Dissemination of methicillin-resistant Staphylococcus aureus (MRSA) remains one of the most difficult challenges for prevention, control, and treatment of health careeassociated infections. A survey and interviews were conducted on nurses from a hospital center. We found that most nurses' perceived risk of acquiring MRSA related to themselves (72%), other nurses (88.5%), and patients (97.8%). This perception influences attitudes, leading to compliance with the existing recommendations.Copyright Ó 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.In Portugal, methicillin-resistant Staphylococcus aureus (MRSA) is endemic in most hospitals, with resistance rates >49% in cerebrospinal fluid and blood samples. 1 Several international organizations have developed guidelines for prevention and control of MRSA, 2-4 namely patient isolation or cohorting, contact precautions, active patient screening at admission, decolonization, and environmental decontamination.Full adoption of guidelines for prevention of cross infection depends on the awareness of the guidelines and risk perception related to the presence of MRSA by health care workers (HCWs). Behavioral theories suggest that a high-risk perception encourages individuals to adopt actions to reduce risk. 5,6 METHODS We conducted a cross-sectional study to determine perception and attitudes in relation with risk of exposure to MRSA. The study included nurses from 10 clinical units in a teaching medical center in Lisbon, which is composed of 4 hospital sites, though only 2 were used to conduct the study, in old buildings with wards of 4 beds and very limited isolation facilities. Wards with patients with more risk factors for acquiring MRSA and where surveillance of MRSA has been in place longer were selected.We intended to identify nurses' knowledge about the MRSA chain of transmission and nurses' perception of risks related to acquisition and transmission of MRSA for themselves, other nurses, and patients. We also identified how knowledge and perception are reflected in practices described by HCWs.The study protocol was submitted for approval by the hospital board and ethics committee. Internal consistency was evaluated with the Kaiser-Meyer-Olkin test. 7 After factorial analysis the sentence about "MRSA isolation report in discharge and transfer forms" was categorized as "risk perception" for purposes of analysis. Following expert review, the questionnaire and semistructured interview guide were subjected to pilot testing on a sample of the study population and were modified accordingly.The self-assessed anonymous questionnaire was distributed to a sample of nurses from 3 intensive care units and 7 medical wards (MWs). Additionally, an interview was conducted with 1 nurse per unit, selected on a voluntary basis.The questionnaire was composed of 21 items: 6 assessed knowledge, 8 addressed risk perception, and 7 addressed attitudes. Knowledge questions were multiple choice, and risk perce...