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AI-Generated response:

How does a family prevent spread of MRSA between family members?

Answer generated on June 4, 2024

The AI-generated responses are for illustration purposes only and should not be used for medical purposes.

To prevent the spread of methicillin-resistant Staphylococcus aureus (MRSA) between family members, it is recommended to use targeted decolonization strategies and maintain rigorous hygiene practices.

  • Use mupirocin nasal ointment and chlorhexidine soap for decolonization, applying mupirocin in each nostril twice daily for 5 days and bathing with chlorhexidine soap daily for 5 to 10 days.[1-3]

  • Implement hand hygiene practices rigorously, including the use of alcohol-based hand rubs or thorough handwashing.[1]

  • Employ barrier precautions such as gloves and gowns when handling infected wounds or contaminated materials to minimize contact.[1]

  • Consider household decolonization strategies, especially in homes with young children, multiple infections, or ongoing transmission despite optimized hygiene and wound care.[1]

  • Maintain environmental cleanliness in the home to reduce the risk of surface-mediated transmission of MRSA.[4]

Additional info

The use of mupirocin and chlorhexidine as part of a decolonization protocol is well-supported by clinical evidence, particularly in settings where there is a high risk of transmission or recurrent infections. These measures are not only effective in reducing the bacterial load but also in minimizing the risk of infection spread among close contacts, such as family members. It's important to note that while these interventions are beneficial, their effectiveness can diminish over time, and they may be associated with costs that should be considered.[4] Additionally, ongoing research into novel preventive strategies like S. aureus vaccines and microbiota transplants may offer new avenues for prevention in the future. Ensuring that all family members adhere to the recommended practices is crucial for the success of these preventive measures.

References

Reference 1

1.

Liu, Catherine, Shopsin, Bo, Chambers, Henry F. (2024). In Goldman-Cecil Medicine (pp. 1902). DOI: 10.1016/B978-0-323-93038-3.00267-7

The best-studied regimens are topically applied mupirocin nasal ointment and daily bathing with chlorhexidine soap for 5 to 10 days. Household decolonization may be considered in households with young children, where there are multiple family members with infections, or if there is ongoing transmission despite optimization of wound care and hygiene measures. The number of surgical siteS. aureusinfections can be reduced by the rapid screening of nasal carriers by real-time PCR assay followed by the decolonization of carriers with mupirocin nasal ointment and chlorhexidine soap.

Infection prevention strategies are critical to limiting both community-acquired and health care–associated staphylococcal infections. Because infections mayarise from the patient’s resident flora or be acquired from direct contact with a contaminated source (e.g., a wound or dressing, the skin or hands of an asymptomatically colonized individual, or a contaminated health care provider), the most effective strategy is adherence to principles of basic infection control. The key intervention is hand hygiene, whether it is handwashing or use of an alcohol-based hand rub. Barrier precautions (gloves and gowns), which are important for minimizing contact with infected wounds, contaminated secretions, and dressings, should be used to interrupt transmission during uncontrolled outbreaks. The role of contact precautions outside of these scenarios is more controversial, with some studies demonstrating a benefit in reducing MRSA transmission while others do not.For patients undergoing surgical procedures, surgical hand and surgical site antisepsis, aseptic surgical technique, and antimicrobial prophylaxis are important preventive measures. Another potentially effective means of preventing infection is screening and decolonization ofS. aureuscarriers.Studies to determine whether screening, decolonization, and isolation actually prevent MRSA infection have had mixed results. In the ICU setting, universal decolonization with 2% chlorhexidine baths, mouthwash, or showers plus 2% intranasal mupirocin ointment is more effective than targeted screening and decolonization or education alone in reducing rates of MRSA infection. Postdischarge decolonization of MRSA carriers with topical chlorhexidine and mupirocin twice monthly for 6 months also can reducte the risk of MRSA infection in the year after discharge compared with education alone.However, daily bathing with chlorhexidine alone does not reduce the incidence of health care–associated infections in critically ill adults in ICUs. Decolonization may be considered in two other settings: prevention of recurrent skin and soft tissue infection and prevention of surgical site infections. The best-studied regimens are topically applied mupirocin nasal ointment and daily bathing with chlorhexidine soap for 5 to 10 days.

Reference 2

2.

Elsevier ClinicalKey Drug Monograph

Content last updated: January 3, 2024.

Indications And Dosage Infants, Children, and Adolescents: Apply a small amount (500 mg) in each nostril twice daily for up to 5 days pre-operatively. Consider using in combination with chlorhexidine baths. **for postdischarge methicillin-resistant S. aureus decolonization using methicillin-resistant S. aureus nasal carriage eradication to reduce postdischarge infections and readmission †** Intranasal dosage Adults: Apply a small amount (500 mg) in each nostril twice daily for 5 days twice monthly for 6 months. Use in combination with chlorhexidine baths and mouthwash. Infants, Children, and Adolescents: Apply a small amount (500 mg) in each nostril twice daily for 5 days twice monthly for 6 months. Use in combination with chlorhexidine baths and mouthwash.

Reference 3

3.

Elsevier ClinicalKey Drug Monograph

Content last updated: March 5, 2024.

Indications And Dosage Infants, Children, and Adolescents: Apply topically to the skin once daily, as part of daily bathing without rinsing off, for 5 days twice monthly for 6 months. Use in combination with chlorostat mouthwash and mupirocin nasal decolonization. Peridontal dosage (oral rinse) Adults: 15 mL by oral rinse twice daily for 5 days twice monthly for 6 months. Use in combination with chlorostat baths and mupirocin nasal decolonization. Infants, Children, and Adolescents: 15 mL by oral rinse twice daily for 5 days twice monthly for 6 months. Use in combination with chlorostat baths and mupirocin nasal decolonization.

Reference 4

4.

Kao CM, Fritz SA. ?. Clinical Microbiology and Infection : The Official Publication of the European Society of Clinical Microbiology and Infectious Diseases. 2024;:S1198-743X(24)00010-7. doi:10.1016/j.cmi.2024.01.004.

Publish date: January 4, 2024.

Targeted decolonization with topical antimicrobials should be prescribed to all affected individuals within the household. IMPLICATIONS: S. aureus infections result in substantial mortality and morbidity because of the high incidence of recurrent skin infections. Although current decolonization strategies are beneficial, interventions are often costly to families and effectiveness wanes over time. Results from a recently completed trial evaluating integrated periodic decolonization and household environmental hygiene will further add to our understanding of what constitutes a sustainable decolonization approach. In addition, novel preventive strategies are being developed such as S. aureus vaccines, lytic agents, probiotics, microbiota transplants, and phage therapy.

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