MRSA & VRE
Methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE) are specific, antibiotic-resistant bacteria that spread by contact and can cause serious infections. MRSA can be spread by touching articles that have been contaminated by the skin of an infected or colonized person, such as towels, sheets, and wound dressings; VRE can be transmitted by touching articles soiled by an infected person’s feces. Both of these bacteria survive well on hands and for weeks on inanimate objects.
Colonization occurs when bacteria are present on or in the body (i.e., nose, skin, rectum, moist areas of the body and the newborn’s umbilicus) without causing illness.
Infection is more likely to develop when a person becomes vulnerable or immunocompromised, e.g., people with underlying medical conditions. Infections with MRSA may be minor, such as pimples and boils, but serious infections may also occur, such as surgical wound infections and pneumonia. VRE can cause infection of the urinary tract, bloodstream or wounds associated with surgical procedures.
Pregnant clients or newborns (with the exception of premature and critically ill infants in a neonatal intensive care unit) are not at an increased risk of infection. There is little evidence to suggest a newborn should be cared for any differently if the birthing parent has been identified to have an antibiotic-resistant organism.
Healthy individuals may carry MRSA or VRE and clear the bacteria without treatment, while
others may be carriers indefinitely and experience recurrence following an infection.
Screening
See Public Health Ontario's Antibiotic Resistant Organism (ARO) Risk Factor-Based Screening, Guidance for All Health Care Settings Screening Checklists (June 2024, PDF 303 KB).
Caring for Clients
To prevent transmission, consider the following when caring for clients colonized or infected with an antibiotic resistant organism:
- Perform routine hand hygiene using alcohol-based hand rub with minimum 70% alcohol or soap and water if hands are visibly soiled.
- Wear gloves prior to client contact or for contact with items touched by the client. Wear a gown using proper donning and doffing techniques for direct contact or if it is likely clothes will be soiled.
- After providing care, disinfect all equipment and horizontal surfaces that have been in contact with the client’s skin (e.g., blood pressure cuff, stethoscope, bed, etc.) using a low-level disinfectant (e.g., 70% isopropyl alcohol). Horizontal surfaces that have not come into direct contact with bare skin (e.g., floors and walls) do not require cleaning.
- If possible, see symptomatic clients at the end of the day or have them wait in a vacant clinic room.
- Refer to your practice, hospital or birth centre policies as appropriate.
- Routine screening of all health-care workers for MRSA and VRE is not currently recommended.
Advice for Clients
If a client or their partner has MRSA or VRE, the chance of spreading the bacterium to their family is small. Consider providing the following recommendations:
- The colonized or infected person and those providing care should practice good hand hygiene, including after helping the infected person with their personal hygiene, before preparing food and eating, and after using the toilet.
- If not visibly soiled, launder clothing in the same manner as the rest of the household laundry. If laundry is soiled with blood, wound drainage or other bodily fluids, wash separately.
- No special cleaning of furniture or items (e.g., dishes).
- Clients should inform care providers that they (or their support persons attending a visit) carry MRSA or VRE to help prevent the spread to others.