries. Some people carry MRSA on their skin or in their nostrils quite harmlessly. Some people carry MRSA for just a few hours or days, but other people carry MRSA for weeks or months. They don't know that they carry MRSA because they have no symptoms and it does not harm them. This is called 'colonisation'.

MRSA and other micro-organisms (germs) can cause problems in hospitals. Complicated medical treatments, including operations and intravenous lines (drips), provide opportunities for micro-organisms to enter the body. MRSA and other types of Staphylococcus aureus can cause local skin infections such as boils and, in more vulnerable patients; they can cause more serious infections in wounds, bones, lungs and blood (bloodstream infections).

How do you know if someone has MRSA?

People who carry MRSA do not look or feel different from anyone else. The MRSA does not harm them and they have no symptoms of infection. When patients come into hospital, a nurse may take swabs for laboratory tests to check for MRSA.

Patients who have an infection may develop signs and symptoms, such as a high temperature or a fever. An infected wound may become red and sore and discharge pus. Many different micro-organisms can cause these signs and symptoms. Laboratory tests can show whether MRSA or other micro-organisms are the cause.

How do hospital staff care for patients with MRSA?

A nurse may take swabs from different parts of the patient's body to check if MRSA is present. People who carry MRSA or have an MRSA infection can be treated with antibiotics.

A patient who carries MRSA may be treated with antiseptic cream, antiseptic shampoo and body wash, which reduce or remove MRSA from hair, skin and nostrils. A patient who is infected with MRSA is usually treated with an antibiotic which is given through an intravenous line (drip).

How does MRSA spread?

If people have MRSA on their hands, they can transfer it to people and objects that they touch. Other people can then pick it up on their hands and pass it on to others.

How do hospital staff stop MRSA spreading?

There are people in the community who are colonised with MRSA and don’t show any symptoms. By screening (performing a simple swab test) before your operation, the hospital can find out who is carrying MRSA and provide treatment before you are admitted to hospital. In addition, they can give you an appropriate antibiotic if this is needed at the time of surgery.

If someone is found to have MRSA during their stay, simple hygiene measures reduce the risk of spreading MRSA
- Everyone should clean their hands before and after touching patients
- Alcohol rub is used for clinical care where patients do not have diarrhea and where hands are not soiled, otherwise soap and water should be used
- Staff will wear gloves and aprons when they care for a patient who has MRSA and for all patients when dealing with blood and body fluids
- Patients who have MRSA may be moved to a room on their own or into a separate area for people who have MRSA

Do patients have to stay longer in hospital because they have MRSA?

Patients who have any infection, including MRSA, may have to stay in hospital until it shows signs of clearing up.

Where possible, patients will be allowed to complete their antibiotic course at home.

A patient who has MRSA can go home or be cared for safely in a nursing home or residential home, using simple hygiene measures.

Can MRSA harm friends and family visiting patients in hospital?

MRSA does not usually affect healthy people. It does not usually harm elderly people, pregnant women, children and babies. But it can affect people who have serious health problems, and people who have chronic skin conditions or open wounds.

Nurses can give you advice, which reflects the hospital's policy. You should ask nurses for advice if:
- Someone who has a long-term health problem wants to visit a patient who has MRSA
- A patient who has MRSA wants to visit another patient in the hospital

Visitors can reduce the risk of spreading MRSA to other people if they do not sit on beds and if they clean their hands using alcohol hand rub or washing hands prior to leaving.

Some useful tips if you are going into hospital to have surgery

The skin carries lots of bacteria, including Staphylococcus aureus, so do not shave the area where you are to have surgery, tiny nicks and cuts in the skin may provide a harbour for the bacteria. Surgeons are now using clippers to avoid surgical site infection; you may want to check this by asking your surgeon.

Do not touch any wound or device that enters your body, such as a drip or catheter. This will help keep the area or device free from bacteria.

Shower as frequently as you can, using antibacterial soap and change into clean clothes regularly, particularly clothes that are next to your skin. At the start of treatment you should change your bed clothes and towels. Do not use sponges. Face-flannels should only be used once before washing. If you have any open wounds, dressings or devices you may need to check with your surgeon or the staff looking after you, as there may be a requirement to keep these dry.

Do not share personal items or equipment with other patients.

Tell one of the nurses as soon as possible if you have diarrhoea or vomiting. It is important to let staff know so they can keep you and other patients safe.

Hospital cleanliness

Cleanliness in hospitals is now recognised as being critical in minimising the spread of infection. You can help prevent the spread of infections by keeping the space around you tidy and uncluttered so that cleaning staff can access all the surfaces easily. Your relatives and visitors can also help you with this.

If you are concerned about cleanliness in the hospital or if you spot any dirt or dust, let the ward staff know. Minimising hospital infections is a top priority so staff don't mind being asked.

Hand hygiene

The number of healthcare associated infections in hospital can be kept down if all hospital staff adhere to good hygiene measures. The most important is to wash hands before and after contact with each patient, and before carrying out any procedure. Bacteria get onto hands very easily, so this simple measure reduces the chance of passing on bacteria from patient to patient. Most staff remember to do this, but sometimes when they are busy they can forget and don't mind being reminded. If this does happen politely, but firmly ask staff to wash their hands before touching you if they have come from another patient or were finishing a task before they came to treat you.

