Screening for MRSA / MSSA and CPO in the Kent Kidney Care Centre

We offer patients having dialysis in the Kent Kidney Care Centre or affiliated Units screening for MRSA, MSSA and, in selected cases CPO. This leaflet explains the following.

• What MRSA, MSSA and CPO are.

• What the signs of infection are.

• How MRSA, MSSA and CPOs are found.

• How MRSA, MSSA and CPOs can be treated.

• What precautions need to be taken in hospital.

We hope this leaflet answers some of the questions you may have. If you have any further questions or concerns, please speak to a member of your healthcare team.

What are Meticillin Resistant and Sensitive Staphylococcus aureus?

Staphylococcus aureus (often called “staph”) is a bacterium or germ. It is often found in the nose and / or on the skin of 20 to 30% of the normal healthy population.

• Meticillin Resistant Staphylococcus aureus (MRSA) is a strain or type of Staph. It is resistant to some of the antibiotics commonly used to treat infections. People with MRSA may have acquired it before they came into hospital or while they were an inpatient.

• Meticillin Sensitive Staphylococcus aureus (MSSA) refers to all other strains or types of staphylococcus that are sensitive to most antibiotics commonly used to treat infections.

Most people with MRSA or MSSA are called “carriers” or “colonised”. This means they have MRSA or MSSA in their nose or on their skin, and sometimes in other body sites. However, it is not causing that person any harm.

What are the signs / symptoms of MRSA and MSSA?

Most people who are MRSA or MSSA carriers do not know that they have it. MRSA and MSSA do not generally cause any signs or symptoms, unless the patient has an infection.

MRSA or MSSA infection can occur in the respiratory system, urinary system, bones, joints, and blood. However, it most commonly affects the skin, including:

• haemodialysis lines or peritoneal dialysis catheter exit sites; and

• chronic (long-term) wounds, such as leg ulcers.

Signs of infection include:

• a temperature;

• pain at or in the site of infection;

• redness / oozing from an exit site or wound; and

• changes found from a blood test, which show that the patient is fighting an infection.

How are MRSA and MSSA found?

To see if a patient is an MRSA or MSSA 'carrier', we take swabs from their:

• nose and groin; and

• sometimes from exit sites, wounds, skin breaks, or other body sites.

If we suspect an infection, we can also take samples of sputum, blood, and urine.

All patients having dialysis in East Kent Hospitals and affiliated Units are regularly swabbed for MRSA and MSSA carriage.

Are MRSA and MSSA dangerous?

MRSA and MSSA do not generally pose any risk to the general public. The people most “at risk” from MRSA and MSSA are patients with:

• other serious illness / disease; and

• those with open wounds or small breaks in their skin where they have tubes inserted, such as a drip or a drain.

All dialysis patients are at increased risk of MRSA or MSSA infection, because of the devices used for dialysis access. These include peritoneal dialysis catheters or haemodialysis lines, and very occasionally AV fistula or grafts.

Can MRSA and MSSA be treated?

People with MRSA or MSSA carriage do not generally need treatment with antibiotics. Antibiotics are only used to treat patients with infections. However, we may give dialysis patients with MRSA or MSSA carriage a 5 day course of decolonisation treatment. The treatment will reduce the number of MRSA and MSSA bacteria they are carrying.

Decolonisation treatment consists of:

• a gel or ointment applied to the inside of each nostril twice a day for 5 days; and

• a body wash applied neat to wet skin, like a liquid soap and then rinsed thoroughly, once a day for 5 days.

If we find an infection, we will prescribe antibiotics as well.

Once the patient completes a course of decolonisation treatment, we may take further swabs. If the swabs again show carriage of MRSA or MSSA, we may give further courses of decolonisation treatment (as above). We give no more than two courses. Repeated tries at decolonisation are not recommended. Some people will continue to have carriage of MRSA or MSSA whatever treatment they have.

People with MRSA carriage do not need treatment with systemic antibiotics (such as tablets or liquids). We use these antibiotics to treat patients with infections. If we use antibiotics where they are not needed, it can lead to more antibiotic resistant bacteria developing.

What precautions are taken in hospital and on the haemodialysis units?

• We may move patients with MRSA to a single room, to protect other patients who are very susceptible.

• If there are no side rooms available, we may nurse patients on the open ward with other patients who have MRSA. This is known as cohort nursing.

• Patients with MRSA can have visitors. Visitors do not need to take any special precautions. However, they must clean their hands with alcohol hand rub on leaving the ward or Haemodialysis Unit.

