Staphylococcus aureus is a germ that lives on the skin and mucous membranes of healthy people. Occasionally S.aureus can cause an infection. When S. aureus develops resistance to certain antibiotics it is called methicillinresistant Staphylococcus aureus, or MRSA.

MRSA is spread from one person to another by contact usually on the hands of caregivers. MRSA can be present on the caregiver’s hands either from touching contaminated material excreted by the infected person or from touching articles contaminated by the skin of a person with MRSA, such as towels, sheets and wound dressings. MRSA can live on hands and objects in the environment.

It is important that special precautions are taken to stop MRSA from spreading to other patients in the hospital.

These precautions include:

• Single room accommodation preferred (the door can remain open)
• A longsleeved gown and gloves must be worn by everyone who cares for you
• A sign may be placed on your door to remind others who enter your room about the special
  precautions
• The room and the equipment used in the room will be cleaned and disinfected regularly
• Everyone who leaves your room must clean their hands well
• You must clean your hands before you leave your room

Your family and visitors should not assist other patients with their personal care as this may cause the germ to spread. If your family/visitors are helping you with direct personal care (i.e. bathing or changing bed linens) they need to wear a longsleeved gown and gloves. Before leaving your room, they must remove the gloves and gown and dispose of them in the garbage container and the linen hamper located in your room. Then they must clean their hands. All people entering your room need to perform hand hygiene, and when they exit your room they need to perform hand hygiene.

Remind staff and visitors to practice good hand hygiene before and after they touch you. Ask your nurse or doctor to demonstrate proper hand hygiene techniques. (15 seconds of soap and running water OR waterless alcohol hand rub until hands are dry)

You need to clean your hands:

• After using the bathroom
• After blowing your nose
• Before eating and drinking
• Before and after you touch your dressing or wounds
• When your hands are visibly dirty (soiled)
• Before you leave your room

If you have MRSA at the time of discharge from hospital, the chance of spreading the germ to your family is small. But we do recommend that you practice the following:

• Everyone who might help you with your personal hygiene or with going to the toilet should wash their hands after contact with you.
• Wash your hands before you make any food and before you eat. This practice should be followed by everyone in the household.
• Wash your hands well after using the toilet. Make sure others that use the bathroom wash their hands well afterwards.
• Clothing may be laundered in the same manner as the rest of the household laundry.
• No special cleaning of furniture or items (e.g. dishes) in the home is required.
• If you share a bathroom at home, clean the toilet and sink at least weekly with a germicidal cleanser.
• Always tell your physician, paramedics, nurses or other care providers that you have MRSA. This helps prevent spread to others.

Enterococcus are germs that live in the gastrointestinal tract (bowels) of most individual and generally do not cause harm (this is learned “colonization”). Vancomycin resistant enterococci (VRE) are strains of enterococci that are resistant to the antibiotic vancomycin. If a person has an infection caused by VRE, such as a urinary tract infection or blood infection, it may be more difficult to treat.

VRE is spread from one person to another by contact, usually on the hands of caregivers. VRE can be present on the caregiver’s hands either from touching contaminated material excreted by an infected person or from touching articles soiled by faeces. VRE can survive well on hands and can survive for weeks on rarimate objects such as toilet seats, taps, door handles, bedrails, furniture and bedpans. VRE is easy to kill with the proper use of disinfectants and good hand hygiene.

It is important that special precautions are taken to stop VRE from spreading to other patients in the hospital. Those precautions include:

• Single room accommodation preferred (the door can remain open)
• A long sleeved gown and gloves must be worn by everyone who cares for you
• A sign may be placed on your door to remind callers who enter your room about the special precautions
• The room and the equipment used in the room will be cleaned and disinfected regularly
• Everyone must wash their hands before leaving your room

Your family and visitors should not assist other patients with their personal care as this may cause the germ to spread. If your family/visitors are helping you with direct personal care (i.e. bathing or changing bed linens) they need to wear a longsleeved gown and gloves. Before leaving your room, they must remove the gloves and gown and dispose of them in the garbage container and the linen hamper located in your room. Then they must clean their hands. All people entering your room need to perform hand hygiene, and when they exit your room they need to perform hand hygiene.

