MRSA Prevention in Hospitals: Evidence-Based Infection Control Bundle

Methicillin-resistant Staphylococcus aureus (MRSA) prevention requires a multimodal bundle. No single intervention suffices.

Core Prevention Strategies

1. Hand hygiene: ABHR (alcohol-based hand rub) at WHO 5 Moments. Compliance >90% target. Single most effective measure.
2. Contact Precautions: Gown/gloves for all MRSA-colonized/infected patients. Private room or cohorting.
3. Active surveillance screening: Nares PCR/culture on admission (ICU, high-risk units). Decolonization (mupirocin + CHG) for carriers — reduces transmission & infection.
4. Chlorhexidine gluconate (CHG) bathing: Daily for ICU patients; reduces bloodstream infections.
5. Environmental cleaning: EPA-registered sporicidal disinfectants; terminal cleaning validation (ATP, fluorescent gel). Focus on high-touch surfaces.
6. Antimicrobial stewardship: Restrict fluoroquinolones, 3rd-gen cephalosporins, clindamycin — drivers of MRSA selection. IV→PO switch, duration limits.
7. Device bundles: CLABSI (central line), CAUTI (catheter), VAP (ventilator) — all reduce MRSA entry portals.
8. Staff education & accountability: Annual competency; unit-level champions; feedback on compliance/HAI rates.
9. Leadership engagement: C-suite visibility; zero-tolerance culture; resources for IP staffing.

Special Situations

• Decolonization protocols: Mupirocin intranasal BID × 5 days + CHG body wash × 5 days — pre-op, ICU admission, outbreak.
• Outbreak management: Enhanced surveillance, molecular typing (WGS), root cause analysis, temporary unit closure if needed.

Metrics

• MRSA bacteremia rate (per 10,000 patient-days)
• Hand hygiene compliance
• Screening adherence
• Decolonization completion

Sustained reduction requires systems thinking, not checklists. Culture of safety > policy documents.