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Work across primary and acute care cuts MRSA in drug users

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A drugs specialist nursing team at a Bristol trust has helped to slash rates of MRSA in injecting drug users. 

The team at Bristol Royal Infirmary was set up in April 2007 to bridge the gap between acute and primary care and improve services for patients who misused substances.

They took on the infection control mantle after a hospital audit revealed a significant number of MRSA infections were entering the hospital via injecting drug users.

Between January and April 2007, the hospital recorded 10 cases of MRSA bacteraemia in injecting drug users. Following the introduction of the infection control role, this went down to nine cases for the whole of 2008.

So far this year, the hospital has recorded just one case of MRSA bacteraemia in an injecting drug user.

The drug specialist nurses use the opportunity while these patients are hospitalised to provide health promotion covering MRSA, hand hygiene, and avoiding infections.

‘Hospitalisation was felt to be an often missed opportunity to engage difficult to reach substance misusing patients who often suffer from health access inequalities due to having no or temporary housing, rough sleeping, and lack of GP and primary care service access,’ said Sally Lewis, one of three drug specialist nurses employed by the trust.

‘We provide one-to-one health education to help to raise awareness of MRSA and increase patients’ knowledge. They can then spread the word via peer teaching, sharing the information within their group,’ she added.

In November 2008, the team introduced chlorhexadine impregnated wipes into the community via needle exchanges and the ‘harm reduction’ bus. They are also working with staff in community hostels to set up deep cleans of rooms.

The team has also helped to reduce repeated ‘revolving door’ admissions related to drug users and the number of clinical incidents related to behavioural problems.

Additionally, there has been a dramatic increase in the number of patients completing treatment for drug-substitute options, such as methadone.

The team – which won the Home Office Tackling Drugs Award last year - also help patients with mental health and social issues, works with external agencies and trains healthcare staff.

‘We support staff to develop their skills in managing patients who are often labelled as difficult,’ said Ms Lewis.

‘We help staff identify patients at risk of withdrawal and teach them how to manage difficult situations. It is about managing patients proactively, rather than reactively.’

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