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HealthInfo Waitaha Canterbury

Skin decolonisation

Purenga ihomatua ā-kiri

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

Decolonisation means trying to remove all the antibiotic‑resistant or Staph bacteria from your body, so you do not get so many skin infections. You and everyone living in your house will need to follow this treatment for 5 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 does not cause them any problems. If you are decolonised and they are not, they will transfer the bacteria back to you.

Decolonisation procedure and checklist

You cannot do this treatment if you or anyone else in the house has an active infection. You need to get make sure you are all fully healed. Also, make sure you treat any other skin conditions. This includes eczema, psoriasis and tinea (athlete's foot).

If you or anyone in your house gets a new skin infection, you will have to delay doing the decolonisation.

Decolonisation step-by-step

Follow these steps where day 1 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 are not 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. Take 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.
  • Do not share razors, towels, facecloths or toothbrushes with anyone else in the house. Or containers of creams or ointments, make-up or other personal items.
  • 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. Do not 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 1 – 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 1 – 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 5 days or have a bleach bath twice a week.

Body wash and shampoo

Types of antiseptic cleanser are:

  • Chlorhexidine Gluconate 4% or Octenisan 0.3% hair and body wash solutions.
  • Chlorhexidine Gluconate 1% lotion for pēpi (babies), tamariki (children) and elderly with sensitive skin.

    Use daily as a body wash for showering.

    Use twice weekly as a shampoo for hair washing.

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 1 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 will need enough to cover the surface of your whole body. 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 tamariki 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 pēpi 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 3 or 4.
  • If you do not 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 5 days

Apply mupirocin or povidone-iodine ointment to both your nostrils twice a day for 5 days. Your general practice team will give you a prescription for this.

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

6.

Day 5 – 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 5 – 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 May 2022.

Sources

Page reference: 45032

Review key: HISNI-49791