Decolonization Products for Staphylococcal Infections
For patients requiring decolonization, keep mupirocin 2% nasal ointment and chlorhexidine gluconate 4% body wash on hand.
Specific Products and Regimen
Nasal Ointment
- Mupirocin 2% nasal ointment applied twice daily to the anterior nares 1, 2, 1
- Duration: 5-10 days 1, 2, 1
Body Wash
- Chlorhexidine gluconate 4% (40 mg/mL) antiseptic body wash used daily 3, 4
- Duration: 5-14 days 1
- Alternative: Dilute bleach baths (¼ cup bleach per ¼ tub or 13 gallons of water) for 15 minutes twice weekly for 3 months 1
When to Use These Products
Decolonization should be considered in specific situations, not routinely 1, 2:
- Recurrent skin and soft tissue infections despite optimizing wound care and hygiene measures 1
- Ongoing transmission among household members or close contacts despite hygiene measures 1, 2, 1
- Pre-surgical preparation for cardiac and orthopedic surgery in S. aureus carriers 3, 5
Evidence Supporting Combined Therapy
The combination approach is more effective than mupirocin alone 1:
- Targeted decolonization (mupirocin + chlorhexidine) in S. aureus carriers reduces surgical site infections with a risk ratio of 0.32 (95% CI: 0.16-0.62) 6
- A standardized 5-day regimen achieved 87% decolonization success in MRSA carriers 7
- In Mohs surgery patients, topical decolonization resulted in 0% infection rate versus 9% with oral antibiotics 4
Important Caveats
Mupirocin alone is less effective 1:
- A trial in the CA-MRSA era found mupirocin decreased nasal colonization but did not reduce first-time skin infections compared to placebo 1
- Chlorhexidine wipes alone are also ineffective 6, 1
Resistance concerns 1:
- Monitor for mupirocin resistance in colonizing isolates, though not yet widespread 1
- Decolonization should be coupled with ongoing reinforcement of hygiene measures 1, 2, 1
Practical Application
The most effective protocol based on high-quality evidence 3, 7:
- Mupirocin 2% nasal ointment twice daily for 5 days 3
- Chlorhexidine gluconate 4% body wash once daily for 5 days 3, 7
- Complete decolonization 1-2 weeks before planned surgery when applicable 3
Do not use screening cultures before or after decolonization if prior MRSA infection is documented 1