Methicillin resistant staphylococcus aureus primary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Primary Prevention

Standard Precautions include:

• Handwashing

  • Wash hands after touching blood, body fluids, secretions, excretions, and contaminated items, whether or not gloves are worn.
  • Wash hands immediately after gloves are removed, between patient contacts, and when otherwise indicated to avoid transfer of microorganisms to other patients or environments. It may be necessary to wash hands between tasks and procedures on the same patient to prevent cross-contamination of different body sites.

• Gloving: Wear gloves (clean nonsterile gloves are adequate) when touching blood, body fluids, secretions, excretions, and contaminated items; put on clean gloves just before touching mucous membranes and nonintact skin. Remove gloves promptly after use, before touching noncontaminated items and environmental surfaces, and before going to another patient. Wash hands immediately to avoid transfer of microorganisms to other patients or environments.

• Masking: Wear a mask and eye protection or a face shield to protect mucous membranes of the eyes, nose, and mouth during procedures and patient-care activities that are likely to generate splashes or sprays of blood, body fluids, secretions, and excretions.

• Gowning: Wear a gown (a clean nonsterile gown is adequate) to protect skin and prevent soiling of clothes during procedures and patient-care activities that are likely to generate splashes or sprays of blood, body fluids, secretions, and excretions.

• Appropriate device handling: Handle used patient-care equipment soiled with blood, body fluids, secretions, and excretions in a manner that prevents skin and mucous membrane exposures, contamination of clothing, and transfer of microorganisms to other patients and environments. Ensure that reusable equipment is not used for the care of another patient until it has been appropriately cleaned and reprocessed and that single-use items are properly discarded.

• Appropriate handling of laundry: Handle, transport, and process used linen soiled with blood, body fluids, secretions, and excretions in a manner that prevents skin and mucous membrane exposures, contamination of clothing, and transfer of microorganisms to other patients and environments.

If MRSA is judged by the hospital's infection control program to be of special clinical or epidemiologic significance, then Contact Precautions should be considered.

Contact Precautions consist of:

1. Placing a patient with MRSA in a private room. When a private room is not available, the patient may be placed in a room with a patient(s) who has active infection with MRSA, but with no other infection (cohorting).
2. Wearing gloves (clean nonsterile gloves are adequate) when entering the room. During the course of providing care for a patient, change gloves after having contact with infective material that may contain high concentrations of microorganisms (e.g., fecal material and wound drainage). Remove gloves before leaving the patient's room and wash hands immediately with an antimicrobial agent. After glove removal and handwashing, ensure that hands do not touch potentially contaminated environmental surfaces or items in the patient's room to avoid transfer of microorganisms to other patients and environments.
3. Wearing a gown when entering the room if you anticipate that your clothing will have substantial contact with the patient, environmental surfaces, or items in the patient's room, or if the patient is incontinent, or has diarrhea, an ileostomy, a colostomy, or wound drainage not contained by a dressing. Remove the gown before leaving the patient's room. After gown removal, ensure that clothing does not contact potentially contaminated environmental surfaces to avoid transfer of microorganisms to other patients and environments.
4. Limiting the movement and transport of the patient from the room to essential purposes only. If the patient is transported out of the room, ensure that precautions are maintained to minimize the risk of transmission of microorganisms to other patients and contamination of environmental surfaces or equipment.
5. Ensuring that patient-care items, bedside equipment, and frequently touched surfaces receive daily cleaning.
6. When possible, dedicate the use of noncritical patient-care equipment and items such as stethoscope, sphygmomanometer, bedside commode, or electronic rectal thermometer to a single patient (or cohort of patients infected or colonized with MRSA) to avoid sharing between patients. If use of common equipment or items is unavoidable, then adequately clean and disinfect them before use on another patient.