Updated Strategies for Preventing Resistant Infections

After years of decline, MRSA infections accelerated during the pandemic
Health care provider washing hands

Top infectious disease researchers have updated guidelines to reduce the spread of resistant staph infections in hospital settings. The recommendations released June 29 emphasize basic hand hygiene, careful oversight of antibiotic prescriptions and the use of contact precautions such as gowns and gloves for patients with MRSA, depending on local MRSA control needs.

The report, a collaboration of five medical associations, includes guidelines for health care providers who  do not choose to adopt contact exposure practices.

The recommendations come after the rate of MRSA infections jumped during the COVID-19 pandemic, reversing years of steadily declining rates.

Methicillin-resistant Staphylococcus aureus is a type of staph bacteria that is resistant to many antibiotics used to treat ordinary staph infections. It is most frequently found in health care settings, particularly after procedures such as surgery or the use of central vein catheters. It is spread by hand, person-to-person, or by contact with a contaminated surface, and it can be deadly.

“Basic infection control strategies such as hand hygiene remain essential for MRSA prevention,” said Kyle Popovich, MD, lead author of Strategies to Prevent MRSA Transmission and Infection in Acute Care Hospitals, published in Infection Control & Hospital Epidemiology. “Hand hygiene — something your mother would stress — is simple and cost-effective but often overlooked by busy health care workers. So, there is the need to continue to stress this 'routine' intervention.”

Reducing unnecessary antibiotic use

At the same time, the authors added a new strategy to the list of essential practices: careful oversight of how antibiotics are prescribed and used. In the previous recommendations, published in 2014, such antimicrobial stewardship programs were listed as an additional but not essential practice. Reducing unnecessary use of antibiotics helps to stem the growth of resistant germs and may help decrease MRSA and other infections associated with antibiotic use, such as C. difficile infection.

“With these proven strategies, we can reverse the recent increase in MRSA rates in acute-care settings and back on track to achieving lower rates each year,” Popovich added.

Contact precautions, such as wearing a gown and gloves when caring for patients with MRSA, remain on the short list of essential strategies, even as some hospitals have chosen to move away from the practice. So for hospitals that have discontinued or are considering discontinuing contact precautions for patients with MRSA, the authors included guidance on how to assess the risks, monitor outcomes when contact precautions are changed, and identify people and situations in which continued use of contact precautions should be considered.

Contact precaution options

Use of contact precautions has been controversial in the view of some infection control experts, considering the dropping MRSA rates before the pandemic. With this guidance, hospitals have the option of continuing or, when appropriate, discontinuing contact precautions.

“We provided opt-out strategies, but also outlined other steps to take: Do a risk assessment. How high are MRSA rates? Is there a high rate of hand hygiene compliance?” Popovich said.

The report was created by the Society for Healthcare Epidemiology in collaboration with the Infectious Diseases Society of America, the Association for Professionals in Infection Control and Epidemiology, the American Hospital Association and The Joint Commission.

Popovich has studied MRSA for nearly 20 years, during which time she has watched MRSA infections evolve from being present almost exclusively in acute-care settings to appearing in community settings, including correctional facilities. At RUSH, Popovich led a CDC-funded study using genome sequencing to examine health care worker contamination with antibiotic-resistant organisms and also worked with Cook County Health to research the genomic epidemiology and options for control of MRSA entering a large jail setting.

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