MRSA | VRE Policy and Procedure

POLICY

Specimens for routine screening/surveillance for methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-resistant enterococcus (VRE) are to be obtained in the following manner:

1. For MRSA only:

a single swab from the anterior nares (nasal) AND bilateral groin swab OR rectal swab AND a separate swab(s) from skin lesions, wounds, incisions, ulcers and exit sites of indwelling devices, if present, using aseptic technique where indicated.

2. For VRE only:

a rectal swab OR stool culture

Note: If a client/patient has a colostomy, the specimen for VRE should be taken from this site.

3. For MRSA and VRE:

a single combined nasal AND rectal swab

PROCEDURE

MRSA Only

Obtain cultures for MRSA screening in the following manner:

*MRSA Nares:

  1. Use a cotton-tipped culture swab moistened with sterile saline, sterile water or transport media from the swab. DO NOT lubricate the swab with anything other than sterile saline, sterile water or media from the swab.

  2. Insert the swab into the anterior nares (less then 1cm) and rotate it for approximately 10-15 seconds.

  3. Using the same swab, repeat the procedure in the other nostril.

*MRSA Nares (as above) with Groin Swab:

  1. Take the same nares swab (as collected above) and roll or rub the swab over the skin in the groin area (from the top of the groin area down into the perineum for approximately 10-15 seconds).

  2. Using the same swab, repeat the procedure on the other groin.

*MRSA Nares (as above) with Rectal Swab:

  1. Take the nares swab (as collected above) and collect a rectal culture by inserting the swab into the rectum to obtain fecal staining on the swab.

*MRSA from other Open Sites/Wounds etc.

  1. Using fresh swabs as required, swab any open wounds or around any tube sites, e.g. G-tube using aseptic technique.

Frequency of Cultures:

  1. If additional MRSA screening swabs are required, collect at least 72 hours apart. Note: The lab rejects the swabs unless taken at least 72 hours apart.

  2. The lab has a waiting period of 90 days to process repeat screening cultures on a patient who has been found to be MRSA positive in the past.

  3. The 90 day waiting period may be waived in consultation with an Infection Control Practitioner. If so, note on the microbiology requisition “Requested in Consultation with Infection Prevention and Control”.

VRE Only

Obtain cultures for VRE screening in the following manner:

*Stool Cultures:

1. Use a preservative free specimen container (i.e.: same one as used for Clostridium difficile).

2. Collect a stool specimen the size of a walnut.

3. Do not refrigerate the specimen.

OR

*Rectal Swabs:

1. Use a cotton-tipped culture swab (may be moistened with sterile saline, sterile water or transport media from the swab to aide passage into the rectum).

2. DO NOT lubricate the swab with anything other than sterile saline, sterile water or media from the swab.

Insert the swab into the patient’s rectum in order to obtain fecal staining on the swab.

3. Note: if the patient has an ostomy, collect the specimen (culture or swab) from the stoma site.

*MRSA and VRE

1. When VRE and MRSA screening is required together, submit a combined nares and rectal swab.

2. Collect the nares swab first (as above) and then a rectal swab as above (use the same swab).

3. Collect MRSA swabs from additional open sites or wounds as above.

*Frequency of Cultures:

1. If additional VRE specimens are required, collect at least 24 hours apart.

LABELING AND REQUISITIONS FOR ALL SPECIMENS

1. Complete labeling of specimens and appropriate laboratory requisitions for all specimens following current laboratory standards.

2. Indicate when swabs are from combined sites as appropriate.

3. If a patient refuses multi-site swab collection, collect swabs from separate sites; label as appropriate.

REFERENCE

Infection Prevention and Control Nova Scotia (2012). Best Practice Guidelines for Reducing Transmission of Antibiotic Resistant Organisms (AROs) in Acute Care & Long Term Care Settings, Home Care & Prehospital Care.

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