Despite vigorous attempts at eradication over the last 20 years, methicillin-resistant Staphylococcus aureus (MRSA) continues to be a major nosocomial pathogen in Australian acute care institutions. The epidemiology of hospital spread is now well characterized; infected and colonized patients provide the primary reservoirs, and transmission is mainly via hospital staff. The MRSA remains endemic in most of Australia's large urban teaching hospitals; occasional outbreaks also occur, especially in intensive care areas. The level of MRSA infection is often indicative of the total rate of nosocomial infection within an institution and may reflect overcrowding, heavy workloads and under-staffing of wards. Standard precautions, isolation and cohorting of infected and colonized patients, screening of staff, hand washing campaigns, nasal eradication policies and increased staff education have all been tried, with variable success. There is no universal formula; local problems require local solutions plus commitment of local resources. Preventing surgical infection with MRSA requires the application of surgical first principles, and the routine use of vancomycin for prophylaxis is not recommended.