How to swab for MRSA & VRE screening.

The following guidelines provide information on the collection of swabs for the purpose of screening for MRSA and VRE in the hospital environment.
Be sure to consult your own policy/guidelines in order to comply with local practice standards.

Definitions:

MRSA: Methicillin Resistant Staphylococcus aureus or Multi resistant Staphylococcus aureus. Types of Staphylococcus aureus bacteria that are resistant to a variety of antibiotics including Methicillin.

VRE: Vancomycin Resistant Enterococci. A species of Enterococci bacteria that are resistant to the antibiotic Vancomycin.

Preparation:

Explain the need for specimen collection and obtain a verbal consent from your patient to proceed. They should understand:

  • what the procedure involves
  • why they need it and
  • what the consequences may be if the investigation is not performed.

Wash your hands before and after the procedures.

Ensure you are wearing gloves and adhere to any infection control precautions and PPE (personal protective equipment) requirements that may be required.

Note: whenever taking nasal swabs there is a high probability that the patient will cough or sneeze over you. Using a face shield (or eye protection) is recommended.

Required swabs for MRSA

One specimen from each of the following

Nose mucosal surface
and
Groin or perineum.

Additional separate specimens may be obtained from the following (if relevant):

• skin lesions and wound swab
• sites of catheters, including a catheter urine
• tracheostomy or other skin penetrating devices.

VRE

Rectal or perianal swabs

Additional separate specimens may be obtained from the following (if relevant):

• skin lesions and wound swab
• sites of catheters, including a catheter urine
• tracheostomy or other skin penetrating devices.

Collecting a nasal swab:

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.

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

Collecting perianal or groin swab:

For perianal specimens (preferred specimen type), swab the perianal area (3) times (i.e. swab as if you are wiping after a bowel movement).

If you ask the patient to lie on their side and draw their knees up this may facilitate collection.

Groin- Rotate the moistened swab gently but firmly over the area on each side. One swab can be used.

Collecting rectal swab:

DO NOT lubricate the swab with anything other than sterile saline, sterile water or media from the swab.
Insert the swab into the anal canal and rotate five (5) times.

For patients with ostomies, a swab taken from the junction of the epidermal and mucosal surfaces should be used.

Documentation:

Correctly label the specimens as per your hospitals policy.
Record on the pathology request form site of specimen collection, organism screening for and clinical history.
Document collection in nursing progress notes.


 

References:

  1. Canberra Hospital & Health Services Standard Operating Procedure Multi Resistant Organism (MRO) Screening and Clearance.
  2. MRSA/VRE Specimen Collection (Screening/Surveillance), INFECTION PREVENTION AND CONTROL MANUAL, Capital Health [Internet]. [cited 2015 Feb 27]. Available from: http://policy.nshealth.ca/site_published/dha9/document_render.aspx?documentRender.IdType=6&documentRender.GenericField=&documentRender.Id=37519
  3. Specimen collection and processing instructions for VRE CULTURE test [Internet]. [cited 2015 Feb 27]. Available from: https://www.geisingermedicallabs.com/catalog/details.cfm?tid=880

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