MRSA Decolonization Protocol

Decolonization reduces the carriage of Staphylococcus aureus (including MRSA) on the skin and in the nares, lowering the risk of subsequent invasive infection.

Universal decolonization (recommended for adult ICUs)

For all adult ICU patients, regardless of MRSA status:

• Daily chlorhexidine gluconate (CHG) bathing — 4% solution or 2% CHG-impregnated wipes, head-to-toe, avoiding face and mucous membranes.
• Intranasal mupirocin (2% ointment) twice daily for 5 days on admission.

This protocol (REDUCE-MRSA trial) reduced MRSA bloodstream infections by ~44% across multi-hospital implementation.

Targeted decolonization (non-ICU and pediatric settings)

For known MRSA carriers identified by surveillance cultures:

• Intranasal mupirocin twice daily × 5 days
• CHG bathing daily × 5 days
• Repeat course if recolonization occurs and clinical risk is high (e.g. pre-surgery)

Pre-surgical decolonization

For elective cardiothoracic, orthopedic implant, and neurosurgical procedures, screen for S. aureus carriage 1–2 weeks before surgery. For carriers:

• Mupirocin intranasal × 5 days pre-op
• CHG bathing the night before and morning of surgery

Pediatric considerations

CHG bathing is not recommended for infants <2 months. Use sterile water bathing with 0.5% CHG-impregnated wipes for older infants per facility policy and pediatric guidance.

Mupirocin resistance

Monitor for emergence of high-level mupirocin resistance. If resistance prevalence >10%, consider alternative topical agents (e.g. retapamulin, povidone-iodine) per local antibiogram.

Documentation

Record the indication, regimen, completion date, and post-decolonization screening (if performed) in the patient chart and IPC tracker.