MRSA

Also called Meticillin-resistant Staphylococcus aureus, Superbug

A common skin bacterium resistant to some antibiotics. Carrying it is harmless; the problem is when it gets somewhere it should not.

What it is

Staphylococcus aureus is an ordinary bacterium that around a third of people carry harmlessly in the nose or on the skin. MRSA is a strain resistant to several common antibiotics.

**Carrying it is not an illness.** Colonisation means it is living on the skin without causing harm, and most people who carry it will never be unwell from it. That distinction is the source of most of the fear attached to the word, and getting it right changes how people are treated.

It matters when it gets past the skin: into a wound, a surgical site, a drip line, a catheter, or the bloodstream. Bloodstream infection is serious and can cause sepsis.

It is treatable. Resistance to some antibiotics is not resistance to all, and other drugs work.

Screening before planned surgery, and decolonisation with an antiseptic wash and nasal ointment for five days, substantially reduces surgical infections and is routine.

Rates in the UK fell dramatically after sustained infection control work, which is one of the genuine successes in this area, and the same measures still apply: hand hygiene, careful line and catheter care, and not using antibiotics unnecessarily.

Signs you might notice

Carriage: nothing at all.

Skin and soft tissue infection: a red, swollen, painful, hot area; a boil or abscess; a wound that becomes more painful, red or discharging pus.

Systemic infection: fever, chills, feeling very unwell, confusion, a fast heart rate.

Around a line or catheter: redness, pain or discharge at the site.

999 or urgent: signs of sepsis, including confusion, very fast breathing, mottled skin, not passing urine, or feeling like something is very wrong.

Urgent: a wound becoming rapidly more painful and red, or spreading redness with fever. See cellulitis.

How it can affect day-to-day life

The stigma is out of proportion and does real harm. People who are colonised are sometimes treated as dangerous, isolated unnecessarily in social settings, or refused services, none of which is justified. Ordinary contact, hugging and family life are fine.

Isolation in hospital is used to protect other patients, and it has costs of its own: less mobility, fewer visitors, more delirium. It should be reviewed rather than left in place by default.

In care homes and at home, standard hygiene is the answer, not barrier nursing of everyday life.

Decolonisation before surgery is worth doing properly, all five days, including the body wash and nasal ointment.

Long-term catheters and lines are the commonest route in, which is why removing them as soon as they are no longer needed is a genuine infection prevention measure.

Supporting someone well

Understand carriage versus infection, and say the difference out loud to families.

Wash hands with soap and water; keep wounds covered.

Complete decolonisation properly before planned surgery.

Look after lines and catheters, and ask daily whether each is still needed.

Do not demand antibiotics for colonisation. It is not treated.

Learn the sepsis signs and act on them.

Ask for isolation to be reviewed rather than assumed necessary indefinitely.

Tell any hospital or clinic about a previous MRSA result so screening and precautions are appropriate.

Do not let a positive result be used to refuse ordinary care or contact.

Where to get help

A GP practice for skin infections and for decolonisation advice.

The hospital infection prevention and control team when in hospital.

999 or A and E for suspected sepsis.

UK Sepsis Trust for the warning signs.