Rationale:

• Hand-washing reduces transmission.
• Barrier precautions (gowning and gloving) reduce transmission.
• MRSA is easily communicated to susceptible patients via contact with the colonized hands and clothes of care providers.
• Once colonized, a patient is at increased risk of developing a MRSA infection.

Evidence:

• The Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force published a guideline for hand hygience in health care settings (1).
• The Society for Healthcare Epidemiology of America published a guideline for preventing nosocomial transmission of multi-drug-resistant strains of Staphylococcus aureus (2).
• A review reported that a combined approach of isolation and screening for MRSA confers efficacy and MRSA-prevalence levels can be reduced to <1% in high-endemic settings by using a "search and destroy" method or a stepwise approach to interventions. Use of rapid diagnostic testing can markedly enhance feasibility (3).
• The Centers for Disease Control and Prevention has published guidelines for the management of multi-drug-resistant organisms in health care settings.
• A study examining the cost-effectiveness of active surveillance cultures and barrier precautions for controlling MRSA in the neonatal intensive care units of two tertiary care hospitals found that the cost of identifying colonized patients and implementing effective preventive controls was justified (4).
• Another study showed that universal screening on admission for MRSA resulted in a large reduction of MRSA infections (5). However, a cluster randomized crossover trial concluded that the cost efficacy of universal screening for MRSA is still controversial (6).

Comments:

• MRSA is easily communicated within households. For example, 20% of household contacts of patients with community-acquired MRSA skin and soft tissue infections carried MRSA. Half of these strains were similar to the patient's strain (7). As many as 60% of households of children with community-acquired MRSA infections consist of at least one family member with a MRSA infection within the previous 6 months (8).
• MRSA has emerged in addition to, not in place of, MSSA skin and soft tissue infection among athletes, men who have sex with men, the incarcerated, and those living in public housing (9; 10).
• Mupirocin ointment applied to the nares may reduce colonization, but it does not prevent new colonization nor does it prevent infections due to MRSA (11).