Table 3 Control Measures for MRSA in ICUs
Measure Comments
Culture all patients on admission and weekly
while in the ICU until they become positive for
MRSA or they are discharged
Use selective culture media
Always take cultures from the external nares
Culture wounds and skin eruptions
Consider perirectal cultures if other sites are negative
Flag patients’ charts or flag patients in the hospital computer
system who are MRSA positive
Place patients with MRSA infection and
colonization on contact precautions
Place patients flagged for MRSA on contact precautions on
admission
Wear gloves and a gown to enter the room
Remove gloves and gown prior to leaving the room
Practice hand hygiene after leaving room Wash hands with soap containing an antiseptic or apply an
alcohol hand rub
If hands are visibly soiled, wash with a soap containing an
antiseptic or wash with plain soap followed by application
of an alcohol hand rub
Culture environmental surfaces to assess extent
of contamination with MRSA
Obtain specimens with sterile swabs moistened with sterile
saline without bacteriostatic agents
Use selective culture media to maximize efficiency of
laboratory identification of MRSA
Decontaminate environmental surfaces often
enough to keep them free of MRSA
Thoroughly clean surfaces followed by application of a
hospital-grade disinfectant
Culture environmental surfaces to determine effectiveness
of cleaning and disinfection methods
Do not use phenolic disinfectants in NICUs for
environmental decontamination
Determine what sites to clean and the frequency
of cleaning based on environmental culture
data
Attempts at decolonization of patients with
MRSA should be done only under the
supervision of infection control staff
Mupirocin is the agent of choice
Follow the manufacturer’s instructions for use
Decolonization should be attempted for nasal colonization
only
Total body bathing with chlorhexidine may be combined with
nasal mupirocin for decolonization
Attempts at nasal decolonization should not be done for
patients with the following conditions:
Colonization of multiple body sites
Chronic nonhealing wounds
Presence of colonized foreign bodies such as tracheostomy
tubes or gastrostomy tubes
Take cultures after treatment for decolonization and 12 wk
later
Nasal decolonization is the same in NICUs
Health care workers who have nasal colonization
with MRSA and who have been
epidemiologically implicated in transmission to
patients should be furloughed from patient
care and treated with mupirocin for
decolonization
Mupirocin should be applied to the external nares according
to manufacturer’s instructions
Follow up cultures of the external nares should be taken
after therapy and again at 2, 6, and 12 wk to detect
relapse or recolonization
When decolonization is unsuccessful on the first attempt,
retreatment may be successful
When health care workers are infected with
MRSA or have colonization of dermatitis, they
should be furloughed from patient care and
treated for infection or dermatitis until the
condition clears
Sites of infection or colonization should be culture negative
before the health care worker returns to patient careAbbreviations:MRSA, methicillin-resistantStaphylococcus aureus; ICU, intensive care unit; NICUs, neonatal
intensive care units.
MRSA/VRE Colonization and Infection in the Critical Care Unit 111