Recurrent Skin Sepsis Pathway - 1st Pass Management Topical Decolonisation
First Pass Management:
Always treat active skin infection first with standard systemic antibiotics (guided by sensitivity results where available) emphasising exact compliance e.g. Flucloxacillin, erythromycin or clindamycin must be QID to achieve sufficient time with drug serum concentration above minimum (MIC).
Always aim for optimum treatment and maintenance of skin integrity through effective management of eczema, psoriais, scabies, athletes foot etc.
Encourage washing (preferably hot) of linen and towels at beginning of each treatment step.
STEP 1 Topical Decolonisation:
Establish Staphylococcus aureus carriage:
- Nasal swab index case or if >1 family member affected swab the whole household
- Provide patient information sheet
- Treat with 7 days of:
- Mupirocin to both nares three times a day - see patient information sheet (NB Fucidin second line due to increased background resistance) and
- Daily antiseptic bath or shower (see summary box) with one of :
- Janola (Sodium hypochlorite / household bleach) bath only avoid facial immersion.
1 capful/15mls Janola per 10 litres(1 bucket) bathwater
NB 2 buckets =1 baby bath
- Triclosan bath or shower, subsidised if endorsed recurrent staph infections 25-30mls per bath, or used as shower gel - leave in contact with skin for minimum of 2 minutes prior to washing off, concentrate on flexural areas.
- Chlorhexidine - (not subsidised approximately $16 per 500mls) Shower option only.
- Dettol (Chloroxylenol) (not subsidised expensive) Bath only.
General advice (Summarised in Patient Information):
- Attention to hand washing for all family members and before and after dressing infected skin.
- Regular bathing but try not to share bathwater - e.g put the person with infection in on their own last - showering maybe preferable.
- Launder sheets, towels and clothing using disinfectant or hot water or hot iron at beginning of treatment and weekly.
- Limit sharing of beds, sheets and towels.
- Keep finger and toenails short and scrub with antiseptic washes during treatment, as Staph can be carried there.
- Encourage elimination of mosquito and other insect triggers.
- Clean and cover cuts and scratches.
- Consider script of Betadine or hydrogen peroxide (Crystacide)to treat minor abrasions. Colloidal silver also appropriate but not subsidised.
Last updated : Thursday, September 10, 2015
Next review date : Friday, September 09,2016
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