Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterium responsible for several difficult-to-treat infections in humans. It is also called Oxacillin-resistant Staphylococcus aureus (ORSA). Community-associated MRSA infections (CA-MRSA) are MRSA infections in healthy people who have not been hospitalized or had a medical procedure (such as dialysis or surgery) within the past one year.

1. Presented by : DR Saba
Guided by : Dr Hemant Kumar
DEPARTMENT OF COMMUNITY MEDICINE ,AJIMS& RC,MANGALORE
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MRSA –AN UPDATE

2. WHAT ARE MRSA
Methicillin-resistant Staphylococcus aureus
(MRSA) is a bacterium responsible for
several difficult-to-treat infections in humans.
It is also called Oxacillin-resistant
Staphylococcus aureus (ORSA).
MRSA is any strain of Staphylococcus
aureus that has developed, through the
process of natural selection, resistance to
beta-lactam antibiotics, which include the
penicillins (methicillin, dicloxacillin, nafcillin,
oxacillin, etc.) and the cephalosporins.

4. WHAT IS CA-MRSA?
Community-associated
MRSA infections (CA-
MRSA) are MRSA
infections in healthy
people who have not
been hospitalized or
had a medical
procedure (such as
dialysis or surgery)
within the past one
year.

5. MRSA COLONIZES
 S. aureus most commonly colonizes
the anterior nares (the nostrils).
 The rest of the respiratory tract, open
wounds, intravenous catheters, and
the urinary tract are also potential
sites for infection.
 Healthy individuals may carry MRSA
asymptomatically for periods ranging
from a few weeks to many years.

6. HOW IS IT TRANSMITTED?

7. RISK FACTORS FOR CA-MRSA
 Participating in contact sports.
MRSA can spread easily
through cuts and abrasions
and skin-to-skin contact.
 Living in crowded or
unsanitary conditions.
Outbreaks of MRSA have
occurred in military training
camps, child care centres and
jails.
 Men having sex with men.
Homosexual men have a
higher risk of developing
MRSA infections.

8. MRSA: ENHANCED VIRULENCE?
 Associated with severe
and recurrent SSTI, often
in individuals without
predisposing risk factors.
 Associated with
necrotizing pneumonia.
 Appears to be easily
transmitted in hospitals,
households, and the
community

10. PRESENTATION OF MRSA INFECTION
CA-MRSA infections
generally begin as skin
infections.
They first appear as
reddened areas on the
skin, or can resemble
pimples that develop into
skin abscesses or boils
causing fever, pus,
swelling, or pain.

11. COMPLICATIONS WITH MRSA
Since MRSA resist many common
antibiotics sometimes these become life-
threatening. This can allow the infections
to affect your:
 Bloodstream
 Lungs
 Heart
 Bones
 Joints

12. IMMUNE COMPROMISED AT INCREASED
RISK WITH MRSA
Patients with
compromised immune
systems are at a
significantly greater
risk of symptomatic
secondary infection.

13. MRSA INFECTION
CONTROL
STRATEGIES

14. MRSA INFECTION CONTROL
STRATEGIES
• Contact
precautions
• Screening
• Decolonization

15. CONTACT PRECAUTIONS

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SCREENIN
G

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DECOLONISATION

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21. AJIMS/AJHRC HOSPITAL POLICY
FOR MRSA CONTROL
HIPAC Dept
A. J. Hospital and Research Centre

24. SCREENING
Screening is performed to significantly
decrease transmission.
Active surveillance testing:
 On admission - patients received from other
hospitals
 Periodic screening of healthcare workers
during health care check-ups is done to detect
colonization.
 Routine testing in high risk areas (e.g. ICUs)

25. BODY SITES TESTED
Nares – most
common
Other sites include :-
 wounds
 axillae
 groin
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26. ASSESS HAND HYGIENE PRACTICES

27. IMPLEMENT CONTACT PRECAUTIONS
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28. RECOGNIZE PREVIOUSLY COLONIZED
PATIENTS
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29. RAPIDLY REPORT MRSA LAB RESULTS
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30. PROVIDE MRSA EDUCATION FOR
HEALTHCARE PROVIDERS
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31. DECOLONIZATION OF CARRIERS
 2% Intranasal mupirocin ointment BD x
5-7 days
 Chlorhexidine baths
◦ Bath: 30 ml.
◦ Shower: 10 ml applied neat and then
washed off.
◦ Bed-bath: 3 ml in a bowl of water.
 Using disposable wipes, the skin should be
moistened and the solution applied thoroughly to
all areas, with particular attention to axillae and
groin.

32. ON COMPLETION OF TREATMENT
 The patient is given clean
nightwear, linen and towels /
flannels.
 Repeat MRSA screening swabs
are taken 48 hours after
completion of treatment,
provided the patient is not on any
antibiotics (except
metronidazole) as this may
negate the results.
 Screens thereafter at weekly
intervals for three consecutive
weeks whilst the patient is in
hospital.

33. ADVICE ON CLEARANCE
 Three clear screens at
weekly intervals must be
obtained before the
patient may be moved
out of an isolation facility
and barrier nursing is
discontinued. Individual
cases should be
discussed with the ICN
before patients are
moved.
 Weekly follow-up
screening cultures must
be taken if the patient
remains in hospital.

34. MUPIROCIN RESISTANT MRSA
Mupirocin should be
replaced with the
following products
depending on the
antibiotic sensitivities.
 If neomycin-sensitive
strain use naseptin
 If neomycin-resistant
strain use polyfax
ointment + fucidin
ointment for five days
only.

35. PROPHYLAXIS FOR SURGICAL
/ INVASIVE PROCEDURES
 For patients currently MRSA
positive, or known to have
been positive in the past,
intravenous vancomycin may
be indicated for pre-operative
prophylaxis.
 The patient should also
receive topical MRSA
decolonization therapy pre-
and post-operatively to cover
the period when the risk of
MRSA infection is greatest.

36. GENERAL MEASURES
 Wherever possible - nursing
in a single room with
standard isolation
precautions, or cohort
nursing in a bay or part of a
ward.
 The door should always be
closed during procedures
that may generate
staphylococcal aerosols
(eg: Chest physiotherapy,
Bed-making and
Redressing wounds).

37.  PPE and alcohol hand
rub must be available
outside the room.
 Masks
◦ when giving respiratory
care - MRSA in their
sputum
◦ bed-making - exfoliating
skin condition.
 Wherever possible -
dedicated equipment.

38.  All staff must make every
effort to maintain high
standards of hygiene and
cleaning within the ward
to minimize environmental
contamination.
 All rooms and bays should
be cleaned at least daily
with Chlor-Clean /
hypochlorite (1,000 ppm)
Domestic staff must wear
gloves and aprons when
cleaning such rooms /
bays. 38

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