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Staphylococcus decolonisation

If you have problems with repeat 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.

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 Staph 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 Staph 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 Staph infections without showing any signs.
4.	Skin decontamination Either – use an antiseptic skin cleanser every day for seven days Every day for seven days everyone in the house needs to use antiseptic skin cleanser instead of soap. Follow these steps to make sure you wash properly. Wash all over your body, including between your toes, around your bottom, under your arms, into your groin area, and into any skin folds. Use the antiseptic cleaner on your hair and scalp when washing your hair. Leave the antiseptic on your skin for at least five minutes before washing it off. Types of antiseptic cleanser are: Chlorhexidine 4% (surgical scrub preparation). This costs around $10 to $17 for a 500 ml bottle. 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. It costs around $20 to $25 for a 200 ml bottle. If chlorhexidine irritates your skin too much, use octenidine wash lotion, which costs around $20 for a 500 ml bottle. You can get chlorhexidine and octenidine at a pharmacy. Your GP will recommend which one to use depending on your family's ages and skin characteristics. Or – have a bleach bath twice a week You can also use a dilute bleach bath. Add ¼ cup (about 60 ml) of household bleach to a ¼ filled bath and stir well. Soak in the bath for about 10 minutes. Do this on the first day and on day three or four. If you don't have a bath, add 1 teaspoon of bleach to 4 litres of water in a bucket. Sponge it over yourself generously and leave it on for 10 minutes before showering it off. A bleach bath can be easier for children instead of using an antiseptic cleanser.
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.