MRSA Prevention and Infection-Control Strategies

Screening programs
Patient screening upon hospital admission, with nasal cultures, prevents the cohabitation of MRSA carriers with non-carriers, and exposure to infected surfaces. In the United States and Canada, the Centers for Disease Control and Prevention issued guidelines on 19 October 2006, citing the need for additional research, but declined to recommend such screening.

A report in the journal "Pediatrics" says 2.4% of healthy children may be carrying the staph infection "MRSA" in their nasal passage.

Surface sanitizing
Alcohol has been proven to be an effective surface sanitizer against MRSA. Quaternary ammonium can be used in conjunction with alcohol to extend the longevity of the sanitizing action. The prevention of nosocomial infections involves routine and terminal cleaning. Non-flammable Alcohol Vapor in Carbon Dioxide systems (NAV-CO2) do not corrode metals or plastics used in medical environments and do not contribute to antibacterial resistance.

In healthcare environments, MRSA can survive on surfaces and fabrics, including privacy curtains or garments worn by care providers. Complete surface sanitation is necessary to eliminate MRSA in areas where patients are recovering from invasive procedures. Testing patients for MRSA upon admission, isolating MRSA-positive patients, decolonization of MRSA-positive patients, and terminal cleaning of patients' rooms and all other clinical areas they occupy is the current best practice protocol for nosocomial MRSA.


Hand washing
At the end of August 2004, after a successful pilot scheme to tackle MRSA, the UK National Health Service announced its Clean Your Hands campaign. Wards were required to ensure that alcohol-based hand rubs are placed near all beds so that staff can hand wash more regularly. It is thought that if this cuts infection by just 1%, the plan will pay for itself many times over.

A June 2008 report, centered on a survey by the Association for Professionals in Infection Control and Epimedmiology, concluded that poor hygiene habits remain the principal barrier to significant reductions in the spread of MRSA.


Decolonization
After the drainage of boils or other treatment for MRSA, patients can shower at home using chlorhexidine (Hibiclens) or hexachlorophene (Phisohex) antiseptic soap from head to toe, and apply mupirocin (Bactroban) 2% ointment inside each nostril twice daily for 7 days, using a cotton-tipped swab. Doctors may also prescribe strong antibotics such as Clindamycin, Levofloxacin (Levaquin), and possibly Flagyl for the side effects of the Clindamycin. Household members are recommended to follow the same decolonization protocol.


More information
Mathematical models describe one way in which a loss of infection control can occur after measures for screening and isolation seem to be effective for years, as happened in the UK. In the "search and destroy" strategy that was employed by all UK hospitals until the mid 1990s, all patients with MRSA were immediately isolated, and all staff were screened for MRSA and were prevented from working until they had completed a course of eradication therapy that was proven to work. Loss of control occurs because colonised patients are discharged back into the community and then readmitted: when the number of colonised patients in the community reaches a certain threshold, the "search and destroy" strategy is overwhelmed. One of the few countries not to have been overwhelmed by MRSA is the Netherlands: an important part of the success of the Dutch strategy may have been to attempt eradication of carriage upon discharge from hospital.

Current US guidance does not require workers in general workplaces (not healthcare facilities) with MRSA infections to be routinely excluded from going to work.

Unless directed by a healthcare provider, exclusion from work should be reserved for those with wound drainage that cannot be covered and contained with a clean, dry bandage and for those who cannot maintain good hygiene practices.[39] Workers with active infections should be excluded from activities where skin-to-skin contact is likely to occur until their infections are healed. Healthcare workers should follow the Centers for Disease Control and Prevention's Guidelines for Infection Control in Health Care Personnel.

To prevent the spread of Staph Infection or MRSA Infection in the workplace, employers should ensure the availability of adequate facilities and supplies that encourage workers to practice good hygiene; that surface sanitizing in the workplace is followed; and that contaminated equipment are sanitized with Environmental Protection Agency (EPA)-registered disinfectants.