Management of Patient/Resident with

Methicillin Resistant Staphylococcus aureus (MRSA)

Initiation Discontinuation
Problem Goal Intervention Signature
Date Date
Prevent transmission of To establish the MRSA Please follow procedures outlined in the VIHA Policy 15.2 Management of
MRSA status of specific Patients with MRSA (Acute Care) and VIHA Policy 15.4 Management of Patients
patient/resident population with MRSA (Residential Care)

MRSA Colonization To prevent transmission of
infectious agents which are
spread by direct or indirect
contact with the
patient/resident or their
environment
Precautions
Staff will adhere to Hand Hygiene policy
If a patient/residents electronic record is flagged for MRSA, apply additional
infection control precautions as indicated below regardless of any negatives
observed on patient/residents chart until directly consulting with an Infection
Control Practitioner
Apply Contact Precautions for all close personal care (apply Droplet
Precautions if the patient/resident has a new or worsening cough)
Private room (preferred where possible) OR Precautions in a multi-bed
room
The patient/resident may be out of their room for tests, mobilization or
rehabilitation. If leaving their room they must have the permission of their
healthcare provider, wear clean gowns/pyjamas and housecoat or clean street
clothes, have any wounds covered with fresh dressings and perform hand
hygiene on exiting and re-entering their room. They must not visit public areas
within the facility (unit kitchen, cafeteria, shops/kiosks in main entrance etc.)
For MRSA patients/residents with respiratory symptoms/infection, must remain in
their room unless attending urgent medical procedure
Ensure Contact or Droplet Precautions sign is displayed at the entrance to the
room and at the bedside
o Contact Precautions wear gown and gloves for all contact with the
patient/resident or their environment (which includes the whole room if
single room or bed space if a multi-bedded room)
o Droplet Precautions - wear gown and gloves for all physical contact with
the patient/resident and their environment (which includes the whole room
if single room or bed space if a multi-bedded room), AND wear a surgical
grade (120 mmHg) fluid resistant mask (with attached visor), fitted to the
face when providing care within 2 metres (6 feet) of the patient/resident
Dedicate patient/resident toilet facilities and attach patient/resident identification
(e.g. MRN & Bed#)
Dedicate equipment to the patient/resident and attach patient/resident identifier.

Author: Infection Prevention and Control program Care Plan Working Group Approved: March 23, 2012
Issuing Authority: VIHA Infection Prevention & Control Program Review Date: April 20, 2013
Initiation Discontinuation
Problem Goal Intervention Signature
Date Date
Equipment not dedicated must be thoroughly decontaminated before being
removed from the patient/residents bed-space to be used by another
patient/resident
Linen, garbage and dishes are treated as routine
Ensure patient/resident information leaflet: MRSA is given to
patient/resident/visitors
Housekeeping
On discharge or transfer from the room, or discontinuation of precautions, notify
housekeeping that a terminal clean must be completed
Housekeeping shall remove Precaution sign on completion of terminal clean

To prevent spread of MRSA
and reduce the risk of
transmission associated
with out of room
procedures or tests
A diagnosis of MRSA must not delay or inhibit any procedure or test required for
the care of the patient/resident (discuss with Infection Control Practitioner if the
patient/resident has respiratory symptoms/infection)
Identify additional precautions required on the test/procedure requisition form
Notify the receiving department in advance of the type of additional precautions
and cleaning required
Notify transport staff of additional precautions required

Encourage patient/resident
with hand hygiene
Hand washing is extremely important for staff, visitors and patients/residents,
especially before meals and after using the toilet. Regular soap and water or
alcohol based hand rub is recommended
Teach patient/resident correct procedure to wash hands and when to perform
hand hygiene
Ensure patient/resident information leaflet: Hand Hygiene is given to
patient/resident/visitors

