THE HOSPITAL MANAGEMENT TRUST: PROCEDURE STATEMENT

 

Hospital:          Claremont Hospital                              Reference: CH/HO/CG/33

 

Category:         Clinical Governance                            Effective Date:            02/09  

 

Subject:            MRSA Screening                                 Review Date     02/12

                         

 

Page:                1 of 4                                                   Replaces:         N/A     

 

1)         Background   

 

1-1       Within the 2008/09 NHS Operating Framework          there is a commitment to introduce MRSA screening.

 

            “Meeting the challenge of Healthcare Acquired Infections will require additional actions across the system for 2008/09, including introducing MRSA screening for all elective admissions from 2008/09 and for all emergency admission as soon as practicable within the next 3 years”.

 

            This was again reiterated within the 2009/10 NHS Operating Framework.

 

            “From April 2009, all elective admissions must be screened for MRSA in line with Department of Health guidance.  This should be extended to cover emergency admission as soon as possible and definitely no later than 2011”.

 

1-2       Prior to the above guidance, Claremont Hospital has utilised a risk based assessment tool to identify at pre-admission assessment those patients at high risk of being MRSA positive.  All patients admitted to this hospital have been screened using the risk based assessment tool and those found to be in a high risk category have had swabs taken.  Where swab results prove positive, the patient is referred back to their GP for decolonization prior to being rescheduled for surgery once three negative swab results have been received.

 

2)         Scope of this procedure

 

2-1       This procedure reflects an expansion of the hospitals employed process of MRSA screening so as to include swabbing of all scheduled admissions.

 

2-2       This procedure outlines the hospitals response to the Department of Health’s December 2008 correspondence – “MRSA Screening – Operational Guidance 2”.

 

2-3       The hospital has agreed through its Clinical Governance framework of Committee meetings that private and NHS patients will all be screened in the same manner and using the procedure detailed below.  Hence this procedure provides one system of practice for healthcare professionals and one system of service delivery to all patients.

 

3)         Screening Procedure

 

3-1       This procedure is effective on 1 April 2009 and relates to all patients scheduled for admission to his hospital.  (This hospital is not registered to accept emergency admissions).

 

3-2       All patients scheduled for admission to Claremont Hospital will routinely have swabs taken for MRSA culture at their pre-admission assessment clinic attendance.  The exceptions to this are detailed below in 3.3. 

 

3-3       The following groups of patients do not need to be routinely swabbed but should continue to be routinely screened using the risk based assessment tool.  (Appendix 7).  Those patients found to be in a high risk category must be swabbed with the results available prior to admission.

 

·         Day case ophthalmology

·         Day case dental

·         Day case endoscopy

·         Minor dermatological procedures

 

(The hospital is not registered to admit children under the age of 16 years; maternity/obstetric cases; and mental health patients).

 

3-4       For all patients, swabs will continue to be taken from the following body areas:-

 

·         Nose – one swab for both nostrils – routinely

·         Groin – one swab for both sides – routinely

·         Broken/uncompromised skin  

Surgical wound site

Ulcer

Pressure ulcer

Cut/abrasion

Body piercing site                              As appropriate

·         Unused cannula site if inflamed

·         Current cannula site

·         Sputum if chesty and expectorating

·         CSU if catheterized

·         Urinary catheter site if discharging

 

3-5       All swabs must be forwarded to the laboratory in a timely manner once taken.  This is to allow the laboratory staff the maximum opportunity to process the swabs in the shortest timeframe.  Routinely, 5 working days is required to obtain results, however, in some circumstances this can be reduced to 3 working days.

 

3-6       Where swab results are positive, the laboratory staff will inform the Pre-admission Assessment nurse and take responsibility for liaising with the patient and their GP so as to arrange for the GP to undertaken decolonization/treatment and provide three consecutive swabs following decolonization/treatment all of which must be negative.  Once three consecutive negative swabs have been received the laboratory staff must liaise with the pre-admission assessment nurse and inpatient bookings administrator.  The laboratory staff will employ a robust system to manage and co-ordinate this in a timely manner so as not to delay the pathway of care of any patient.

