Objective Can we control MRSA incidence in head and neck cancer patients by 1) Active surveillance cultures of patients fulfilling Society for Healthcare Epidemiology of America (SHEA) & Scottish Infection Standards and Strategy (SISS) guideline? 2) Cohorting these patients? 3) Restricted Health Care Workers (HCW) access? Methods Prospective case series: July 2007–January 2008. 26 preoperative head and neck cancer patients had a questionnaire filled in to identify known predictors for MRSA as suggested by SISS Group. Intervention: Preoperative nasal swabs, cohorting away from other cases, restricted access. MRSA incidence compared to that over the preceding year(Jan 2006-Jan 2007). Results 26 eligible patients. None of them had known risk factors for MRSA. 17 patients had swabs taken pre-admission. All screened patients were non-carriers of MRSA in their nose and none of them developed MRSA infection during hospital stay. Of remaining 9 patients swabbed after admission, 3 developed MRSA during hospital stay. The incidence of MRSA was 11.5% (3/26) during study period, compared to 28.5% (24/84) the year before implementing these interventions. Conclusions Head and neck cancer patients do not have increased risk factors for MRSA colonization and their active surveillance cultures are unlikely to influence MRSA incidence. Cohorting these patients with restricted HCW access decreased the MRSA rate at our centre.