Outpatient MRSA decolonisation instructions

Your recent pathology test showed that you are carrying a strain of resistant Staphylococcus aureus (MRSA) bacteria that occasionally can cause serious infection.  See also this NSW MRSA Fact sheet.    This treatment aims to completely remove the MRSA from your body. In about half of the people treated in this way, the MRSA remains undetectable for yearsand this will reduce your risk of serious MRSA infection and stop recurrent boils/skin infection. If the first treatment is unsuccessful, repeat treatment may be required.

Getting prepared

Choose a suitable week when you will be uninterrupted by going away or other distractions. To ensure that your skin is in good condition, follow the Routine Skin Care principles to reduce drying and enhance healing. Unless advised, do not start while you have any active boils. If you have a chronic skin condition (dermatitis) then follow the advice of your dermatologist or GP in order to bring it under the best control.

  • Obtain the nasal ointment (mupirocin 2%) and the recommended body-wash or non-rinse chlorhexidine antiseptic body wipes
  • Alcohol hand hygiene rub
  • Sterident or other cleaning solution for dentures (if required)
  • Alcohol-based cleanser (large alcohol-soaked wipes are suitable)

Personal

  • Remove nose, ear and other body piercing items for several days prior to the treatment and keep them out during the treatment period
  • Clean removed items with alcohol wipes or soak in boiling water

Household

  • Replace old toothbrushes, razors, opened roll on deodorant, skin adhesive tapes, skin creams and solutions, pumice stones, sponges, make up brushes, creams, and implements
  • Discard or hot wash all fluffy toys
  • Discard magazines, newspapers, and other clutter.
  • Wash hair brushes and combs, nail files, plastic toys, and clippers in the dishwasher or discard.

Daily routine for 5 days

Antiseptic body wash or wipes

  • Wash hair normally and apply the antiseptic body wash in the shower daily (without soap) to skin below the neck OR apply the non-rinse chlorhexidine wipes after showering to all body surfaces below the neck.
  • Take care to apply the solution under the arms and into the groin and into any folds of skin. Move downward from top to toes.
  • Allow the antiseptic to remain on the skin for 5 minutes at least before rinsing well.  Do NOT rinse off if using the non-rinse wipes.  Avoid exposure of the eyes or mouth to the antiseptic.

Nasal ointment – N.B. Use a separate labelled tube of mupirocin for each treated person.

  • Wash hands well with soap and water or disinfect hands with alcohol gel/rub beforehand
  • Mupirocin 2% nasal ointment (or other ointment as directed) – place small amount (size of match head) of ointment onto a clean cotton bud and massage gently around the inside of the nostril on one side- no more than 2-3 cm inside. Use a new cotton bud for the other nostril so that you do not contaminate the tube.
  • After applying the ointment, press a finger against the nose next to the nostril opening and use a circular motion to spread the ointment within the nose.
  • Apply the ointment morning and evening (twice daily) for 5 days
  • Disinfect hands with alcohol rub/gel after applying the ointment.

Throat disinfection 

A proportion of MRSA carriers carry MRSA in their throat. If so directed , gargle three times daily with the 0.1% chlorhexidine solution for 5 days.

Personal items (dentures, combs, razor, eye-glasses and jewellery)

  • During the decolonisation program, remove dentures every evening and clean carefully using a denture brush and mild soap and water, or denture paste.
  • Disinfect other personal items daily with an alcohol-based cleanser (wipes)

Oral antibiotics (if directed)

In relapsed cases, oral antibiotics may be prescribed. These usually consist of two types of antibiotics to be taken twice a day for 5 days. Follow the medication instructions with care and be sure to take all of the tablets. Contact your Medical Practitioner if you develop a serious reaction to the medication.

House Environment and clothes/linen

Household

  • Use clean bed linen, underclothing, nightwear, bath mats, face cloths and towels on day 2 and day 5.
  • Wash linen and clothes in hot water (60 degrees Celsius) with usual laundry detergent.
  • Alternatively, wash in cold water, dry in the sun, or in a dryer
  • Thorough household clean: .
    • Disinfect reused personal items with an alcohol based cleanser (large alcohol-containing wipes) several times during the decolonisation period.
    • Clean and disinfect the shower floor and/or bath tub daily with a bleach-based cleanser.
    • On days 2 and 5 of treatment clean the house well (especially the bedrooms and bathrooms). Clean dust off all surfaces then vacuum clean floor surfaces and soft furnishings. Wipe over all frequently touched surfaces with large alcohol containing wipes. Wash vinyl/leather covered furniture with warm soapy water and dry with a clean towel.

Sports/Gym (if attended)

  • Surfaces, equipment and towels, skin-to-skin contact are all potential sources for staph. re-infection.
  • Consider questioning the provider(s) about their hygienic measures. There are good educational posters available from the Centers for Disease Control, USA at  and recommendations for management in the community.

Pets

Dogs and other companion animals can be colonised with MRSA without showing any signs of infection.

  • Animal bedding should be washed (60 degree hot wash with laundry detergent) or replaced. Dry in the sun.
  • Wash the animal at least once with an antiseptic solution (e.g. 4% chlorhexidine wash-Hibiclens or triclosan 1% body wash)
  • Ensure that the skin condition of the animal is kept in good condition.

What about my partner/ family or household members?

Usually when an aggressive strain of MRSA moves in to a family or household, only certain members of that group get infections (boils). This is despite the fact that the strain has probably been transferred amongst most of the household.  It is usual for all family or household members (ie. those who live in close contact or who have had boils) to undergo the same decolonisation. Your doctor will provide instruction and necessary supplies if this is to occur.

Follow-up after decolonisation treatment

Possible approaches (consult with your GP for detailed advice):

  • wait and see- if no further boils occur within 6 months then it is probable that the MRSA has been eliminated
  • get re-tested for MRSA colonisation- this is done by taking a further swabs (nose, perianal, throat) for culture. If you remain colonised, then you are likely to remain at risk of further boils. However the improvement in your skin care may be sufficient to prevent further trouble. One can either repeat the decolonisation process or wait and see.
  • continue intermittent antiseptic body washes or bleach baths 1-2 times per week to prevent further infections (not always effective however)

Avoid unnecessary antibiotic exposure – antibiotics remove natural bacteria from your skin and gut which increases the risk of picking up resistant bacteria such as MRSA.

Important note: if presenting to a hospital,  it is important that you remind your medical carers that you have been colonised with MRSA (golden staph.) in the past as they may have to use antibiotics that are specific for MRSA.

References

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