 

3-7       Where swab results are negative, the laboratory staff will inform the pre-admission assessment nurse as soon as the results are available.  The pre-admission assessment nurse will then liaise with the inpatient bookings administrator to schedule admission

 

 

4)         Admission of a known MRSA positive patient

 

4-1       Where the admission of a patient known to be MRSA positive is unavoidable, the patients status will be documented clearly in the appropriate ‘alert’ section on the inside cover of the case notes which are CNST compliant.

 

4-2       The person accepting the admission will advise the following areas:-

 

                        operating theatre

                        inpatient area

                        outpatient nurses

 

            The senior nurse on duty will take responsibility to inform all other relevant healthcare personnel who may come into contact with the patient, e.g. physiotherapy staff etc.

 

4-3       The inpatient area and operating theatre will employ the procedures outlined in the hospital’s Infection Prevention and Control policy – located in the Infection Prevention and Control procedure manual found in each department.  (Procedure = CH/IC/12 – Guidelines for the Nursing Care of Specific Infections).

 

5)         Monitoring

 

5-1       The laboratory staff will record all laboratory activity related to screening  for MRSA.

            This will be reported monthly to the Infection Prevention and Control operational meetings and quarterly to the Infection Prevention and Control Committee.  Data is also forwarded in returns to the Healthcare Commission/Care quality Commission.

 

5-2       The Committee will determine when extraordinary circumstances require report escalation to the Clinical Governance/Medical Advisory Committees who will otherwise receive high level reports only to provide assurance of a robust screening procedure

 

5-3       A Consultant Microbiologist is available at any given time for additional advice and guidance with specific issues.

 

5-4       Any identified changes required to this procedure will be communicated via the hospitals Clinical Governance framework of meetings and committees.

 

6)         Resources

 

6-1       Claremont Hospital has the following resources available to ensure compliance with the MRSA Screening requirements of the DH Operating Framework:-

 

                        -           a procedure which is widely known and understood by all disciplines

                                    of staff and consultant users.

                        -           staff who receive training from the biomedical scientists on how to take

                                    swabs.

                        -           adequate isolation facilities as the majority of patient accommodation is

                                    comprised of single rooms with en-suite facilities

                        -           adequate laboratory personnel

-           a robust Clinical Governance framework structure for monitoring and assurance

 

 

 

 

 

 

 

Authorised Signatory:………………………………………………   Date:………………………

                                                   Sonia Page, Matron

 

 

                                                                                                       

 

 

APPENDIX 1

 

 

 

Risk Based Assessment Tool

 

Patients attending for:-

 

            - day case ophthalmology

            - day case dental

            - day case endoscopy

            - minor dermatological procedures

 

must all continue to be assessed for MRSA colonization/infection.  The following risk based

assessment tool will be utilized by the pre-admission assessment nurse who will establish responses to the questions below:-

 

• The patient is known to be MRSA positive
• The patient has previously been MRSA positive
• The patient is being transferred from another hospital or healthcare setting either in this country or abroad
• The patient has been in in-patient in another hospital in this country or abroad within the last six months
• The patient has attended three or more hospital out-patient attendances within the last12 months
• The patient resides in a nursing or residential home of has close contact with someone who does reside in a nursing or residential home
• The patient is a healthcare worker working in any clinical area
• The patient has regular or close contact with a person who is known, or was known, to be MRSA positive
• The patient has undergone body piercing within the last 6 months
• The patient has broken/compromised skin areas

 

Patients falling into any of the above high risk categories will have swabs taken, the results of which must be available prior to admission for procedure.

 

 

 

 

 

 

 

 

                                                                                                                       

Claremont Hospital

 

PRE-ADMISSION ASSESSMENT QUESTIONNAIRE

Patient Addressograph

 

 

 

 

 

 

 

 

 

This questionnaire is an important part of the preparation for your forthcoming surgery at this Hospital. It tells us important information about you which will help us to give you the best care during and after your surgery.

