From the Guidelines
MRSA requires contact isolation precautions in healthcare settings, including placement in a private room when possible, use of personal protective equipment (PPE), and proper hand hygiene before and after patient contact. This is based on the clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children 1. The guidelines highlight the importance of preventing transmission of MRSA, which spreads primarily through direct contact with infected skin, wounds, or contaminated surfaces and equipment.
Key components of contact isolation precautions for MRSA include:
- Placing the patient in a private room when possible
- Using PPE such as gloves and gowns when entering the room
- Proper hand hygiene before and after patient contact
- Dedicated equipment like stethoscopes and blood pressure cuffs should remain in the patient's room
- Visitors should also follow these precautions
The epidemiology of MRSA has become increasingly complex, with both community-associated (CA-MRSA) and healthcare-associated (HA-MRSA) strains co-mingling in healthcare facilities and the community 1. However, the principles of contact isolation remain the same, with the goal of preventing transmission and reducing the risk of infection. Patients with MRSA can be de-isolated after negative screening cultures and completion of any decolonization therapy, though policies may vary between healthcare facilities.
From the Research
MRSA Isolation Types
- There are different types of isolation practices used to minimize MRSA transmission in acute care settings, including single room isolation and cohorting of MRSA patients 2.
- The effectiveness of these practices has been evaluated in several studies, with some evidence suggesting that cessation of single room isolation and cohorting of MRSA patients does not increase nosocomial MRSA transmission when hand-washing compliance and standard precautions are maintained 2.
- Contact precautions, including isolation in a single room, are commonly used to prevent MRSA transmission, but their effectiveness and potential unintended consequences, such as decreased healthcare provider time spent with patients and low compliance, have been debated 3.
Effectiveness of Contact Isolation
- A study published in 1996 found that contact isolation significantly reduced the risk of nosocomial transmission of MRSA in a neonatal intensive care unit, with a 16-fold reduction in transmission rate 4.
- Another study published in 2019 found that isolation precautions used in MRSA infection control were effective in inhibiting pathogen transmission, but may cause unintended consequences in medical care, such as delays in radiological diagnostics and echocardiographs 5.
- A review of the literature published in 2010 found that the impact of single-room isolation in transmission prevention is often overestimated, and that hand hygiene procedures are more important in preventing transmission 6.
Risks and Considerations
- Social isolation is one of the risks associated with single-room isolation, and should be considered when implementing infection control measures 6.
- The economic impact of using shared rooms as single rooms should also be taken into account, as well as the potential for understaffing to worsen the situation 6.
- Up-to-date, evidence-based standard operating procedures and individual infection control recommendations should be developed to address these considerations and optimize compliance with standard precautions 6.