High-risk groups include patients with MRSA, C.difficile, tuberculosis (within the first two weeks of treatment), or pandemic influenza (where there is no vaccine available) and Staphylococcus aureus, which have caused particular concern in recent times.

Staphylococcus aureus is a bacterium that can reside on the skin, or can be found in the nose. About one third of healthy individuals carry S. aureus. MRSA is a less common variant of S. aureus which may be resistant to many antibiotics making it more difficult to treat than normal strains of the bacterium. MRSA is a problem in many hospitals. Although the risk of serious infection with MRSA is lower in the community, it is increasingly seen in community health care units, such as nursing homes. MRSA does not cross intact skin.

There is little risk of infection for healthy clinical staff; however, infection control is important to avoid transmission to vulnerable people.

MRSA detected in the community may be the result of:

1. patients discharged from hospital with MRSA
2. nursing home residents who have acquired MRSA
3. MRSA transmitted to non-hospitalised patients, or other individuals, from MRSA patients
4. MRSA arising naturally in the community.

If you examine a patient with a known transmissible infection, you should:

1. increase the effectiveness of your hand hygiene by:
   • keeping nails short, clean and free of nail varnish, and by avoiding artificial nails
   • avoiding wearing jewellery, especially rings with ridges or stones
   • avoiding wearing wristwatches
2. keep in mind NHS policy on clinician attire by:
   • wearing short sleeves or rolling up long sleeves
   • not wearing a tie.