MRSA decolonization protocol for HCWs

Protocol only used to halt an ongoing outbreak

Infection control professionals at Parkland Hospital in Dallas have developed a decolonization protocol for health care workers (HCWs) with methicillin-resistant Staphylococcus aureus (MRSA) that includes the following elements:

Employee decolonization to halt an ongoing MRSA outbreak episode is only done with the approval of infection control and is coordinated with occupational health services.

The MRSA decolonization regimen is considered safe; however, health care workers must be assessed for contraindications (including allergies and renal failure) to the medications used.

If widely used, the decolonization regimen may increase antibiotic resistance. Decolonization is frequently unsuccessful in persons with open or draining sites, or if indwelling line/tubes are required for activities of daily living.

The success of decolonization frequently is dependent on rigid adherence to the protocol and application of infection control principles (i.e., hand washing between patients) to hinder transmission of MRSA.

Decolonization may be an important adjunct to decrease patients’ contact with employees who have MRSA during an outbreak situation.

Release of MRSA results and patient assignment

All HCW lab results and work release are issued through occupational health services. The lab will notify a member of infection control or occupational health services when a HCW’s surveillance culture is reported positive for MRSA. Occupational health and infection control work closely during HCW decolonization; however, for confidentiality purposes, only the occupational health service will release HCW information. The infection control team, the infection control chairman, or the occupational health service physician will determine the appropriateness of HCW patient assignment, decolonization protocol, and follow-up. The HCW will be removed from active duty or away from direct patient care for at least the first 24 hours of the decolonization regime. It may be necessary to restrain HCW direct-patient assignment for greater than 24 hours as determined by occupational health and infection control, based on risk of MRSA transmission and the patient population at risk.

Decolonization procedure

The decolonization protocol is completed without any expense to the employee for medications. For five days, the employee will:

• Take Sulfa-trimethoprim, two single-strength tablets or one double-strength tablet, PO BID.

• Take Rifampin 300 mg PO BID.

• Apply Bacitracin or Mupirocin ointment to the anterior nose, BID.

• Bathe daily (bath or shower) with Chlorhexidine gluconate scrub or 3% Hexachlorophene or Povidone iodine by: a) wetting skin; b) apply two ounces of antimicrobial scrub, full strength, to the skin and scrub for five minutes; c) do not get in eyes or ears; d) rinse off thoroughly and dry with a clean towel; e) put on clean clothes; f) bedding and linens must be changed/cleaned daily until the end of the decolonization protocol.

• Reculture the HCW (nares and original MRSA-positive site if applicable) a minimum of 24 hours after completion of the above five-day decolonization protocol.

• If the reculture is negative, repeat in one week.

Treatment failures are addressed individually by the hospital epidemiologist, occupational health services, and infection control and may result in assignment change.