Table 1: Comparison of Healthcare Associated and Community Associated MRSA

Table 2: In vitro Activity of Antimicrobial Agents Against Staphylococcus aureus           

Adapted from references 17, 20, 36, 38, 72, 79, 115, 128, 152, 185, 257, 262, 283, 285, 313, 343, 350, 374, 385, 393, 420, 423, 443, 449

^aMSSA: Methicillin-susceptible S.  aureus; MRSA: Methicillin-resistant S.  aureus.  

Table 3. Suggested Antibiotics, Doses and Duration for Treatment of Staphylococcus aureus Infections [Download PDF]

Table 4: Most Commonly Recommended Treatment Regimens for Staphylococcus aureus Endocarditis [Download PDF]

* Daptomycin 6mg/kg daily

Table 5: Isolation Precautions Recommended for Hospitalized Patients [Download PDF]

Standard precautions

·         Wash hands after touching blood, body fluids, secretions, excretions, or contaminated items, whether or not gloves are worn; wash hands promptly upon removing gloves and between patient contacts

·         Use plain (nonantimicrobial) soap for routine handwashing

·         Use antimicrobial soap or waterless antiseptic agent for special circumstances (e.g. for control of outbreaks)

·         Wear clean, nonsterile gloves when touching blood, body fluids, secretions, excretions

or contaminated items; remove gloves immediately after use

·         Wear a clean, nonsterile gown during procedures and patient-care activities that are likely to generate splashes or sprays of blood, body fluids, secretions or excretions; remove gown as soon as possible, and wash hands

·         Wear a mask and eye protection or face shield during procedures that are likely to generate splashes or sprays of blood, body fluids, secretions or excretions

·         Handle contaminated patient-care equipment carefully, and ensure that reusable equipment is cleaned appropriately before it is used for another patient

·         Housekeeping personnel should routinely clean environmental surfaces of beds, bedrails, bedside equipment, and other frequently touched items

·         Handle soiled linen in a manner that prevents skin exposure and contamination of clothing

Contact precautions

·         Place patient in a private room or in a room with another patient who is infected with the same organisms (cohorting)

·         Wear clean nonsterile gloves when entering patient’s room

·         Change gloves during course of care and after contact with infective material

·         Remove gloves upon leaving patient’s room

·         Wash hands with an antimicrobial soap or waterless antiseptic agent after removing gloves

·         Wear a gown when entering room if substantial contact with the patient or environmental surfaces in the room are anticipated, or if the patient has wound drainage not contained by a dressing; remove gown before leaving patient’s room

·         Limit transport of patient from the room to essential purposes only

·         When possible, dedicate the use of noncritical equipment to a single patient or cohort of patients; if use for another patient is unavoidable, adequately clean and disinfect item before use for another patient

·         No special precautions are needed for dishes, glasses and other eating utensils

From Centers for Disease Control and Prevention

Table 6:  Recommendations to Prevent The Spread of Vancomycin-Resistant Staphylococcus aureus [Download PDF]

·         The laboratory should immediately notify infection-control personnel on the clinical unit, and the attending physician

·         Infection-control personnel, in collaboration with appropriate authorities, including the state health department and the CDC, should initiate an epidemiologic and laboratory investigation

Medical and Nursing Staff Risks

·         Isolate the patient in a private room and use contact precautions (gown, mask, gloves, and antibacterial soap for hand washing) recommended for multidrug-resistant microorganisms

·         Minimize the number of persons with access to colonized/infected patients

·         Dedicate specific healthcare workers to provide one-on-one care of the colonized/infected patient or the cohort of colonized/infected patients

Infection Control Personnel Tasks

·         Inform all personnel providing direct patient care of the epidemiologic implications of such strains and of the infection control precautions necessary for their containment

·         Monitor and strictly enforce compliance with contact precautions and other recommended infection control practices

·         Determine whether transmission has already occurred by obtaining baseline cultures (before initiation of precautions) for staphylococci with reduced susceptibility to vancomycin from nares and hands of all healthcare workers, roommates, and others with direct patient contact

·         Assess efficacy of precautions by monitoring healthcare personnel acquisition of staphylococci with reduced susceptibility to vancomycin as recommended by consultants to the state health department or CDC

·         Avoid transferring infected patients within or between facilities and, if transfer is necessary, fully inform the receiving institution or unit of the patient’s colonization/infection status and appropriate precautions

·         Consult with the state health department and CDC before discharge of a colonized/infected patient

Table 7.  Recommendations to prevent MRSA in Athletes [Download PDF]

Hand Washing/ Personal Hygiene

Skin-to-skin contact is the primary mode of transmission, thus personal hygiene is very important.

