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During the COVID pandemic, methicillin-resistant Staphylococcus aureus (MRSA) infections in acute care hospitals rose steeply, despite a decrease of infections before the pandemic, the Society for Healthcare Epidemiology of America (SHEA) said in its latest guidelines.

"It is unknown if declining use of contact precautions for MRSA-colonized or MRSA-infected patients played a significant role in this increase," noted David Calfee, MD, of Weill Cornell Medical College in New York City, and colleagues in .

About 10% of infections in U.S. hospitals are due to MRSA, the authors said. During the first year of the pandemic, progress against deadly antimicrobial-resistant infections reversed course, according to data from the CDC.

"The enormous strain put on healthcare during the pandemic may have contributed to the observed increase in some hospital infections. We have data that show MRSA infections rose," Calfee said in a press release issued by SHEA.

In the updated guidelines, Calfee and co-authors recommended active surveillance to detect asymptomatic MRSA, particularly among certain vulnerable patient populations, noting that patients should be assessed on a continual basis, especially if hospital precautions have been modified, or are in the process of being modified.

Bacteria that causes MRSA infection is resistant to many antibiotics used to treat ordinary staph infections. MRSA infections are commonly seen after surgery, or after use of hospital equipment such as central venous catheters. The bacteria spreads easily in hospitals through patients, healthcare providers, equipment, and contaminated surfaces.

For all recommendations, the authors reviewed the quality of evidence. Recommendations considered to have moderate- or high-quality evidence and recommended as essential practices included:

• Promote compliance with CDC or World Health Organization (WHO) hand hygiene recommendations
• Use contact precautions for MRSA-colonized and MRSA-infected patients (and assess whether they are effective)
• Ensure cleaning and disinfection of equipment and the environment

Additional approaches with moderate- or high-quality evidence include:

• Implementation of a MRSA active surveillance testing program for select patient populations as part of a multifaceted strategy to control and prevent MRSA
• Active surveillance for MRSA in conjunction with decolonization for targeted populations prior to surgery to prevent post-surgical MRSA infection
• Hospital-wide active surveillance for MRSA in conjunction with contact precautions to reduce the incidence of MRSA infection

"Basic infection prevention practices, such as hand hygiene and cleaning and disinfection of the healthcare environment and equipment, remain foundational for preventing MRSA," Calfee said in the press release. "These fundamental practices help to prevent the spread of other pathogens as well."

Contact precautions and use of gowns and gloves when treating a patient with MRSA colonization or infection remain an essential practice in the new guidelines.

"The evidence that informs these recommendations shows that we can be successful in preventing transmission and infection," he added. "We can get back to the pre-2020 rates and then do even better."

Despite its low-quality evidence, the guidelines noted that "an antimicrobial stewardship program is an important part of many quality and safety metrics, including MRSA prevention," adding that patients receiving treatment with antibiotics for another infection could be at higher risk of developing MRSA infection, and pass it on to other susceptible patients.

The authors also noted that active surveillance with contact precautions is inferior to universal decolonization for reduction of MRSA clinical isolates in adult intensive care units.

The authors of the guidelines, last updated in 2014, evaluated the literature from January 2012 to August 2021. Representatives from SHEA, the Infectious Diseases Society of America, the Association for Professionals in Infection Control and Epidemiology, the American Hospital Association, the Joint Commission, and the CDC were on the panel. Panel members reviewed and approved the document and its recommendations.

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