Remind staff and visitors to practice good hand hygiene before and after they touch you. Ask your nurse or doctor to demonstrate proper hand hygiene techniques. (15 seconds of soap and running water OR waterless alcohol hand rub until hands are dry)

You need to clean your hands:

• After using the bathroom
• After blowing your nose
• Before eating and drinking
• Before and after you touch your dressing or wounds
• When your hands are visibly dirty (soiled)
• Before you leave your room

If you have VRE at the time of discharge from hospital, the chance of spreading the germ to your family is small. But, we do recommend you practice the following:

• Everyone who might help you with your personal hygiene or with going to the toilet should wash their hands after contact with you
• Wash your hands before you make any food and before you eat. This practice should be followed by everyone in the household
• Wash your hands well after using the toilet. Make sure others that use the bathroom wash their hands well afterwards
• Clothing may be laundered in the same manner as the rest of the household laundry
• No special cleaning of furniture or items (e.g. dishes) in the home is required
• If you share a bathroom at home, clean the toilet and sink at least weekly with a germicidal cleanser
• Always tell your physician, paramedics, nurses or other care providers that you have VRE. This helps prevent spread to others

Clostridium difficile is one of the many germs (bacteria) that can be found in stool (a bowel movement).

Clostridium difficile disease occurs when antibiotics kill your good bowel bacteria and allow the Clostridium difficile grow. When Clostridium difficile grows, it produces substances (toxins). These toxins can damage the bowel and may cause diarrhea. Clostridium difficile disease is usually mild but sometimes can be severe. In severe cases, surgery may be needed and in extreme cases Clostridium difficile may cause death. Clostridium difficile is the most common cause of infectious diarrhea in hospital.

The main symptoms of Clostridium difficile disease are:

• Watery diarrhea
• Fever
• Abdominal pain or tenderness

Clostridium difficile disease usually occurs during or after the use of antibiotics. Old age, presence of other serious illnesses and poor overall health may increase the risk of severe disease.

If you have symptoms of Clostridium difficile, your doctor will ask for a sample of your watery stool. The laboratory will test the stool to see if Clostridium difficile toxins are present.

Treatment depends on how sick you are with the disease. People with mild symptoms may not need treatment. For more severe disease, an antibiotic is given.

When a person has Clostridium difficile disease the germs in the stool can soil surfaces such as toilets, handles, bedpans, or commode chairs. When touching these items our hands can become soiled. If we then touch our mouth we can swallow the germ. Our soiled hands also can spread the germ to other surfaces.

If you have Clostridium difficile diarrhea you will be moved to a private room until you are free from diarrhea for at least 2 days. Your activities outside the room will be restricted. Everyone who enters your room wears gown and gloves. Everyone MUST clean their hands when leaving your room. Always wash your hands after using the bathroom. Cleaning hands is the most important way for everyone to prevent the spread of this germ. Because Clostridium difficile can live on objects in your room, it will be cleaned twice daily.

Healthy people like our family and friends who are not taking antibiotics are at very low risk of getting Clostridium difficile disease.

Wash your hands for 15 seconds:

• After using the toilet or touching dirty surfaces
• Before eating or preparing meals.

How to Wash Your Hands

Use either a household cleaner, diluted according to the instructions or dilute household bleach:

• Wet the surface well and clean using good friction
• Allow the surface to air dry
• Pay special attention to areas that may be soiled with stool such as the toilet and sink. If you see stool remove first and then clean as described above.

Wash clothes/fabric separately if they are heavily soiled with stool:

• Rinse stool off,
• Clean in a hot water cycle with soap
• Dry items in the dryer if possible.

Regular cleaning, you can use the dishwasher or clean by hand with soap and water.