MMRSA Guide
Microscopic illustration of MRSA (Staphylococcus aureus) bacteria
Reference · Is MRSA contagious? · Hospitals

Preventing MRSA in hospitals and after surgery

Hand hygiene is the single most effective measure, but it works because it's layered on top of screening, chlorhexidine bathing, contact precautions and disciplined antibiotic use. No one intervention gets the credit.

Reviewed and updated by the MRSA Guide editorial team.

The evidence-based bundle

Hospitals that have driven MRSA bacteraemia rates down over the past two decades did it by combining several interventions rather than picking a favourite. The core bundle used across the NHS, the VA and most European systems includes:

  • Hand hygiene — soap and water or alcohol gel before and after every patient contact, with audit and feedback.
  • Contact precautions — gown and gloves for known MRSA carriers, single-room isolation or cohorting.
  • Universal chlorhexidine bathing in ICUs and selected surgical units.
  • Active surveillance — nasal PCR or culture on admission to high-risk wards.
  • Environmental cleaning — daily disinfection of bed rails, call buttons, stethoscopes and shared equipment.
  • Antimicrobial stewardship — narrowing unnecessary broad-spectrum use to reduce selection pressure.

Before elective surgery

If you are having planned joint replacement, cardiac or major abdominal surgery, ask about MRSA screening. Many centres now swab the nose (and sometimes groin and axilla) 1–4 weeks before the operation. Carriers are treated with:

  • Mupirocin 2% nasal ointment twice daily for 5 days.
  • Chlorhexidine 4% body wash daily for 5 days.
  • An IV dose of vancomycin at induction, in addition to the standard cefazolin.

Decolonisation before orthopaedic and cardiac surgery has been shown to reduce surgical-site infection with Staphylococcus aureus, including MRSA.

After discharge

Keep the wound clean and dry, follow dressing instructions, and wash hands before and after touching the site. Watch for increasing redness beyond the wound edge, pain out of proportion to healing, drainage, or fever within the first two weeks — all reasons to contact your surgical team promptly.

Related reading

Back to the prevention hub, or read about preventing MRSA at home, in sports, and why MRSA comes back.

Frequently asked questions

How do hospitals prevent MRSA?
The evidence-based bundle is: rigorous hand hygiene before and after every patient contact, contact precautions (gown and gloves) for known carriers, single rooms or cohorting, daily chlorhexidine bathing in ICUs, active screening on admission in high-risk units, disinfection of high-touch surfaces and shared equipment, and antimicrobial stewardship to reduce selection pressure.
How can I prevent MRSA after surgery?
Ask whether you should be screened for MRSA nasal carriage before elective surgery. If you carry it, most units will decolonise you with mupirocin nasal ointment and chlorhexidine body wash for 5 days pre-op, and give an IV dose of vancomycin (in addition to the usual cefazolin) at induction. Keep the surgical wound clean and dry after discharge, and watch for redness, swelling or discharge in the first two weeks.
Does chlorhexidine bathing actually work?
Yes — multiple large trials in ICUs and surgical units have shown that daily 2% chlorhexidine gluconate bathing reduces MRSA acquisition and bloodstream infections. Universal bathing outperforms targeted bathing of known carriers in most settings.
Should visitors wear gowns and gloves?
Guidance varies. UK and many European hospitals ask visitors of MRSA-positive patients to wash hands on entry and exit and to avoid using the bathroom in the room. Gowns and gloves for visitors are less consistently required and are the subject of ongoing debate.
How long do hospitals keep MRSA precautions in place?
Contact precautions usually continue for the duration of admission once MRSA is detected. Some units de-isolate after three negative screening swabs taken at least 48 hours apart and after antibiotic therapy has ended, but this varies between health systems.

Is MRSA contagious?

The short answer, contagious period and surface survival.

MRSA bacteria: what it is and how it gets into the body

The organism, resistance, and the routes it uses to enter the body.

At home & family

Wound care, laundry, cleaning and shared items.

Sports & locker rooms

Skin checks, covered wounds and cleaning shared gear.

Intimacy & sexual transmission

Skin-to-skin risk and when to abstain.

References
  1. Calfee D.P. et al., SHEA/IDSA/APIC. Strategies to prevent MRSA transmission and infection in acute care hospitals: 2022 update (2023)
  2. Huang S.S. et al., REDUCE MRSA trial, NEJM. Targeted versus universal decolonization to prevent ICU infection (2013)
  3. CDC. MRSA in healthcare settings (2024)
  4. NICE. Surgical site infections: prevention and treatment (NG125) (2020)
  5. Cochrane Database of Systematic Reviews. Chlorhexidine bathing of hospitalised patients for prevention of infection (2019)
  6. Bode L.G.M. et al., NEJM. Preventing surgical-site infections in nasal carriers of Staphylococcus aureus (2010)
  7. UK Health Security Agency. MRSA screening and suppression: quick reference guide for acute trusts (2014)
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