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Information for Inpatient Clinicians and Administrators

Numerous studies show that MRSA infections can be prevented, and CDC offers clinicians practical guidelines and tools to help reduce infections and protect patients. MRSA is important to control for three main reasons:

  • Pathogenicity.
    MRSA bacteria have many virulence factors that enable them to cause disease. For example, MRSA is a cause of healthcare-associated bloodstream and catheter-related infections. MRSA is also a common cause of community-associated infections, especially skin and soft tissue infections, and can also cause necrotizing pneumonia.
  • Limited treatment options.
    MRSA is resistant to first-line antibiotics, leaving clinicians and patients with limited treatment options. IDSA has recent guidelines for treatment of MRSA.  CDC published a landmark report, Antibiotic Resistance Threats in the United States, listing MRSA as a “serious” threat to health.
  • Transmissibility.
    See how your facility and state are performing in publicly available reports from CMS Hospital Compare which uses data from CDC’s NHSN to publicly report data about hospital quality measures, including MRSA and and other infections.
  • Contact Precautions
    CDC recommends the use of Contact Precautions (CP) in inpatient acute care settings for patients known to be colonized or infected with epidemiologically important Multidrug-Resistant Organisms (MDROs) including Methicillin-Resistant Staphylococcus aureus (MRSA).

From 2005 to 2014, the overall estimated incidence of invasive MRSA infections from normally sterile sites (i.e. , blood, pleural fluid, etc.) in the United States declined by 40% and the estimated incidence of invasive hospital-onset MRSA infections declined by 65%. Interventions designed to decrease risk of device and procedure-associated infections and interventions to reduce transmission, like CP and hand hygiene, both likely contributed to these decreases. The relative contribution of CP in comparison to other interventions is unknown.

In the past five years, more than a dozen studies, review articles, and editorials have sought to address whether CP should continue to be recommended for endemic MDROs like MRSA. The impact of discontinuing CP for MRSA-colonized or infected patients has been assessed primarily in single-center studies using lower quality quasi-experimental designs that have not identified changes in MRSA infection or acquisition rates. These studies likely underestimate the impact of discontinuing CP, including the effect on downstream adverse events (e.g., post-discharge infections).

Based on the current evidence CDC continues to recommend the use of CP for MRSA-colonized or infected patients. CDC will continue to evaluate the evidence on CP as it becomes available. In addition, CDC continues to work with partners to identify and evaluate other measures to decrease transmission of MDROs in healthcare settings.

SELECTED BIBLIOGRAPHY

  1. Morgan DJ, Wenzel RP, Bearman B. Contact Precautions for Endemic MRSA and VRE: Time to Retire Legal Mandates. JAMA. 2017; 314 (4): 329-330.
  2. Rubin MA, Samore MH, Harris AD. 2018. The Importance of Contact Precautions for Endemic Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococci. JAMA. 2018; 319 (9): 863-864.
  3. Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html
  4. Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee. Management of Multidrug-Resistant Organisms in Healthcare Settings, 2006 https://www.cdc.gov/infectioncontrol/guidelines/mdro/index.html

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