Methicillin-resistant Staphylococcus aureus (MRSA) refers to types of staph bacteria that are resistant to the antibiotic methicillin. While about 1% of healthcare workers are colonized with MRSA, they rarely transmit it to patients. Routine screening and decolonization of asymptomatic healthcare workers is not recommended by US guidelines. If a healthcare worker is found to be the source of an MRSA outbreak, decolonization may be considered along with infection control measures. However, consistent hand hygiene is the most important way to prevent MRSA transmission.

1. HOW TO DEAL WITH A MRSA COLONISED HEALTH CARE WORKERS?
Dr.T.V.Rao MD
A complex question to many health care establishments what are implication of health care workers
practicing critical care procedures, with MRSA positive nasal swabs, In a good organization with strict
health care practices and effective housekeeping practices we listen to both positive and negative voices
on concern with MRSA as we are aware Methicillin-resistant Staphylococcus aureus (MRSA) refers to
types of staph that are resistant to a type of antibiotic methicillin however it is no more used in testing
and the testing method replaced with Cefoxitin , MRSA is often resistant to other antibiotics, as well.
While 33% of the population is colonized with staph (meaning that bacteria are present, but not causing
an infection with staph), it is the true problem when we randomly screen all the Health care workers
attending a procedure as in Surgical operation theater or a critical care, however approximately 1% is
colonized with MRSA in Workers who are in frequent contact with MRSA and staph-infected people and
animals are at risk of infection. These included those in hospitals and healthcare facilities, correctional
facilities, daycare facilities, livestock settings, and veterinary clinics. The rights of the people to continue
to work with MRSA as they subscribe they got infected from the work place ie the Hospitals, Although
studies have demonstrated that patients colonized with MRSA are at a higher risk of subsequent MRSA
infection due to their own flora, than the colonized, Major studies proving healthcare workers (HCWs)
are rarely the source of MRSA transmission to patients. In fact, literature review found that only 1.6% of
191 MRSA outbreaks in a nosocomial setting were associated with asymptomatic HCWs. (Ref 1) I wish to
state that I am associated with at least 5 to 6 major studies at several work places, there was never
major our break with MRSA in any critical care or surgical patients, even though 0.5 to 1% isolation of
MRSA, Today most of the Indian establishments are loaded with Superbugs as ESBL and Carbapenem
resistant gram negative bacteria as the trends change with more use of broad spectrum antibiotics to
deal with Gram negative bacteria, In comparison with the issues related with MRSA are lesser threat
than many gram negative bacteria, and certainly one fells with much pressure on Gram negative both as
commensals and pathogen trends are changing and many are less concerned with MRSA when we have
options to decide which needs a priority, However today many peer reviewed surveys think Routine
screening of asymptomatic HCWs for MRSA colonization is thus not warranted. Of note, when HCWs are
implicated in MRSA transmission, this is more likely due to poor hand hygiene resulting in patient-to-
patient transmission, Although MRSA is still a major patient threat, a CDC study published in the Journal
of the American Medical Association Internal Medicine showed that invasive life-threatening) MRSA
infections in healthcare settings are declining. Invasive MRSA infections that began in hospitals declined
54% between 2005 and 2011, with 30,800 fewer severe MRSA infections. In addition, the study showed
9,000 fewer deaths in hospital patients in 2011 versus 2005. ( Ref 2 )Routine decolonization of HCWs
who are asymptomatic MRSA carriers is not recommended. However, if a HCW is identified as the
source of a MRSA outbreak, as happens when multiple cases infected by the surgeon or a regular care
taking nurse then decolonization is considered in combination with a full infection control management
plan. In this situation, the HCW should avoid direct patient care activities until culture results are
negative. In situations where decolonization is necessary, the optimal pharmacologic regimen has not
been firmly established. Options include topical decolonization of the nares alone; topical nasal and
whole body decolonization; and topical decolonization plus oral antimicrobial agents. Mupirocin remains
the only medication approved by the US Food and Drug Administration for nasal decolonization.
However, other topical products such as bacitracin are under investigation for mupirocin-resistant MRSA

2. strains. Mupirocin is commonly used with antiseptic body washes such as chlorhexidine, with or without
oral agents such as rifampin, tetracyclines, or trimethoprim-sulfamethoxazole. Two recent reviews
provide a detailed discussion of the evidence for each therapy and are useful resources. Importantly,
investigations to date have not addressed key areas such as the long-term effect of decolonization on
infection recurrence, rates of re-colonization after a pharmacologic intervention, or the effect of
decolonization on drug resistance
In summary, given that asymptomatic MRSA-colonized HCWs rarely transmit MRSA to patients, US
guidelines do not recommend routine screening of or decolonization for asymptomatic HCWs. Similarly,
guidelines do not recommend restricting work activities unless colonized HCWs are found to be the
source of MRSA transmission and causing work place infections with MRSA Although pharmacologic
decolonization is an important tool in clinical management of MRSA colonization in certain situations, it
cannot replace the importance of consistent hand hygiene.
This article is created for the benefit of post graduates on basic understanding, need to track the
matters in their own work place with coordination of the Clinicians and outcomes of the MRSA isolations
in Laboratories with quality controls
YET THERE IS NO BETTER WAY THAN HAND WASHING
Ref 1 and adopted from -Should Healthcare Workers Colonized with MRSA Avoid Patients? Kimberly K.
Scarsi, PharmD, MS Medscape
Ref 2 MRSA Tracking CDC Atlanta USA guidelines on new trends
Dr.T.V.Rao MD Freelance Clinical Microbiologist and Reporter on Infectious diseases