 

Please answer all the questions honestly and give us as much information as you can.

 

You must bring this completed questionnaire with you when you attend your pre-admission assessment appointment. A nurse will look through the questionnaire and may ask you further questions if necessary.

 

At your pre-admission assessment appointment a nurse will take your blood pressure and also take swabs to screen you for MRSA. The nurse may also take some blood samples depending on what type of surgery you are having. 

 

If you have had surgery before;
Did you have any anaesthetic problems?
Is there family history of anaesthetic problems?
Approximate date of last anaesthetic
Jaw or neck problems				Mallammpati	Nurse to complete
Have you any history of any of the following?
Bleed easily	Yes  No		Detail
Bruise easily	Yes  No		Detail
PE or DVT (blood clot)	Yes  No		Detail
Stomach ulcers	Yes  No		Detail
Jaundice	Yes  No		Detail
Liver failure / disease	Yes  No		Detail
Kidney / urinary problems	Yes  No		Detail
Muscle weakness / disease	Yes  No		Detail
TIA / stroke	Yes  No		Detail
Epilepsy / seizures	Yes  No		Detail
Thyroid problems	Yes  No		Detail
Diabetes	Yes  No		Detail
Palpitations	Yes  No		Detail
Angina / Heart Attack	Yes  No		Detail
Cardiac surgery	Yes  No		Detail
Breathlessness	Yes  No		Detail
Ankle swelling	Yes  No		Detail
Sleep apnoea	Yes  No		Detail
Ladies only Date of last menstrual period	______/______/______
Living Will / Advance Directive in place		Yes  No				If yes, please bring a copy  to your appointment

 

 

 

 

 

 

 

Have you ever been refused as a blood donor?	Yes     No
Have you ever received growth hormone or gonadotrophin treatment?	Yes     No
If yes, do you know whether the hormone was derived from human pituitary glands	Yes     No
If yes, did you receive the hormone prior to 1985	Yes     No
Have you had surgery on your brain or spinal cord prior to August 1992 ?	Yes     No
Have you any history of CJD or other prion disease in your family ?	Yes     No
If yes, have you had - genetic testing	Yes     No
- a blood relative known to have a gene disorder indicative of familiar CJD	Yes     No
- 2 or more blood relatives affected by CJD or other prion disease	Yes     No
Have you ever been contacted as potentially at risk of CJD or vCJD for public health purposes ?	Yes     No
If yes, for which reason
- due to exposure to certain instruments used on a patient who went on to develop   CJD or	Yes     No
-  was at risk of CJD	Yes     No
- due to receipt of blood components or plasma derivatives	Yes     No
- due to the receipt of tissue/organs	Yes     No
- due to the probability you could have been the source of infection for a patient                 transfused with your blood who was later found to have vCJD	Yes     No
Do you have a latex allergy?	Yes     No
MRSA Screening                                             Nurse to complete
Nasal swabs           Yes     No      N/A                     Groin swab            Yes     No      N/A
Wound swab          Yes     No      N/A                     OTHER – SPECIFY
Have you experienced vomiting and/or diarrhoea within the last week	Yes     No

 

 

Teeth                                                                     Own                     Dentures

 

Do you have regular dental checks                           Yes                    No                                         

Have you received recent dental treatment               Yes                    No

 

If yes, what treatment have you had?____________________________________________________________

 

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Medications

List all medications currently being taken, including dose and frequency (plus herbal or recreational drugs)

 

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Do you smoke                 Yes               No                    If yes, how many each day?______________________

 

 

Alcohol consumption  ___________________Approximately how many units per week

 

Patient Addressograph

 

List Any Serious Illnesses/Operations in the past which are not already included

 

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Allergies

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Special Dietary Requirements

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What plans have you made your for your discharge from hospital?

 

Who will be able to help and support you?

 

How long will this help and support be available?

 

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Is there any other important information about you which you need to tell us?

 

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Thank you for completing this questionnaire – please remember to bring this with you when you attend

your  pre-admission assessment appointment