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  6. MRSA in Paediatric Cystic Fibrosis Patients, Eradication and Treatment (636)
Important: please update your RDS app to version 4.7.3 Details with newsletter below.

Please update your RDS app to v4.7.3

We asked you in January to update to v4.7.2.  After the deployment planned for 27th February, this new update will be needed to ensure that you are able to download RDS toolkits even when the RDS website is not available. We will wait until as many users as possible have downloaded the new version before switching off the old system for app downloads and moving entirely to the new approach.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. 

To update to the latest release:

 On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Right Decision Service newsletter: February 2025

Welcome to the February 2025 update from the RDS team

1.     Next release of RDS

 

A new release of RDS is planned (subject to outcomes of current testing) for week beginning 24th February. This will deliver:

 

  • Fixes to mitigate the recurring glitches with the RDS admin area and the occasional brief user interface outages which have arisen following implementation of the new distributed technology infrastructure in December 2024.

 

  • Capability to embed content from Google calendar, Google Maps, Daily Motion, Twitter feeds, Microsoft Stream into RDS pages.

 

  • Capability to include simple multiplication in RDS calculators.

 

The release will also incorporate a number of small fixes, including:

  • Exporting of form within Medicines Sick Day Guidance in polypharmacy toolkit
  • Links to redundant content appearing in search in some RDS toolkits
  • Inclusion of accordion headers alongside accordion text in search result snippets.
  • Feedback form on mobile app.
  • Internal links on mobile app version of benzo tapering tool

 

We will let you know when the date and time for the new release are confirmed.

 

2.     New RDS developments

There is now the capability to publish toolkits on the web with left hand side navigation rather than tiles on the homepage. To use this feature, turn on the “Toggle navigation panel” option at the top of the Page settings menu at toolkit homepage level – see below. Please note that publication to downloadable mobile app for this type of navigation is still under development.

The Benzodiazepine tapering tool (https://rightdecisions.scot.nhs.uk/benzotapering) is now available as part of the RDS toolkit for the national benzodiazepine prescribing guidance developed by the Scottish Government Effective Prescribing team. The tool uses this national guidance developed with a wide-ranging multidisciplinary group. This should be used in combination with professional judgement and an understanding of the needs of the individual patient.

3.     Archiving and version control and new RDS Search and Browse interface

Due to the intensive work Tactuum has had to undertake on the new technology infrastructure has pushed back the delivery dates again and some new requirements have come out of the recent user acceptance testing. It now looks likely to be an April release for the search and browse interface. The archiving and version control functionality may be released earlier. We’ll keep you posted.

4.     Statistics

At the end of January, Olivia completed the generation of the latest set of usage statistics for all RDS toolkits. If you would like a copy of the stats for your toolkit, please contact Olivia.graham@nhs.scot .

 

5.     Review of content past its review date

We have now generated reports of all RDS toolkit content that has exceeded its review date by 6 months or more. We will be in touch later this month with toolkit owners and editors to agree the plan for updating or withdrawing out of date content.

 

6.     Toolkits in development

Some important toolkits in development by the RDS team include:

  • National CVD prevention pathways – due for release end of March 2025.
  • National respiratory pathways, optimal cancer diagnostic pathways and cancer prehabilitation pathways from the Centre for Sustainable Delivery. We will shortly start work on the national cancer referral pathways, first version due for release via RDS around end of June 2025.
  • HIS Quality of Care Review toolkit – currently in final stages of quality assurance.

 

The RDS team and other information scientists in HIS have also been producing evidence summaries for the Scottish Government Realistic Medicine team, to inform development of national guidance around Procedures of Limited Clinical Value. This guidance will in due course be translated into an RDS toolkit.

 

7. Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:

  • Friday 28th February 12-1 pm
  • Tuesday 11th March 4-5 pm

 

To book a place, please contact Olivia.graham@nhs.scot, providing your name, organisation, job role, and level of experience with RDS editing (none, a little, moderate, extensive.)

 

To invite colleagues to sign up to receive this newsletter, please signpost them to the registration form  - also available in End-user and Provider sections of the RDS Learning and Support area.   If you have any questions about the content of this newsletter, please contact his.decisionsupport@nhs.scot  If you would prefer not to receive future newsletters, please email Olivia.graham@nhs.scot and ask to be removed from the circulation list.

With kind regards

 

Right Decision Service team

Healthcare Improvement Scotland

 

 

MRSA in Paediatric Cystic Fibrosis Patients, Eradication and Treatment (636)

Disclaimer:
The following guideline has been developed for use within the Royal Hospital for Children, NHS Greater Glasgow and Clyde (NHSGGC). The guideline has been developed in collaboration with key stakeholders within NHSGGC, including Microbiology, Cystic Fibrosis, Infectious Disease and Pharmacy teams. The guideline has been approved by the Paediatric Antimicrobial Management Team and ratified by the NHSGGC Antimicrobial Utilisation Committee. The guideline does not account for epidemiology and resistance patterns outside of NHS GGC and use outside of the designated organisation is at the individual’s risk. 

