Does a patient with Methicillin-resistant Staphylococcus aureus (MRSA) need to be on isolation?

MRSA Isolation Requirements

Yes, patients with MRSA should be placed on contact precautions, which includes single-room isolation or cohorting with other MRSA-positive patients, along with gown and glove use by healthcare workers. This recommendation is supported by multiple international guidelines and represents standard practice to prevent transmission and reduce morbidity from healthcare-associated MRSA infections. 1, 2

Core Isolation Components

Contact precautions for MRSA patients must include:

• Single room placement or cohorting with other MRSA-positive patients if single rooms are unavailable 3, 1, 2
• Gown and glove use by healthcare workers before entering the patient's room or before any patient contact 1, 2
• Removal of gown and gloves before leaving the room, followed by immediate hand hygiene with antiseptic soap or waterless antiseptic agent 1, 2
• Dedicated equipment (stethoscope, blood pressure cuff) for the MRSA patient or cohort to prevent cross-contamination 1, 2

Special Considerations for Wound Infections

For MRSA wound infections specifically, contact precautions are particularly critical when:

• Wounds are draining or not fully contained by dressings 1
• The patient requires substantial contact during care 2
• Keep draining wounds covered with clean, dry bandages at all times 1

Duration of Isolation

Maintain contact precautions throughout the hospital stay unless specific discontinuation criteria are met 1, 2:

• At least three consecutive negative cultures from multiple body sites including wounds 1, 2
• Cultures taken at least one week apart 1, 2
• MRSA colonization can persist indefinitely, requiring strict criteria before removing precautions 2

Implementation Priorities

Focus initial control efforts on high-risk areas:

• Intensive care units where transmission rates are highest 2
• Surgical units and other acute care settings 3
• Consider cohorting staff to minimize contact between MRSA-positive and MRSA-negative patients 3, 1, 2

Evidence Nuances and Caveats

Important context about isolation effectiveness:

While one prospective ICU study found no additional benefit from moving MRSA patients to single rooms when standard precautions were maintained 4, this finding should be interpreted cautiously. The study had significant limitations including endemic MRSA prevalence and may not apply to general ward settings. Current guidelines from WHO, CDC, and other major organizations continue to strongly recommend isolation based on broader evidence and the precautionary principle. 1, 2

The Dutch "search and destroy" approach demonstrates that aggressive isolation combined with screening and decolonization can maintain very low MRSA prevalence (0.3%) even when outbreaks occur, though this requires substantial resources. 3

Practical Implementation

Environmental and administrative measures:

• Enhanced environmental cleaning with monitoring of cleaning performance 3
• Flag medical records of MRSA-positive patients for prompt identification upon readmission 1
• Screen roommates of newly identified MRSA patients 1
• Establish systems to monitor compliance with isolation precautions 2

Patient education components:

• Maintain good personal hygiene with regular bathing and hand cleaning 1
• Keep wounds covered and practice appropriate wound care 1

Cost-Benefit Considerations

One study showed that reducing contact precaution days (from 11.9 to 6.8 days average) did not increase MRSA transmission rates and reduced costs significantly 5. However, this approach requires robust hand hygiene compliance and universal gloving, and current guidelines still recommend maintaining precautions throughout hospitalization unless negative cultures are documented. 1, 2