Ask the nursing staff about the five key moments of hand-hygiene, they can explain about why these are important, it's a way of alerting them that you know about the importance of hand-hygiene in preventing infections and that you are helping to remind them.

Always wash your hands with soap and water after using the lavatory or commode, keep nails clipped and avoid wearing rings and jewellery, these can harbour bacteria. Apply hand rub after washing with soap and water.

Wash your hands with soap and water before eating or preparing food, if you have any food brought in keep it covered, talk to the staff about whether it is appropriate for your visitors to bring in food and ensure it is stored at the correct temperature.

If you need help with washing your hands then ask the nursing staff or get your carer to talk to the staff about any assistance you may need.

Visitors

Ask your visitors to wash their hands before they come onto the ward and when they leave, ask them not to sit on the bed and that they follow the guidance on visiting times.

If your visitors are unwell with a fever or tummy upset ask them not to visit until they have been well for at least 48 hours after they have had any symptoms.

It is also best if visitors do not sit on your bed. To minimise the risk of infection, visitors should not use the patient toilets on the ward. Staff can direct family and friends to the visitors' toilets.

Equipment

Do not tamper with drips or catheters. Some hospitals advise changing the cannula after 3 days, that is the area where the drip enters the body, you may wish to ask staff about this if your cannula has been left in for longer than 3 days without changing. If there are any signs of redness or soreness at drip sites then you should tell the nursing staff immediately.

If you need a "central line" catheter, ask your doctor about the benefits of one that is antibiotic-impregnated or silver-Chlorhexidine coated to reduce infections.

Do not be afraid to ask if equipment is cleaned before any procedure as stethoscopes, blood-pressure cuffs and other items used for daily observations, as these can easily become contaminated with micro-organisms.

Personal items

Keep all towels, flannels, toothbrushes, razors, combs etcetera separate for your own use, do not share personal items.

Try to avoid walking around in bare feet and take in some comfortable slippers. Look after your feet and dry between your toes after bathing.

If you have soiled laundry it should be bagged and sealed if taking home and washed separately on the hottest wash recommended for the fabric. If using antibacterial detergent it is a good idea to check that it is labelled as being effective against MRSA and Clostridium difficile and follow the manufacturers' instructions.

Your comfort and peace of mind

Staying warm before surgery can lower the risk of post-operative complications (including surgical site infection). The hospital environment may be colder than your own home so bringing additional clothing, such as a dressing gown, a vest, warm clothing and slippers, can help keep you comfortably warm. You should tell staff if you feel cold at any time during your hospital stay.

Speak to the staff or your GP for further guidance on the importance of being warm around the time of your operation.

Do not put up with soreness or discomfort, or be afraid to speak up if you feel things aren't right. Talk to the ward sister.

Remember you know your own body and you know 'what normal looks like' so will friends or close family. If you have any questions about your treatment or care do not be afraid to ask.

Facts & figures

The NHS performs a lot of procedures and operations and not all infections are avoidable. To set the context NHS hospital statistics showed that over 17.7 million procedures and operations were performed between April 2012 to March 2013. Every infection is one too many however which is why staff are working to do everything possible to reduce the numbers of people affected. There are a number of websites that give information about the numbers of people affected and we also collate figures on MRSA and Clostridium difficile on a monthly basis. This is in response to the public asking us for information on the numbers of infections in hospitals, monthly statistics on MRSA bloodstream infections and Clostridium difficile by region and hospital trust are available here

The source of this information can be found on the Public Health England website. For Scotland visit Health Protection Scotland and for Wales see the National Public Health Service for Wales

Other sources of information and help

Our downloadable leaflet "Information for patients and carers about MRSA and going into hospital" is available here

Going into hospital - The NHS in England - NHS Choices - Page last reviewed: 24/09/2014. Next review due: 24/09/2016

National Institute for Health and Care Excellence (NICE) quality standard [QS113]: Healthcare-associated infections - Published date: February 2016 - Information resource added 17 February 2016

Age UK (formerly Help The Aged) offer advice on going into hospital, which includes information on benefits for patients and carers

Useful information and resources for parents and children:
You and Your Child in Hospital by Margaret Carter. (Methuen)
Great Ormond Street - Hospital Dash game zone
Action for Sick Children

References

Inadvertent perioperative hypothermia: The management of inadvertent perioperative hypothermia in adults - Nice guideline CG65 1.1.1 Published April 2008

National Institute for Health and Clinical Excellence: Prevention and control of healthcare-associated infections quality improvement guide [PH36]:- Published date: November 2011

National Institute for Health and Care Excellence (NICE): Infection Control Quality Standard [QS61]: - Published date: April 2014

Urinary tract infections in adults Quality standard [QS90] Published date: June 2015

References for our downloadable leaflet "Information for patients and carers about MRSA and going into hospital"

Content written: 01/06/2015
Review due: 01/06/2018

The information on this website is for general purposes only and is not a substitute for qualified medical care, if you are unwell please seek medical advice.

(c) MRSA Action UK 2015

email: info@mrsaactionuk.net

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