Preventing MRSA in hospitals and after surgery

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.

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.

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.

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