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HealthInfo Canterbury

Skin decolonisation

If you have problems with repeat antibiotic‑resistant infections or Staphylococcus aureus (Staph) infections, your GP may recommend that you undergo what's called decolonisation treatment to try to get rid of what's causing your infections.

Antibiotic‑resistant infections

Antibiotic‑resistant infections are when bacterial infections no longer respond to some antibiotics. These resistant bacteria are also sometimes called multi‑drug‑resistant organisms (MDRO).

For more information about different types of antibiotic‑resistant infections, see Antibiotic‑resistant infections.

Staphylococcus aureus

Staphylococcus aureus (commonly called Staph or Staph aureus) is a type of bacteria (germ). It's on the skin and in the noses of about a quarter of healthy people.

Staph is usually harmless and you don't even notice it. But if your skin is damaged with a scratch or even a small cut or graze, it can cause skin infections such as boils and abscesses.

Children who have eczema are more likely to get skin infections because it's more likely that their skin will get dry and crack when they scratch it.

Decolonisation treatment

Decolonisation means trying to remove all the antibiotic‑resistant or Staph bacteria from your body so you don't get so many skin infections. You and everyone living in your house will need to follow this treatment for seven days.

Other people in the house need to do it because they may carry antibiotic‑resistant or Staph bacteria in their nose or on their skin even if it doesn't cause them any problems. If you're decolonised and they aren't, they'll transfer the bacteria back to you.

Decolonisation procedure and checklist

You can't do this treatment if you or anyone else in the house has an active infection, so you need to get make sure you're all fully healed. Also make sure you treat any other skin conditions, such as eczema, psoriasis, or tinea (athlete's foot).

Important

If you or anyone else in the house gets a new skin infection just before your planned decolonisation week, contact your general practice team, as you'll need to postpone the treatment.

Decolonisation step-by-step

Follow these steps where day one is the first day of the decolonisation treatment.

Step

Action

Done?

1.

Getting ready

Make sure everyone in the house understands good personal hygiene and what they need to do to achieve it.

  • Have a bath or shower at least daily and more often if you do very sweaty activities. If you have dry skin and aren't very active, a bath or shower every second day should be OK.
  • Wash your hands properly with liquid soap and water or an alcohol-based hand gel, taking care to clean between your fingers and up to your wrists. See the page on Hand hygiene to find out when you should wash your hands and how to wash them properly.
  • Keep your fingernails clean and short.
  • Don't share razors, towels, facecloths, toothbrushes, containers of creams or ointments, make-up or other personal items with anyone else in the house.
  • Throw away any used razors. Also throw away any skin creams or make-up that might have been contaminated.
  • Use an electric razor rather than a blade shaver during decolonisation treatment. Don't have any hair removal treatment including waxing during decolonisation treatment.
  • If you use creams or ointments from a container, use a new clean stick or spoon to remove the amount you need each time. This stops you contaminating the whole container.

2.

Day one – washing

  • Make sure everyone in the house has a bath or shower then puts on clean clothes.
  • Put clean bedding on all beds and use clean towels and facecloths.

To make sure your clothes, bedding and towels are clean, wash them in hot water with your usual laundry detergent. Or if you wash them in cold water, either iron them with a steam iron, dry them in the sun or put them somewhere dry and uncontaminated for 10 to 14 days.

3.

Day one – house cleaning

  • Clean all hard surfaces including bathrooms and floors with detergent and water.
  • Vacuum all carpets, rugs, mattresses and electric blankets.
  • Take extra care vacuuming bathrooms and bedrooms (make sure you vacuum around and under the bed).
  • Wash any pet bedding, especially dog bedding. Dogs can carry antibiotic‑resistant or Staph infections without showing any signs.

4.

Skin and hair decontamination

You can either use an antiseptic skin cleanser every day for seven days or have a bleach bath twice a week.

Antiseptic skin cleanser

Every day for seven days, everyone in the house needs to use antiseptic skin cleanser instead of soap.