• We do not need to isolate patients with MSSA carriage from other patients.

What are Carbapenemase-producing Organisms (CPO)?

There are many different types of bacteria that live harmlessly in the human gut. If these bacteria get into the wrong place (such as the bladder or bloodstream) they can cause infection.

Carbapenemases are enzymes (chemicals), made by some strains of these bacteria. This allows them to destroy carbapenem antibiotics (a powerful group of antibiotics). These CPO bacteria are resistant to these antibiotics. People who carry these CPOs are “colonised” or “carriers”.

Although generally uncommon in the UK at the moment, outbreaks of CPO’s have been reported in other hospitals. CPO carriage is being found in other European and North American countries and, especially on the Indian subcontinent.

What are the signs and symptoms of CPOs?

Most people with CPOs are said to be “carriers” or “colonised”. This means that the germs are in their gut but not causing that person any harm. Most people with CPOs do not know that they have it. CPOs do not generally cause any signs or symptoms, unless the patient has an infection.

CPO infection can occur in the respiratory system, urinary system, and blood. It can also occur in wounds, including:

• haemodialysis lines; or

• peritoneal dialysis catheter exit sites.

Signs of infection include:

• a temperature;

• pain at or in the site of infection;

• redness / oozing from an exit site or wound; and

• changes found from a blood test, which show that the patient is fighting an infection.

How are CPOs found?

The bacteria commonly linked to CPOs normally lives in the gut. So, we take swabs from the patient’s anus (a rectal swab). This swab will find whether the person is a CPO “carrier”. In people with a stoma, we dip the swab into their stoma bag. The swab is not inserted into the stoma.

Sometimes we take swabs from wounds, skin breaks, or other body sites. We may also take samples of sputum, blood, and urine.

Only selected groups of dialysis patients need swabbing for CPO. These include the following patients.

• Patients told they are a carrier of CPO or they have an infection with a CPO.

• Patients admitted to a hospital outside of Kent in the last 12 months.

• Patients returning from holiday, where they had dialysis.

• Patients who have been in contact with someone who is colonised or infected with CPO in the past 12 months.

Some other haemodialysis units now need patients to be swabbed for CPO carriage, before accepting them for holiday dialysis.

Are CPOs dangerous?

CPOs do not generally pose any risk to the general public. The people most “at risk” from CPOs are patients with:

• other serious illness / disease; and

• those with open wounds or small breaks in their skin where they have tubes inserted, such as a haemo- or peritoneal dialysis catheter, a drip, or a drain.

Can CPOs be treated?

People with CPO carriage or colonisation do not generally need treatment with antibiotics.

It is not possible to eradicate (get rid of) CPO in those who are carriers. There are limited antibiotics available for the treatment of infections. The Trust’s Infection Prevention and Control Team will give advice on this.

What precautions are taken in hospital and on the haemodialysis units?

• We will move patients with CPO carriage or infection to a single room, to protect other patients who are very susceptible.

• Patients with CPO can have visitors. Visitors do not need to take any special precautions. However, they must clean their hands with alcohol hand rub on leaving the ward or Haemodialysis Unit.

Further information

If you have any further questions, please contact the Renal Team on the following numbers.

• Renal Unit, Buckland Hospital, Dover
  Telephone: 01304 222695

• Thomas Becket Renal Unit, Kent and Canterbury Hospital, Canterbury
  Telephone: 01227 783047

• Maidstone Renal Unit, Maidstone
  Telephone: 01622 397400

• Medway Renal Unit, Gillingham
  Telephone: 01634 959804

• Renal Unit, Queen Elizabeth the Queen Mother (QEQM) Hospital, Margate
  Telephone: 01843 234270

• Renal Unit, William Harvey Hospital, Ashford
  Telephone: 01233 651872

References

• Coia, J.E., Wilson, J.A., Bak, A., et al. Joint Healthcare Infection Society (HIS) and Infection Prevention Society (IPS) guidelines for the prevention and control of methicillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. The Journal of Hospital Infection 118 (2021); S1 – S39.

• UK Health Security Agency (2022). Framework of actions to contain carbapenemase-producing Enterobacterales.

• East Kent Hospitals University NHS Foundation Trust (2025). Management and Control of Meticillin Resistant Staphylococcus aureus (MRSA) and Panton-Valentine Leukocidin (PVL–SA) Staphylococcus aureus: approved guideline.

• East Kent Hospitals University NHS Foundation Trust (2024). Management of Patients Colonised or Infected by Drug Resistant Micro-Organisms: approved guideline.

[Web sites last accessed 25 November 2025]

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