The effectiveness of decolonization methods to interrupt MRSA recurrence and transmission are not well-established. However, it may be reasonable to consider decolonization on a case-by-case basis in two circumstances: (1) for persons with recurrent MRSA infections (e.g., three or more infections in less than six months); and (2) in outbreak situations in which ongoing MRSA transmission is occurring among a well-defined cohort with close contact (e.g. a household).

Decolonization may be considered in patients with recurrent CA-MRSA infections or in households with several members who have CA MRSA skin and soft tissue infections. However, little data exist to determine the effectiveness of decolonization in the non-healthcare setting. Other strategies to prevent transmission in households and community settings should be emphasized first.

The decolonization procedure often recommended includes both of the following measures:

• Apply 2% mupirocin ointment generously throughout the inside of both nostrils with a cotton swab— twice daily for five days (to be applied in Health Services); and
• Bathe—with liquid chlorhexidene soap, washing all skin surfaces—daily for five days. †

Daily bathing or showering using an antibacterial agent such as chlorhexidine gluconate is recommended during mupirocin treatment to improve chances of eradication. Alternative treatment with tea tree oil body lotion and shampoo have been shown effective in achieving decolonization, and have the benefit of being less harsh on the skin. ††

  1. † Management of Methicillin-Resistant Staphylococcus aureus (MRSA) Infections [↩]
  2. †† CA MRSA Guidelines for Clinical Management and Control of Transmission, Wisconsin Division of Public Health [↩]