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MRSA Decolonization Strategies

Dr. Stephen Berry

There is no good proof that decolonization will prevent recurrences of Staphylococcal infection; however, in my experience it may help reduce frequency of attacks.

  1. Pick a start date for everyone in the household to begin together.
  2. Bactroban (mupirocin 2% ointment): apply to nose and inhale if nasal applicator or if using ointment work up to inside of both nostrils. Use twice daily for 5 days.
  3. Skin Washes: use chlorhexidene (Hibiclens) or hexachlorophene (Phisophex) every other day for 1-2 weeks and then decrease to twice weekly. Try to apply to all body areas (except eyes, mouth) and let sit for 5 minutes before showering off.
  4. Use dilute bleach (10% or 1 part bleach to 9 parts water) to wipe down all bathroom surfaces twice the first week and then weekly for one month.
  5. Any clothing that is next to skin and rarely washed should be washed/laundered in hot water +/- bleach--or thrown out. This includes sports equipment, athletic supports, etc.
  6. Use hand sanitizers such as Purell frequently, especially if you take care of children or have contact with other people on a physical basis regularly.
  7. Do not shave skin in armpits, groin or legs. If you must shave, first wash with Hibiclens as in #2 and then use a fresh disposable razor for each shaving.

Additional MRSA Information

Per Dr. Zenilman

MRSA

MRSA (Methicillin Resistant Staphylococcal aureus) is a common infection which generally affects the skin and soft tissues. This organism is resistant to many of the typical antibiotics that are often used to treat staph infection. Furthermore, it is more virulent (aggressive) because many of the strains produce a toxin which is the reason why people are prone to abscesses, boils and other problems of inflammation.

Who gets MRSA?

Answer: Until about 2000, most people with MRSA acquired the infection as a hospital-acquired infection. However, the infection has now been disseminated into the community. Most of the patients that we see do not have any specific risk factors for MRSA. Prominent groups who have acquired MRSA infection include professional football players, wrestlers, military, and student groups. In fact, over 70% of the patients who come to the emergency department with staph infection now have MRSA.

Where is MRSA carried?

Answer: In persons who are infected, MRSA becomes part of the native flora which an individual carries. The two major carriage sites are in the nose and on the skin. Large cross-sectional surveys in the United States general population have demonstrated that approximately 20% of persons carry staph aureus (asymptomatically) in their nose, and approximately 1/10 of these are MRSA.

What is the approach to treating MRSA?

Answer: We have utilized a staged approach to treating MRSA infection. This includes:

  1. Hygiene. MRSA is transmissible between family members and close contacts. Transmissibility is typically through direct skin to skin contact or sharing of materials (such as towels, soap), which can have direct skin to skin contact. Therefore, in individuals who are infected, we recommend no sharing of towels, soap and toiletries.
  2. First stage of treatment is treatment of the infection itself. This will typically resolve with a short course of antibiotics (such as bactrim, doxycycline). However, in cases where there was a frank abscess or boil, this may need to be opened and drained. If the abscess is opened and drained, antibiotics are not needed afterwards, and the drainage takes care of the problem.
  3. Following treatment of the acute episode, we generally offer a period of decolonization. Decolonization literally means attempting to rid the body of the organism from places where it may be resident without symptoms. Decolonization includes several parts; these include:

    A. The use of mupirocin ointment (bactroban) to clear the nasal passages of MRSA. Generally, this requires approximately five days of applying the ointment twice daily.

    B. In addition to the ointment, we recommend using antiseptic soaps such as chlorhexidine (such as hibiclens, phisohex) for a period of one week. The appropriate protocol for using these soaps is to later the soap while in the shower, step away from the shower for 2 minutes (count to 100) and then wash off. Avoid direct contact with eyes or other sensitive areas.

  4. In selected cases your physician may decide to perform the decolonization procedure every two months. Clinical studies have demonstrated that decolonization is generally effective in approximately 75% of cases done over a two month period.
  5. In cases where decolonization is not resulted in cessation of outbreaks, your physician may elect one of two options. These include:

    A. “Presumptive treatment” with antibiotics. In this case, your physician will give you a prescription for antibiotics to hold at home. When you detect the onset of an outbreak, you’d be instructed to take the antibiotics until the outbreak has ceased and then several days thereafter. Care must be taken to avoid too frequent use of antibiotics, as this will result in development of antibiotic resistance. However, the idea behind this approach is to avoid the 1-2 day delay which often occurs between a patient detecting the outbreak, and making an appt. to see a physician.

    B. In extreme cases, we would recommend use of prophylaxis/preventive antibiotics for a prolonged course of suppression. This generally works, but does expose the patient to a prolonged course of antibiotics, potential side effects and development of resistance.

Questions:

Can I transmit this to my children?
Answer: Generally not, although care must be taken to avoid direct skin to skin contact of infected area.

What about sexual/intimate partners?
Answer: This is an interesting area, and to be perfectly honest, we have no solution. There are partners who seem to be resistant; this is an area which is of particular interest to us.