Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterium resistant to many common antibiotics, including methicillin and related penicillin-like drugs. This resistance makes MRSA infections significantly more challenging to treat compared to typical staph infections. MRSA is particularly problematic in hospital settings, where it spreads easily through direct contact and contaminated surfaces, posing a serious risk to vulnerable patients with weakened immune systems or those recovering from surgery. The bacterium can lead to severe conditions like bloodstream infections, surgical site infections, and pneumonia, resulting in long hospital stays and increased mortality. Hospitals employ a comprehensive, multi-layered strategy designed to identify, contain, and eliminate the pathogen from the healthcare environment.
Active Surveillance and Patient Screening
Hospitals begin MRSA elimination by proactively identifying where the bacteria resides within the facility and among patients, a process known as active surveillance. This involves systematically tracking and monitoring the presence of MRSA. Many individuals can be colonized, meaning they carry the bacteria without showing symptoms, yet they can still transmit it to others.
Active screening cultures are the primary tool for this surveillance. Swabs are commonly taken from the patient’s nose, and sometimes from wounds, usually upon admission to a high-risk unit like the Intensive Care Unit (ICU) or when transferring from another facility. These swabs are tested using rapid molecular diagnostic techniques to quickly detect the MRSA genetic marker. Identifying colonization allows the hospital to implement preventive measures before an infection develops or transmission occurs.
Both colonization and active infection trigger containment protocols. Hospitals also use epidemiological analysis to track positive MRSA cases and create “line lists” of affected patients. This data tracking helps infection control teams pinpoint potential “hot spots” within the facility, such as specific wards or equipment. This allows for targeted intervention and auditing of staff compliance with screening and isolation procedures.
Strict Contact Precautions and Barrier Methods
Once a patient is identified as colonized or infected with MRSA, the focus shifts to containment to prevent the spread of bacteria to other patients, healthcare workers, or the environment. This containment phase is achieved through the rigorous application of contact precautions. The patient is typically placed in a private room, or cohorted with other MRSA-positive patients, to physically separate them from the general population.
A mandatory component of contact precautions is the use of Personal Protective Equipment (PPE) by all staff entering the room, including clean gloves and a gown. This barrier prevents MRSA from contaminating the healthcare worker’s skin or clothing. Hand hygiene is strictly enforced, requiring staff to perform hand antisepsis with an alcohol-based rub or soap and water immediately after removing their gloves and gown.
Dedicated medical equipment, such as a stethoscope or blood pressure cuff, is often assigned to the patient’s room to prevent cross-contamination. Limiting the patient’s transport out of the room also reduces the risk of spreading the organism to other hospital areas. These procedural barriers are foundational for interrupting transmission.
Targeted Decolonization and Environmental Disinfection
The next phase moves from containment to active eradication, focusing on eliminating the bacteria from both the patient and the physical hospital environment. Patient decolonization protocols aim to suppress or remove MRSA from common body sites like the nose and skin.
The most common decolonization regimen involves the intranasal application of an antibiotic ointment, such as mupirocin, often twice daily for five days. Simultaneously, patients are typically bathed daily with an antiseptic body wash containing chlorhexidine gluconate (CHG). CHG bathing reduces the bacterial load on the skin surface, complementing the nasal treatment. This targeted approach reduces both MRSA carriage and the risk of subsequent infections.
The hospital environment requires rigorous disinfection, a process known as terminal cleaning, which occurs after an MRSA-positive patient is discharged or moved. Housekeeping staff use hospital-grade disinfectants on all high-touch surfaces, including bed rails, call buttons, and bedside tables. Some facilities also employ specialized disinfection technologies for comprehensive surface decontamination, such as mobile devices that emit ultraviolet (UV) light or systems that disperse hydrogen peroxide vapor. These advanced methods sterilize the environment and break the chain of transmission.
Antibiotic Stewardship and Systemic Policy
Hospitals implement long-term strategies to prevent the emergence of new resistant strains and sustain low MRSA rates. The most significant strategy is the establishment of an Antibiotic Stewardship Program (ASP). This is a multidisciplinary effort involving physicians, pharmacists, and infection preventionists. The primary goal of the ASP is to optimize antibiotic use by ensuring patients receive the right drug, at the correct dose, for the appropriate duration, and only when necessary.
Inappropriate or excessive use of broad-spectrum antibiotics creates selective pressure that encourages MRSA and other resistant organisms to thrive. By monitoring and limiting the unnecessary use of high-risk antibiotics, ASPs reduce the environment in which MRSA gains a competitive advantage. For example, the program may require a review after a set period of antibiotic use to determine if the therapy can be stopped or narrowed to a more specific agent.
Systemic policies also include mandatory and recurring education for all hospital staff, from nurses and physicians to environmental services personnel, on the latest infection control protocols. Multidisciplinary committees meet regularly to analyze MRSA data, set facility-wide standards, and assess compliance with hand hygiene and contact precaution policies. This institutional commitment helps prevent the resurgence of MRSA strains.