New Strategies to Prevent MRSA Infections in Your Hospital

David C. Ham, MD, MPH; Athena P. Kourtis, MD, PhD


December 23, 2019

Editorial Collaboration

Medscape &


To address the recent rise in S aureus BSIs in US hospitals, the CDC recently released a framework of strategies, many of which have been part of MRSA control efforts for years, including preventing device- and procedure-related infections and using contact precautions for patients infected or colonized with MRSA. The framework also includes newer source control strategies that have shown great promise in reducing S aureus infections. Source control strategies generally use topical and intranasal antiseptics or antibiotics during high-risk periods to reduce the burden of S aureus organisms, resulting in reduced risk for the individual patient as well as reductions in transmission.

The REDUCE MRSA trial found that universal use of twice-daily intranasal mupirocin for 5 days plus daily chlorhexidine bathing for all patients in the ICU for the duration of their ICU stay was an effective approach to reducing MRSA infections. In contrast, the ABATE trial concluded that these same tools did not reduce BSIs significantly for most patients on general medical and surgical units. There was one important exception, however: Patients with a central venous catheter, a midline catheter, or a lumbar drain had a 32% greater reduction than controls in all-cause BSIs and a 30% reduction in MRSA clinical cultures compared with control patients.

Source control could also be considered for all patients undergoing high-risk surgeries (eg, cardiothoracic, orthopedic, and neurosurgery). For these patients, an intranasal antistaphylococcal antibiotic/antiseptic (eg, mupirocin or iodophor) and chlorhexidine wash or wipes may be used before surgery. Possible regimens include:

  1. Intranasal antistaphylococcal antibiotic/antiseptic

    1. Mupirocin twice daily to each nostril for the 5 days before the day of surgery

    2. Two applications of nasal iodophor (at least 5%) to each nostril within 2 hours before surgery

  2. Chlorhexidine

    1. Daily chlorhexidine wash or wipes for up to 5 days before surgery

Facilities can choose to apply the selected preoperative source control regimen universally to all patients or can screen patients undergoing a high-risk surgery for both methicillin-sensitive and -resistant S aureus, and provide the decolonization regimen only to those from whom S aureus is identified.

There is no evidence to suggest a benefit of extending the duration of perioperative antibiotic prophylaxis, and the well-recognized downside to this unnecessary use of antibiotics is a higher likelihood of adverse events.

Web Resources

MRSA in Healthcare Settings

MRSA: Outpatient Management

MRSA: Preventing Infections in Healthcare

CDC's Strategies to Prevent Hospital-onset Staphylococcus aureus Bloodstream Infections in Acute Care Facilities

AHRQ Universal Source Control Protocol for ICU

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