[Margaret Pilkington]

If I ruled the world..... these are the measures that I would implement to combat the spread of MRSA.

VISITING......would be strictly limited. Patients would be given 2 visiting cards for their visitors to use. These cards would have magnetic strips on them and would open the ward doors only at certain times. At all other times anyone coming to the ward would have to use the intercom system......this would have the beneficial spin off of allowing the staff to know exactly who was in their ward area.
No children under the age of 12 years would be allowed to visit....unless the patient was a close relative who was considered to be on deaths door.
Parents would have open visiting on childrens ward......but other relatives would have to stick to the regimented visiting times...and then only 2 visitors per bed.
There would be a visitors waiting area attached to each ward.
Patients would be discouraged from visiting the restaurant, and would only leave the ward for diagnostic procedures.....X-rays, scans etc.

Ward Cleanliness.......domestic cleaners would be allocated permanently to their own wards. This ensures the continuity in the cleaning process.
Two people would be employed on each ward to clean all equipment.....trolleys, drip stands, commodes, locker tops and surfaces......with hot soapy water....this would be done every day regardless of whether the equipment had been used or not....and these would not be ordinary cleaners......they would be part of the Control of Infection Team.....and their uniforms would identify them as such.
Carpets would be removed from ward areas.
The rolling process of laundering drapes and screens would have to be documented and audited regularly.
Wards would be closed in rotation for 'Fogging'...... this is a steam cleaning process with detergent in the steam.
All the ventilation systems would have to be checked for bacteria on a monthly basis......who is to say that the bacteria is not being spread through the air conditioning.

Other Measures.
Routine surgical admissions would either be checked at Pre-operative assessment clinic to make sure they are not a carrier of this organism......if this was to be too costly/would swamp lab services, then alternatively patients could be prescribed a weeks course of Aquasept Wash ......this to be used in accordance with instructions in the week prior to their admission.
Emergency admissions quarantined until swabs proved that they were not carrying the organism.
Foot operated door mechanisms.......door knobs are known to be vectors in the spread of infection.
Patients know to have MRSA.....barrier nursed......full gowns like they used to be covering the whole of the nurses uniform.......not the silly plastic aprons......are the bugs just going to land on the plastic apron.....I don't think so!

Nurses to wear uniform in hospital only.....proper change facilities and time to change given.
If a uniform is contaminated then the nurse should change into a clean one immediately.......a central store of uniforms should be kept for such occasions.
Handwashing.....everyone, staff and visitors to wash their hands and DRY them properly......hand that are not properly dry might just as well never have been washed.
If a ward has an apparently high rate of infections then the staff should be required to give swabs.....if these prove positive then the staff go off duty until they are cleared.....when I first started in nursing this was one of the role of Occupational Health Dept.

All of these measures would come at a cost......and some will observe that it will reduce the ability of the hospital to meet its targets......and therefore may be seen as impractical, but how important is it that this bug is beaten...?