Background

“MRSA infection will lead to a reduction in options for antibiotic treatment and a likelihood of deterioration in lung function, therefore MRSA infection should be avoided“ 
CF Trust MRSA 2008

“At first isolate, or in a person who has been free of MRSA following previous treatment, aim to eradicate the organism.“ 
CF Trust Antibiotic Treatment for CF 2009

“There are a small number of studies of the use of treatment regimens to eradicate MRSA lower respiratory tract infection in people with cystic fibrosis. The rate of clearance of infection without treatment is unknown. The eradication regimens in these studies have included combinations of oral, intravenous and nebulised antibiotics. The optimum regimen remains unclear...
CF Trust MRSA 2008

If one treatment regimen fails to eradicate MRSA infection, two further attempts with the same or different regimens may still be successful and should be considered.“
CF Trust MRSA 2008

General Recommendations

CF Trust MRSA 2008:

  1. Every Specialist CF Centre and CF Clinic should have a microbiological surveillance and infection prevention and control policy that considers cross-infection risk for MRSA.
  2. The methods used and extent to which Specialist CF Centres and CF Clinics segregate patients should be determined by local policy.
  3. Good hygiene should be practised in all outpatient clinics and inpatient facilities to minimise the risk of transmission of MRSA between patients.
  4. Specialist CF Centres and CF Clinics should monitor the rate of new acquisition of MRSA. 
  5. A policy of segregation that covers both inpatient admissions and outpatient clinics is advised.
  1. Stop Flucloxacillin/Erythromycin administration on first culture of MRSA
  1. Skin and nasal swabs - To be obtained from patient at baseline and around every inpatient admission. Anterior nares and Perineum are the minimum number of swabs required.  Other sites are included if applicable, such as skin lesions/ wounds, catheter sites, e.g. Central Venous Catheters, Hickman Lines, catheter urine,  umbilicus (neonates only). If patient refuses perineal screening they should be offered throat screening.  
  1. Seek Infection Prevention and Control advice re- extended screening if there is persistent or rapidly recurrent MRSA colonisation of the patient.
  1. Source isolation as per local hospital policies at Out-patient and Inpatient attendances
  1. Sputum / Cough swab cultures obtained to monitor colonization
  1. MRSA would be considered eradicated if cultures remain clear for 12 months or more.

Management of MRSA infections at RHC:

The CF Team and RHC Microbiology /Infection Prevention and Control Teams have reviewed the
available information regarding current MRSA eradication and treatment regimens, including
recent local audit data. The following regimens have been selected as being most suitable for use
at RHC Glasgow CF Unit

1. Eradication

FOR MRSA COLONISED PATIENTS NOT ON ROUTINE ANTIBIOTICS and NOT EXPERIENCING A RESPIRATORY EXACERBATION

Regime A1: MRSA COLONISATION OF RESPIRATORY TRACT +/- SKIN /NOSE COLONISATION IN PATIENTS NOT CURRENTLY RECEIVING A CFTR MODULATOR

*The antibiotics listed must be used in combination as listed below and are not suitable for use as monotherapy in the eradication of MRSA*

IN COMBINATION WITH ONE OF THE FOLLOWING

 

Regime A2: MRSA COLONISATION OF RESPIRATORY TRACT +/- SKIN /NOSE COLONISATION IN PATIENTS WHO ARE CURRENTLY RECEIVING A CFTR MODULATOR

Due to the risk of cytochrome mediated drug-drug interactions with the CFTR modulator therapies, patients receiving these treatments who require respiratory tract decolonisation for MRSA should be discussed with an infection specialist in the first instance.

Recommendations for decolonisation therapy will be based on individual microbiology and sensitivity patterns.

Check for drug-drug interactions before initiating treatment. For further advice please contact Pharmacy.

 

Regime B: MRSA COLONISATION OF SKIN / NOSE ONLY

If skin swabs or nasal swabs +ve For decontamination guidance see NHS GG&C Infection Prevention and Control pathways - MRSA
Repeat cultures on two occasions following each eradication period– first culture at least 48 hours after antibiotic/ decolonisation therapy has been completed ; second culture no less than 72 hours after first.

Eradication Regimes A and/or B should be undertaken on a maximum of three occasions

2. Treatment

IV ANTIBIOTIC REGIMEN (MRSA COLONISATION) –RESPIRATORY EXACERBATION OR REGULAR IVs

MRSA COLONISATION OF SKIN / NOSE ONLY

Assume skin swabs and nasal swabs +ve For decontamination guidance see NHS GG&C Infection Prevention and Control pathways - MRSA
Repeat cultures on two occasions following each eradication period– first culture at least 48 hours after antibiotic/ decolonisation therapy has been completed ; second culture no less than 72 hours after first.

Editorial Information

Last reviewed: 22/02/2022

Next review date: 22/02/2024

Author(s): Jane Wilkinson.

Version: 3

Approved By: Antimicrobial Utilisation Committee

Document Id: 636

References