1. Keep hands clean. Hands should be washed thoroughly with soap and water or cleansed with an alcohol-based sanitizer.
2. Showering after each practice or sports event is imperative.
3. Do not share washcloths or bar soap.
4. A liquid antibacterial soap is recommended during outbreaks.
5. Do not use a standing basin of water to rinse.
6. Do not share towels or any other toilet articles such as razors.
7. Each athlete should have his /her own washcloths, towels and bar soap (if used).
8. Liquid soap should never have more soap added to the container. The container should be used until empty and discarded. A reusable container is not recommended since it may not be cleaned properly between refills.
9. Athletes should not walk around barefoot. Wear flip-flops in the gym showers.
10. Towels and washcloths should be only used once.

Care of Clothing

1. Do not share uniforms, underclothes, socks or athletic supports.
2. Each athlete should have an adequate supply of uniforms, socks, athletic supports, and underclothes so that proper laundering can be accomplished.
3. All personal clothing should be laundered after wearing once.
4. The used clothing should be placed in individual laundry bags assigned to each player. The laundry bag should be laundered after each use.
5. If the laundering is done at the team site, the following should be considered:

A.  The washing machine should not be overloaded.

      B.  Consider the 1) mechanical action of the machine, 2) water flow, 3) water  

            temperature, 4) time and 5) chemicals used.

C.  Sodium hypochlorite (chlorine bleach) is the disinfectant of choice for

            clothing. If the clothing is made of polyester/cotton, chlorine alternatives   

                  may   be used. However, bleach is the optimal choice if the fabric allows.

      D.  Clothes can be washed with regular detergent.

      E.  Dry clothes in a hot temperature dryer as opposed to air-drying.

6. Hands should be washed after handling soiled clothes.

Wound Care/Antibiotic Use

1.      Cover a wound with a clean dry dressing so that any drainage is contained.

2.      Use clothes or towels as a barrier between your skin and equipment.

3.      Cover scrapes/cuts with a clean dressing until healed.

4.      Avoid contact with another person’s wound or dressing.

5.      Wound dressings can be placed in the regular trash.

6.      Wash hands after each dressing change.

7.       A physician should drain abscesses and obtain a culture.

8.      Do not use antibiotics until the culture is taken and results are known.

9.      Do not share antibiotics.

10.  Take the antibiotic as prescribed. Do not hoard or self-medicate.

11.  Place used dressings in a disposable plastic bag, tie, and discard.

Athlete Education

1.      Infected individuals should receive hand washing and other personal hygiene instructions as related to transmission between players. Skin-to-skin contact is the mode of transmission.

2.      Use of antibiotics should be reviewed with the athlete if it is prescribed.

3.      Trainers and players should be educated concerning MRSA transmission and prevention.

4.      The health department should be notified if MRSA infections occur (if required in that state).

Environmental Cleaning

1. Use disposable cleaning cloths and mop heads.
2. Avoid use of sponges to clean; they harbor organisms.
3. Clean and disinfect all exercise equipment before and after use according to the manufacturer’s recommended guidelines.
4. Frequently touched surfaces should be cleaned daily or more often if indicated.
5. Floors and showers should be cleaned daily or after use.
6. Player lockers should be cleaned on a routine basis and before assigning to a new player.
7. Culture the player’s nares if an outbreak occurs and treat the carriers with mupirocin.

Figure 1:  Algorithm for Testing Staphylococcus aureus Vancomycin Susceptibility (VISA or VRSA)