Home Decontamination Protocol for MRSA
For patients with recurrent MRSA skin infections or ongoing household transmission, focus environmental cleaning on high-touch surfaces (doorknobs, counters, bathtubs, toilet seats) using standard commercial cleaners or EPA-registered hospital disinfectants, combined with personal decolonization strategies including intranasal mupirocin and chlorhexidine body washes. 1
When Home Decontamination is Indicated
Environmental hygiene measures should be implemented in the following scenarios:
- Recurrent MRSA skin and soft tissue infections despite optimizing wound care and personal hygiene 1
- Ongoing transmission among household members or close contacts despite hygiene interventions 1
- Failed initial decolonization attempts in healthcare workers or patients, where environmental contamination may be perpetuating recolonization 2
Priority Surfaces for Cleaning
Target high-touch surfaces that come into frequent contact with bare skin daily, as these are the primary reservoirs for MRSA transmission in home environments 1:
- Doorknobs and light switches
- Countertops (especially bathroom and kitchen)
- Bathtubs and shower surfaces
- Toilet seats and handles
- Bed frames and nightstands
- Faucet handles
Research demonstrates that high-touch surfaces should be prioritized over low-touch surfaces, and frequent cleaning (multiple times daily) is more effective than whole-room cleaning once daily 3.
Cleaning Products and Methods
Use commercially available cleaners or detergents appropriate for the surface being cleaned, following label instructions for routine cleaning 1. EPA-registered hospital disinfectants are acceptable but not mandatory for home use 4.
Cleaning Protocol:
- Clean surfaces with detergent and water first to remove organic material 1
- Apply disinfectant according to manufacturer instructions, ensuring adequate contact time 1
- Prepare fresh cleaning solutions daily and discard after use 1
- Clean mops and cloths after each use and allow to dry completely, or use disposable cleaning materials 1
Personal Hygiene Items and Linens
Avoid sharing personal items that contact skin, including razors, towels, linens, and clothing 1:
- Wash towels, sheets, and clothing in hot water regularly 5
- Do not reuse or share disposable razors that have contacted infected skin 1
- Replace or thoroughly disinfect personal hygiene articles including toothbrushes, combs, and nail care items 2
Environmental sampling in healthcare worker homes found contamination of personal hygiene articles was a major source of recolonization failure 2.
Bathroom-Specific Decontamination
Bathrooms require particular attention as they are frequently contaminated and involve high skin contact 2:
- Clean and disinfect bathtubs, showers, and sinks thoroughly
- Disinfect toilet seats, handles, and surrounding surfaces
- Replace or disinfect bath mats and shower curtains
- Clean and dry bathroom surfaces completely to prevent moisture accumulation 4
A study of healthcare workers with persistent MRSA colonization found that bathroom contamination was detected in 7 of 8 screened home environments, and decolonization only succeeded after thorough bathroom cleaning 2.
Concurrent Personal Decolonization
Environmental cleaning alone is insufficient; it must be combined with personal decolonization strategies 1, 2:
Nasal Decolonization:
Body Decolonization:
- Chlorhexidine gluconate 4% soap for daily full-body washing for 5-14 days, OR 1, 5
- Dilute bleach baths: 1 teaspoon per gallon of water (or ¼ cup per ¼ tub/13 gallons), 15 minutes twice weekly for 3 months 1, 5
Note: Use chlorhexidine with care in infants under 2 months of age due to risk of irritation or chemical burns 6.
Household Contact Management
Evaluate all household contacts for signs of MRSA infection 1:
- Symptomatic contacts should be evaluated and treated for active infection 1, 5
- Asymptomatic household contacts may require decolonization if ongoing transmission is occurring despite hygiene measures 1, 5
- Coordinate decolonization timing so all colonized household members are treated simultaneously to prevent ping-pong recolonization 2
Research in healthcare workers demonstrated that failure to identify and treat colonized household contacts was a major cause of persistent colonization, with some cases requiring up to 2 years to clear 2.
Wound Care Integration
Keep all draining wounds covered with clean, dry bandages at all times 1:
- Change bandages when soiled or wet
- Dispose of used bandages in sealed plastic bags
- Wash hands immediately after changing bandages 1
- Clean surfaces that may have contacted drainage 1
Critical Pitfalls to Avoid
Do not rely on environmental cleaning alone without concurrent personal decolonization—surfaces are rapidly recontaminated from colonized individuals 3, 2.
Do not use liquid chemical sterilants or high-level disinfectants for routine home surface cleaning; standard cleaners are appropriate and safer 1.
Do not neglect heavily contaminated environments—when home environments are extensively contaminated, eradication can take months to years even with adequate medical treatment 2.
Avoid carpeting in areas where spills are likely or where infected individuals spend significant time, as carpets are difficult to decontaminate effectively 1, 4.
Frequency and Duration
Clean high-touch surfaces multiple times daily during active decolonization periods, as surfaces become rapidly recontaminated 3:
- Research modeling suggests cleaning frequency >3 times per hour is optimal for high-touch surfaces 3
- Continue enhanced cleaning for the full duration of decolonization treatment (5-14 days minimum) 1, 5
- Maintain routine cleaning of high-touch surfaces even after successful decolonization to prevent reacquisition 1
Monitoring Success
Recolonization occurs in 40-60% of patients within 3 months after decolonization, emphasizing the need for sustained hygiene measures 5. Continue environmental cleaning protocols and personal hygiene practices indefinitely to minimize recolonization risk 1.