Screening and contact precautions in hospital

Most people who carry MRSA have no symptoms. Screening — usually a nasal swab, sometimes with throat, groin or wound sites added — identifies carriage before an operation or an ICU stay turns it into infection.

Screening can be universal on admission or targeted at higher-risk groups: pre-operative patients, ICU admissions, dialysis, previous MRSA, transfers from other facilities or long-term care.

Contact precautions mean gloves and a gown for contact with the patient or their immediate environment, ideally a single room or cohorting with other MRSA-positive patients, and dedicated or decontaminated equipment.

• Swab identified risk groups on admission and act on the result rather than filing it.
• Pair a positive screen with decolonisation before surgery, not just isolation.
• Apply gown and gloves before entering the room and remove them inside the room, then clean hands.
• Use dedicated stethoscopes, cuffs and thermometers, or disinfect shared equipment between patients.
• Flag the record so future admissions start with precautions in place.
• Review precautions regularly — indefinite isolation without review has measurable downsides for patient care and mental health.

The US Veterans Affairs MRSA Prevention Initiative combined universal admission screening, contact precautions, hand hygiene and institutional accountability, and reported a roughly 60% fall in ICU MRSA healthcare-associated infections.

Trials of screening in isolation, without decolonisation or reliable hand hygiene, show much weaker effects — the bundle works because the components reinforce each other.

Guidelines therefore recommend screening as part of a programme with defined actions attached to a positive result.

• Screening without a protocol for what happens when the swab is positive.
• Gowning up but skipping hand hygiene after glove removal.
• Moving positive patients between bays without cleaning the vacated space properly.