To prevent spread of MRSA
and reduce the risk of
transmission associated
with visitors
Provided visitors of patient/resident are healthy, there is no restriction on visiting
Visitors must be directed to wash their hands with soap and water or use alcohol
based hand rub on entering and leaving the patient/resident room
Visitors must use gown and gloves in addition to hand washing only if they are
providing close personal care. Guidance must be given by the Most
Responsible Nurse
Visitors will not be required to wear PPE for social visits (i.e. Saturday chat with
the patient, etc)
Visitors must not visit public areas within the facility (unit kitchen, cafeteria,
shops/kiosks in main entrance etc.) and SHALL NOT use the patient/resident
bathroom

To decolonize the The decision to use decolonization therapy will be made in accordance with

Author: Infection Prevention and Control program Care Plan Working Group Approved: March 23, 2012
Issuing Authority: VIHA Infection Prevention & Control Program Review Date: April 20, 2013
Initiation
Problem Goal
Date
patient/resident of MRSA
MRSA Infection Treatment and eradication
of MRSA infection
To assess the MRSA status
of the patient/resident
following treatment
Discontinuation of To discontinue precautions
precautions at the appropriate time
Author: Infection Prevention and Control program Care Plan Working Group
Issuing Authority: VIHA Infection Prevention & Control Program
Discontinuation
Intervention Signature
Date
VIHAs Policy 15.2 - Management of Patient with MRSA in Acute Care and/or
Policy 15.4 Management of Patient with MRSA in Residential Care
Decolonization therapy must be ordered by the Most Responsible Physician
(MRP)
The Most Responsible Physician to coordinate treatment regime
Colonized:
Wait 7 days following completion of any antibiotic treatment (topical, oral or
injectable) or following decolonization therapy then take first set of swabs
Two sets of swabs must be taken, 7 days apart
If the first set of swabs are positive, wait 7 days before doing another set of
swabs
Infection:
Wait 30 days post completion of any antibiotic treatment (topical, oral or
injectable) then take first set of swabs
Two sets of swabs must be taken, 7 days apart
If the first set of swabs are positive, wait 7 days before doing another set of
swabs
Date of antibiotics and treatments discontinued: _____________________________
Dates of cultures (at least 7 days apart; must include nares, groin and other sites
previously positive)
#1_________________ Nares MRSA positive MRSA negative
Groins MRSA positive MRSA negative
Other site MRSA positive MRSA negative
#2_________________ Nares MRSA positive MRSA negative
Groins MRSA positive MRSA negative
Other site MRSA positive MRSA negative
Please refer to Table 10: Procedure for Discontinuing Additional
Precautions in the Infection Prevention and Control Manual and discuss
potential removal of ARO flag with Infection Control Practitioner
Most Responsible Nurse notifies Housekeeping a clean is required according to
Approved: March 23, 2012
Review Date: April 20, 2013
Initiation Discontinuation
Problem Goal Intervention Signature
Date Date
current VIHA Guidelines
If precautions are discontinued prior to patient/resident discharge, ensure:
o Patient/resident is helped into a clean gown/pyjamas and housecoat
o Hand hygiene is performed and the patient/resident brought out of room
o The bedspace/room has a terminal clean
o If possible, the patient/resident is showered or bathed and clean
gown/pyjamas and housecoat is donned and the bathroom is terminally
cleaned
o Patient/resident is helped into a clean gown/pyjamas and housecoat
Once bedspace/room has been cleaned by housekeeping in a timely manner,
precautions can be formally discontinued, sign will be removed from entrance to
room and at bedside by housekeeping and the patient/resident may return

Discharge Planning Ensure discharge of the May discharge home or transfer to another facility
patient/resident is done in a Must inform Infection Control Practitioner of any transfers/discharges
manner to ensure the risk Must inform receiving caregivers or receiving agency of additional
of transmission is reduced, precautions if required and course of treatment
and the receiving facility is Must inform any transport services of additional precautions if required
fully aware of the
patient/residents diagnosis
See also the Infection Prevention and Control Manual

Author: Infection Prevention and Control program Care Plan Working Group Approved: March 23, 2012
Issuing Authority: VIHA Infection Prevention & Control Program Review Date: April 20, 2013