Your recent pathology test showed that you are carrying a strain of resistant Staphylococcus aureus (MRSA) bacteria (germ) that may cause boils or other more serious infections (See also NSW MRSA Fact sheet).    Eradication treatment aims to completely remove MRSA from your body. In more than half of the people treated in this way, MRSA is removed long term and this reduces your risk from recurrent skin infection due to MRSA. If the first eradication treatment is unsuccessful, repeat treatment may be required.  This eradication treatment can also be used for recurrent infections due to other strains of S. aureus that are not MRSA.

Getting prepared

Choose a week when you and your family will be uninterrupted by distractions. To improve your skin  condition, follow the Routine Skin Care principles to reduce drying and enhance healing. Unless advised, do not start eradication 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 control as well as possible.

Items required

• Obtain the nasal antiseptic ointment – separate prescription required for each member of the household
• Oral antibiotics if required (prescription as well)
• Obtain recommended antiseptic body-wash (non-rinse chlorhexidine 2% antiseptic body wipes OR Microshield 2 chlorhexidine OR triclosan (Phisohex).
• Sterident for dentures (if required)
• Surface disinfectant for household cleaning

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 and soak in boiling water

Household

• Replace personal items which are contaminated by staph. e.g. toothbrush, razor, opened roll-on deodorant, skin tapes, skin cream and solutions, pumice stones, sponges, make-up brushes
• Wash hair brushes and combs, nail files, plastic/fluffy toys, pet bedding and clippers in a hot water cycle (dishwasher or washing machine) or discard
• Discard magazines, newspapers and other household clutter

Daily routine for 5 days

1. Antiseptic wipes or body wash 

• 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 antiseptic 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.  If using the non-rinse wipes, do NOT rinse off – allow to air dry.  Avoid exposure of the eyes or mouth to the antiseptic.

2. Nasal ointment – N.B. Use a separate tube for each treated person

• Wash your hands
• Open the ointment and squeeze a small amount onto the tips of two cotton buds
• Apply the ointment around the inside of one nostril (don’t put in deeper than 2 to 3 cms)
• Apply ointment to other nostril using the second bud
• Press index finger and thumb against both nostrils and use a circular motion to massage the ointment within the nose
• Discard buds and clean hands again

3. Oral antibiotics (if directed)

In relapsed cases, treatment with two oral antibiotics may be prescribed as well for 5 days. Follow the medication instructions with care and be sure to take all of the tablets. Contact your doctor if you develop a serious reaction to the medication.

4. Household cleaning – days 2 AND 5

• Clean the house well (especially the bedrooms and bathrooms). Clean dust off surfaces then vacuum clean the floor and soft furnishings. Clean and disinfect the shower floor and/or bath tub with an antiseptic cleanser.
• Clean household surfaces with a damp clean cloth containing antiseptic e.g. chair arms, vinyl/leather covered furniture, flat surfaces, light switches and controls, toilet buttons, computer keyboard and mouse, cupboard handles, home gym equipment. Dry as required with clean towel.
• Change bed linen, towels and put on clean clothes.  Hot (60 degrees C) machine wash linen, towels and clothes with normal laundry detergent. Dry in sun or in a dryer.

5. Other issues

Dentures:  During the decolonisation program, remove dentures every evening and clean carefully using a denture brush and mild soap and water, or denture paste.

Pets:  Dogs and other companion animals can also be carrying MRSA- Wash animal bedding (60 degree hot wash with laundry detergent) or replace.  Wash the animal at least once with an antiseptic solution (e.g. Microshield 2 chlorhexidine wash-or triclosan 1% ) and allow to stay on the skin for 5 minutes before rinsing.

Partner, family or household members:  It is usual for all family or household members to undergo eradication whether they have boils or not.  Each member requires a separate tube of nasal ointment.

Follow-up after eradication treatment

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.

• non-healthcare patients – if no further boils occur within 6 months then it means that the MRSA has been eradicated.  Re-culture can be done (nose, perianal, throat swabs) for culture to check- at 6 months. Two separate negative sets are required to document eradication.
• healthcare staff – re-culture is done (nose, perianal, throat swabs) for culture – at 1, 3 and 6 months. If the swabs detect MRSA, then you remain at risk of further boils and may cause a risk to patients.  A more intensive decolonisation is indicated with oral antibiotics – consult infectious diseases

References

• Recurrent Staphylococcal Infection, HNE and Central Coast LHD GP HealthPathways site
• NSW MRSA Fact sheet
• Wiese-Posselt et al German approach (good home environmental protocol example) Clin Inf Dis 2007:44:e88
• Centres for Disease Control, USA cMRSA resources