MRSA Prevention Clinical Practice Guidelines

2021 clinical guidelines for the prevention and control of methicillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities were published jointly in October 2021 by the Healthcare Infection Society (HIS) and the Infection Prevention Society (IPS) in the Journal of Hospital Infection.^[1]

Patient screening

Use a targeted approach at a minimum, but universal screening may be appropriate, depending on local facilities.

If a patient undergoes decolonisation therapy, consider determining the success of decolonisation with repeat MRSA screening 2-3 days after therapy. Do not postpone surgery if repeat screening remains positive.

Staff screening and management

For employees with positive test results, consider also screening the throat, hairline, and groin/perineum because if positive, the risk increases for shedding into the environment and MRSA transmission.

Develop local policies regarding exclusion from work and return of staff colonised with MRSA, Considering the worker’s risk for transmission to patients.

Decolonisation therapy

To decolonize the skin, moisten the skin, apply 4% chlorhexidine wash, and leave for 1-3min before washing off. If using 2% chlorhexidine wipes, do not rinse off.

Environmental sampling and cleaning/disinfection

Routine screening/sampling of the environment is not necessary. Routine surveillance should be undertaken in accordance with the hospital’s infection and control strategy and in compliance with mandatory national requirements.

Standard vs. contact precautions and the use of isolation/cohorting

For patients with known MRSA colonization/infection, consider using contact precautions when in direct contact with the patient or their immediate environment; gloves and aprons must be changed between procedures and hand hygiene must be performed after removing gloves.

Consider placing these patients in a single room, based on the extent of their colonization or infection and their risk for transmission to others.

Patient transfer and transport

Do not transfer patients between hospitals, hospital wards and units, or other clinical settings unless it is clinically necessary. Notify the receiving party and the ambulance/transport service that the patient is colonised/infected with MRSA.

Shared equipment

Clean and disinfect shared equipment after each use; ensure all healthcare workers know cleaning and decontaminating requirements; and ensure staff, patients, and visitors clean hands before and after using shared equipment.

Patient information

Inform patients of their screening result as soon as possible; for patients who are MRSA positive, inform about the difference between colonization and infection; the microorganism; how MRSA is acquired and transmitted; how it is treated; and the reasons for contact precautions or isolation.

On discharge provide thorough information about risks to household members, friends, and family, as well as the implications for the patient’s future health and healthcare.

Handling the deceased

Follow national guidance for managing infection risks when handling the deceased.

For more information, see Staphylococcal Infections.

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