How can MRSA infection be prevented from an infected inpatient?

Preventing MRSA Infection from an Infected Inpatient Case

Isolation is the most effective measure to prevent MRSA transmission from an infected inpatient case, combined with active surveillance and strict infection control practices. 1

Primary Prevention Strategies

1. Isolation Measures

• Single room isolation or cohorting of MRSA-positive patients is recommended as a high-priority intervention 1
• Healthcare workers should wear gowns and gloves when caring for MRSA-colonized patients 1
• Dedicated equipment should be used for isolated patients to prevent cross-contamination 1

2. Active Surveillance

• Implement MRSA surveillance cultures to identify the reservoir among high-risk patients 1
• Establish automated flagging systems to identify previously colonized patients upon readmission 1
• Use rapid molecular methods for screening and detection of MRSA carriers, particularly in high-risk units like ICUs 1

3. Hand Hygiene

• Hand hygiene remains the cornerstone of MRSA prevention 2
• The main transmission path of MRSA is bacterial spread through healthcare workers' hands 2
• Compliance with hand hygiene protocols should be regularly audited and feedback provided to staff 1

Secondary Prevention Strategies

1. Decolonization

• Attempt to decolonize MRSA carriers in the absence of chronic lesions or indwelling devices 1
• Mupirocin nasal ointment is the most effective agent for nasal decolonization 3
• However, decolonization has limited effectiveness in patients carrying MRSA at multiple body sites 3

2. Environmental Measures

• Regular environmental cleaning of patient rooms and high-touch surfaces
• Proper disinfection of shared equipment between patient use
• Adequate spacing between beds in multi-bed rooms when isolation is not possible

Implementation Considerations

Successful Implementation Requires:

• Sufficient isolation facilities (single patient rooms) 1
• Adequate staffing to manage the workload of contact isolation 1
• Education and training of healthcare workers on MRSA prevention 1
• Regular auditing of compliance with prevention measures 1

Evidence and Controversies

While one study questioned the effectiveness of isolation in ICU settings 4, this study had significant limitations including poor hand hygiene compliance (only 21%) and delays in obtaining MRSA screening results 1. The consensus among guidelines remains that isolation is essential.

The Dutch "search and destroy" approach demonstrates the effectiveness of aggressive MRSA control measures, including isolation, in maintaining very low MRSA prevalence (0.3% of patients) 1. This approach has proven cost-effective, preventing an estimated 520,000 infections per year 1.

Common Pitfalls to Avoid

1. Inadequate screening: Failure to identify MRSA carriers promptly leads to delayed isolation
2. Poor hand hygiene compliance: Even with isolation, transmission occurs if hand hygiene is suboptimal
3. Inconsistent application: Isolation measures must be applied consistently to all MRSA-positive patients
4. Overreliance on antibiotics: Vancomycin should be reserved for treating active infections, not for prophylaxis or colonization 2
5. Neglecting healthcare worker screening: During outbreaks, healthcare workers should be screened for MRSA carriage 1

In conclusion, while nasal swabs are important for surveillance and vancomycin is crucial for treating active MRSA infections, isolation remains the primary intervention for preventing MRSA transmission from infected inpatients when combined with comprehensive infection control practices.