Types of antiseptic cleanser are:

  • Chlorhexidine 4% (surgical scrub preparation). As it can dry out your skin, you may also need to use an emollient or moisturiser if your skin is dry.
  • Chlorhexidine 2% wash. This is a bit more expensive but is better for people with sensitive skin.
  • Chlorhexidine 1% (obstetric cream preparation), which is often better for babies, children and older people with sensitive skin.
  • Octenidine wash lotion, which you can use if chlorhexidine irritates your skin.

Your GP will recommend which antiseptic cleanser to use depending on your family's ages and skin characteristics. You can get antiseptic cleansers at pharmacies but ask your pharmacist which antiseptic cleansers they have and what their costs are.

Follow these steps to make sure you wash properly

Hair washing:

  • Wet your hair and scalp.
  • Apply a small amount of undiluted antiseptic cleanser and lather well.
  • Leave on for one minute then rinse.
  • If you want to, you can use your usual shampoo and conditioner afterwards.

Body washing:

  • Wet your whole face and body in the shower or bath.
  • Turn off the shower or stand out of the bath.
  • Apply the undiluted antiseptic cleanser to a damp clean flannel or cloth. You'll need enough to cover the surface of your whole body and you may need to add more to the flannel or cloth during the process.
  • Start with your face, paying special attention to your nose area. Avoid contact with your eyes.
  • Work down to your neck then arms including your fingers and underarms.
  • Then wash your chest and back including your belly button and skin folds.
  • Next clean down your thighs and legs including your toes.
  • Lastly clean your genital areas, groin, bottom and anal area with the flannel or cloth.
  • Leave the cleanser in contact with your body for one minute before rinsing it off in the shower or bath.
  • Dry yourself with a freshly washed clean and dry towel.

Bleach bath

You can have a diluted bleach bath at a concentration of 0.005% instead of using an antiseptic cleanser. A bleach bath can be easier for children than using an antiseptic cleanser.

Ensure the bleach you use has no added fragrance or detergent. Bleach comes in different strengths so be sure to read the label to know what strength your bleach is.

Follow these steps to make sure you wash properly with a bleach bath

  • Fill your bath or tub with warm water.

    A full-size bath filled 10 cm deep holds about 80 litres of water.

    A baby’s bath holds about 15 litres of water.

  • Add bleach and mix well

    For a 4.2% bleach product, add 1 ml for every litre of water.

    For a 3.1% bleach product, add 1.3 ml for every litre of water.

    For a 2.1% bleach product, add 2 ml for every litre of water.

  • Soak in the bath for about 10 minutes before rinsing off.
  • Do this on the first day and on day three or four.
  • If you don’t have a bath, use the above measurements to mix the bleach in a bucket. Sponge it over yourself generously and leave it on for 10 minutes before showering it off.

5.

Nose decontamination – twice daily for seven days

Apply mupirocin or povidone-iodine ointment to both your nostrils twice a day for seven days. Your GP will give you a prescription for this.

  • Apply it with a cotton bud to a depth of about 1 cm (just enough so the tip of the bud goes into your nose) and apply the ointment fully around the inside surface of each nostril.
  • Use a new cotton bud for each nostril so you don't contaminate the tube.
  • Take care around the entrance to your nostrils, as povidone-iodine ointment can stain your skin.

6.

Day seven – house cleaning

  • Clean all hard surfaces including bathrooms and floors with detergent and water.
  • Vacuum all carpets, rugs, mattresses and electric blankets.
  • Take extra care vacuuming bathrooms and bedrooms (make sure you vacuum around and under the bed).
  • Wash any pet bedding, especially dog bedding.

7.

Day seven – washing – the last day of decontamination

  • Wash all clothes, bedding, and towels that have been used during the week.
  • Put clean bedding on all beds.
  • Make sure clean underwear, clothes and towels are available for everyone for the next day.

To make sure your clothes, bedding, and towels are clean, wash them in hot water with your usual laundry detergent. Or if you wash them in cold water, either iron them with a steam iron, dry them in the sun or put them somewhere dry and uncontaminated for 10 to 14 days.

Written by HealthInfo clinical advisers. Last reviewed August 2019. Last updated February 2021.

Page reference: 45032

Review key: HISNI-49791