The compliance, cost, and feasibility of decolonization measures for methicillin-resistant Staphylococcus aureus (MRSA) eradication in outpatients are unknown. While there is demonstrated benefit in decolonization and reduced burden of infection, effectiveness is irrelevant if measures are unfeasible. This study sought to identify potential barriers to compliance for families assigned a 5-day decolonization protocol.
Households (n=68) of children with a history of MRSA skin and soft tissue infection were enrolled in a decolonization study. All household members were given a hygiene curriculum (Figure), and some were assigned a 5-day decolonization protocol consisting of intranasal 2% mupirocin ointment applied twice daily and a once daily dilute bleach bath. A tool to assess compliance, feasibility, and cost of the protocol was given to each participant.
Among 310 household members enrolled, 218 were assigned the decolonization protocol. Ninety-nine (45%) participants completed all 10 applications of mupirocin (median 9), and 143 (66%) completed all 5 bleach baths (median 5); 82 (38%) completed all mupirocin applications and bleach baths.
Regarding feasibility of mupirocin, 168 (77%) found application to be easy; 71 (33%) reported symptoms (runny nose [13%], itching [9%]). Barriers were dislike of something in the nose (17%), forgetting (8%), and being too busy (6%). Regarding bleach baths, 138 (64%) found them to be easy; 78 (36%) reported symptoms (dry skin [24%], itching [13%]). Barriers were being too busy (15%), skin irritation (11%), and aversion to smell (10%).
To comply with the hygiene curriculum, 22 households bought new lotion bottles (2/household, $3.96/bottle) and 18 bought new liquid soap bottles (2/household, $3.53/bottle). Four households bought new bed sheets ($21.57/set) and 6 bought new bath towels ($2.37/towel). Thirty households did additional loads of laundry each week (3/household). Other items purchased included razors, hairbrushes, deodorant, washcloths, and toothbrushes.
While most household members completed some decolonization measures, less than half were fully compliant with the complete protocol. Feasibility and cost are important considerations when prescribing decolonization.
J. Morelli, None
J. Wang, None
R. Thompson, None
S. Fritz, None