What type of isolation should be ordered for a Methicillin-resistant Staphylococcus aureus (MRSA) wound?

Contact Precautions for MRSA Wound Infections

Contact precautions should be implemented for all patients with MRSA wound infections to prevent transmission in healthcare settings. 1

Rationale and Implementation

• Contact precautions are considered an "essential practice" for patients known to be infected with MRSA in acute care facilities 1
• These precautions are particularly important for wounds that are draining or not fully contained by dressings 1
• Implementation should include:
  • Placing patients in a single room or cohorting with other MRSA-positive patients 1
  • Healthcare workers must wear gowns and gloves when entering the patient's room or before contact with the patient 1
  • Removal of gloves and gown before leaving the patient's room, followed by immediate hand washing with an antiseptic soap or waterless antiseptic agent 1

Additional Infection Control Measures

• Dedicate non-critical medical equipment (e.g., stethoscope, blood pressure cuff) to the patient or cohort of patients with MRSA 1
• If equipment must be shared, ensure proper cleaning and disinfection between patients 1
• Keep draining wounds covered with clean, dry bandages at all times 1
• Maintain good environmental hygiene with focus on high-touch surfaces in the patient's room 1
• Screen roommates of newly identified MRSA patients to determine colonization status 1

Duration of Precautions

• Contact precautions should be maintained throughout the hospital stay unless specific criteria for discontinuation are met 1
• Discontinuation may be considered after multiple negative cultures (at least three consecutive negative results from multiple body sites including wounds, taken at least one week apart) 1
• Establish a system to flag medical records of MRSA-positive patients for prompt identification upon readmission 1

Special Considerations

• In settings with ongoing MRSA transmission despite basic precautions, consider:
  • Cohorting staff to minimize contact between MRSA-positive and MRSA-negative patients 1
  • Active surveillance cultures to identify MRSA carriers more rapidly 1
  • Decolonization strategies for patients with recurrent MRSA infections 1

Patient Education

• Provide preventive educational messages on personal hygiene and appropriate wound care 1
• Instruct patients to:
  • Keep draining wounds covered with clean, dry bandages 1
  • Maintain good personal hygiene with regular bathing and hand cleaning 1
  • Avoid sharing personal items that have contacted infected skin 1

Controversies and Emerging Evidence

• Recent research has questioned the universal application of contact precautions for MRSA, with some hospitals discontinuing routine use without increases in MRSA transmission 2, 3
• Potential negative consequences of contact precautions include:
  • Decreased healthcare provider time spent with patients 4
  • Negative psychological impact on patients 4
  • Environmental impact from increased use of disposable gowns and gloves 2
• However, until more definitive evidence emerges, contact precautions remain the recommended standard practice for MRSA wound infections, especially in epidemic settings or when wounds are draining 1