It is estimated that up to 15-30% of the human population in developed countries are colonized by the community acquired strains of methicillin resistant staph aureus. The risk of developing a skin infection in the year following discovery of colonized status is approximately 1-in-4. Autoinfection rates are between 76-86% – thus most people that get MRSA infections get it from themselves.
Some initial efforts to reduce MRSA carriage that you can recommend to patients:
- Keep fingernails cut short
- Change underwear, towels, washcloths, and sleepwear each day- wash frequently
- Wash bed sheets and pillow cases every week in the hottest water possible (>160 degrees) – Then dry on the hot setting as well
- Keep cuts and scrapes clean, dry and covered with a bandaid until they heal
- Avoid sharing personal items like towels, washcloths, razors,brushes, combs, makeup, clothes or uniforms
- If anyone at home uses loofahs or nylon scrubbers, everyone should have their own and not share
Antibiotics in the nose
Bactroban AKA mupirocin ointment can be used in the nose to help with decolonization. Immediately after completion of a regimen, 81.5% to 100% of patients are decolonized. Unfortunately, the recolonization rate by 3 months is relatively high. So you can recommend it for the short-term, but don’t expect long term benefit. There is more clearly understood benefit for higher risk patients – such as those in the ICU. Data is inadequate to fully define the benefit for outpatients – which make up the majority of our patients in the Pediatric Emergency Department.
If you are going to recommend it – all family members/close contacts should do the following:
- Put a small amount of cream or ointment on one end of a cotton-tip swab (Q-tips)
- Apply the medicine all around the inside of one nostril
- Then, put the cream or ointment on the other unused end of the cotton-tip swab, and apply the medicine inside the other nostril
- Do this three times a day for 5 days
