What is the management for exposure to Methicillin-resistant Staphylococcus aureus (MRSA)?

Management of MRSA Exposure

For individuals exposed to MRSA, management should include evaluation for active infection, implementation of hygiene measures, and consideration of decolonization strategies only in specific circumstances such as recurrent infections or ongoing transmission despite standard measures. 1

Initial Assessment and Management

Evaluation of Exposed Individuals

• Symptomatic contacts must be promptly evaluated for active MRSA infection and treated appropriately 1
• Asymptomatic contacts should be assessed for risk factors for MRSA colonization or infection
• After treating active infections, consider nasal and topical body decolonization 1

Immediate Hygiene Measures

1. Hand hygiene:

   • Regular cleaning of hands with soap and water or alcohol-based hand gel
   • Particularly important after touching infected skin or items that contacted draining wounds 1

2. Personal item management:

   • Avoid reusing or sharing personal items (razors, linens, towels) that have contacted infected skin 1
   • Ensure proper laundering of potentially contaminated items

Environmental Control Strategies

High-Touch Surface Cleaning

• Focus cleaning on surfaces with frequent skin contact:
  • Counters, doorknobs, bathtubs, toilet seats
  • Other surfaces that may contact bare skin or uncovered infections 1
• Use commercially available cleaners according to label instructions 1

Decolonization Strategies

Decolonization is not routinely recommended for all MRSA exposures but should be considered in specific situations:

When to Consider Decolonization

• When a patient develops recurrent skin and soft tissue infections despite optimized wound care and hygiene 1
• When ongoing transmission is occurring among household members despite proper hygiene measures 1

Decolonization Protocol

When indicated, decolonization should include:

1. Nasal decolonization with mupirocin ointment twice daily for 5-10 days 1
2. Consider adding topical body decolonization with:
   • Chlorhexidine skin antiseptic solution for 5-14 days, OR
   • Dilute bleach baths 1

Special Considerations

Healthcare Settings

• In healthcare facilities, more aggressive screening and isolation protocols may be necessary 1
• The "search and destroy" approach used in low-prevalence countries like The Netherlands has proven cost-effective 1

Monitoring for Complications

• Monitor for signs of active infection (increasing redness, swelling, pain, fever)
• Seek medical attention if symptoms develop after exposure

Common Pitfalls to Avoid

1. Unnecessary antibiotic use: Avoid prescribing systemic antibiotics for asymptomatic colonization, as this may contribute to resistance development 2, 3

2. Inadequate follow-up: Failure to monitor exposed individuals for development of active infection

3. Inconsistent hygiene practices: Sporadic rather than consistent implementation of hand hygiene and environmental cleaning 4

4. Overlooking household transmission: Failing to address potential colonization of household members when recurrent infections occur 1

5. Premature discontinuation of precautions: Stopping isolation or contact precautions too early in healthcare settings 5

By following these evidence-based guidelines, the risk of MRSA transmission and subsequent infection can be significantly reduced while avoiding unnecessary interventions for those with simple exposure.