Text A

MRSA (methicillin-resistant Staphylococcus aureus) is the name given to a

subset of Staphylococcus aureus, a type of bacteria that can occur on skin, in
the nose, groin, respiratory tract and other areas of the body. An estimated
30% of people carry the more common type of S. aureus without developing
symptoms or otherwise becoming aware of its presence, while approximately
3% of the population are carriers of the more dangerous, drug-resistant form
known as MRSA.
Transmission
MRSA can be transmitted in communities through skin-to-skin contact with a
carrier or contact with a surface or item where the bacteria is present, such as
a towel or sheet. Most such infections are restricted to the skin and are easily
treatable. In healthcare settings, however, there is a risk of more serious
infection, as the sites of wounds, burns, IV drips, feeding tubes and catheters
provide bacteria with an easier route into the bloodstream. In these cases,
potentially life-threatening conditions such as septicaemia, pneumonia and
endocarditis can develop.
Symptoms
Community-acquired MRSA typically presents with small red marks on the
skin which are similar in appearance to pimples or spider bites. If untreated,
these can develop into boils, blisters or abscesses, which contain pus and may
itch or burn. They may also be accompanied by fever. Hospital-acquired
MRSA can also result in high temperatures, along with head and muscle
ache, fatigue, shortness of breath and chest pains.
Risk factors
MRSA is associated with hospitals, not only because of the increased chance
of infection due to open wounds and other entry points, but also because of
the use of antibiotics and because patients’ immune systems are often
weakened by existing medical conditions, making them more susceptible to
the effects of the bacteria. Prisons, military training facilities and gyms are
other high-risk locations due to poor hygiene practices and frequent skin
contact in confined spaces.

Text B
Guidelines: MRSA in the Workplace
• Point-of-care risk assessment
  This process will determine whether you are at risk of contracting an infection and
requires you to be aware of your environment, the health status of your patient and
whether the type of task you are doing may bring you into contact with MRSA bacteria.
• Hand hygiene
  Appropriate hand hygiene is the most effective way to stop the spread of MRSA. Perform
hand hygiene before and after every patient interaction and in any situation where you
may have touched contaminated surfaces or equipment.
• Personal protective equipment
  Wear gloves and a gown when dealing with a patient with an MRSA infection.
• Environmental controls
  Ensure that equipment and surfaces are kept clean and that bed linens and other fabrics
are regularly changed.

Text C
Deaths involving S. aureus (including MRSA)
Figure 1: Number of death certificates mentioning Staphylococcus
aureus: by methicillin resistance, England and Wales, 1993 to 2012

Note: From 2008-12, the death rate in cases related to  S. aureus  (including MRSA) was
higher for males than for females and increased overall with age. S. aureus deaths stood
at 1.8 per million population for men aged under 45 and 415.8 per million population for
men over 85. Among women, the rates were 1.4 per million population and 200.4 per
million population for the same age groups.
 Text D
MRSA management
Due to the possibility of resistance developing rapidly, rifampicin should not
be the sole antibiotic treatment. Clindamycin or a tetracycline may be used
alone, or rifampicin and fusidic acid may be used together, for MRSA-related
infections of the skin and soft tissue. Glycopeptides such as vancomycin are
recommended if this type of infection is severe; however, if these are not
suitable, linezolid can be used, but expert advice must be sought. Linezolid is
ineffective against Gram-negative organisms and must be used with other
antibacterials for infections that also involve Gram-negative organisms.
Fusidic acid and a glycopeptide or a glycopeptide and clindamycin are
possible alternatives for skin and soft-tissue infections if a single antibacterial
has no effect.

13 Questions: short answer and gap-fill questions (try to finish in 10 minutes)

 Short-answer questions: key

Gap-fill questions: key

1. bed linens and other fabrics - text B

2. immune systems - text A
3. age text C
4. (expert) advice - text D
5. drug resistant - text A
6. bloodstream text - A