Staphylococcus Aureus Decolonization Study
Condition: Staphylococcal Skin Infections; Abscesses; Furunculosis; Staphylococcus Aureus; MRSA Infection
MeSH terms: Infections; Communicable Diseases; Staphylococcal Infections; Abscess; Cellulitis; Skin Diseases, Infectious; Staphylococcal Skin Infections; Furunculosis
Study type: Interventional

Summary: 
      The purpose of this study is to determine whether measures to eliminate the Staph germ from
      the skin of the index patient (with a special ointment and soap) are more effective when
      performed by everyone in the household rather than the patient alone, and whether these
      methods are effective in preventing future Staph infections. The investigators hypothesize
      that there will be a greater number of households who are successful in eradicating the staph
      germ from the index patient when all members of the household participate than households
      where only the index patient is treated.
    

Detailed description: 
      Methicillin-resistant Staphylococcus aureus (MRSA) was once uniformly associated with
      hospital-acquired infections; however, MRSA strains have emerged that thrive outside the
      hospital environment, causing significant morbidity and mortality among immunocompetent
      individuals, leading to their designation as community-acquired methicillin resistant
      Staphylococcus aureus (CA-MRSA).

      CA-MRSA has become a major source of morbidity and mortality in our pediatric population. An
      important prerequisite for S. aureus infection may be nasal carriage of the organism. A
      variety of decolonization strategies have been used for infection prophylaxis, primarily in
      patients undergoing hemodialysis or surgery, with varying results. However, there are no
      published randomized eradication trials evaluating the decolonization and prevention of
      CA-MRSA infections in immunocompetent children in the outpatient setting. While the
      transmission of CA-MRSA within households has been reported, its contribution to recurrent
      CA-MRSA infection among household members is undetermined. The investigators hypothesize that
      spread of CA-MRSA among household members leads to recolonization or failure of
      decolonization in children undergoing eradication efforts.

      Specific Aim: In pediatric patients presenting with a MRSA skin or soft tissue infection,
      compare the effectiveness of decolonization measures performed by an entire household in
      comparison to measures directed at the index patient alone. The investigators will conduct a
      randomized, controlled trial to test the hypothesis that decolonization measures performed by
      the entire household, specifically application of intranasal mupirocin ointment and bathing
      with chlorhexidine liquid soap, in addition to education and basic hygiene interventions,
      will be twice as effective in eradicating CA-MRSA carriage in the index patient than if the
      measures are performed only by the index patient.
    

Intervention name(s): 2% Mupirocin Ointment; 4% Chlorhexidine liquid soap; Hygiene protocol
Intervention type(s): Drug; Drug; Behavioral
Intervention description(s): Apply ointment to the anterior nares twice daily for 5 days.; Bathe with liquid soap daily for 5 days.; Follow key hygiene tips indefinitely. Tips are:
Throw out all lotions or creams that you dip your hands into and replace with pumps or pour bottles.
Use liquid(pour or pump) soaps instead of bar soaps.
Wash hands frequently or use hand sanitizer(with more than %60 alcohol) such as Germ-X or Purell.
Do not share personal care items such as razors and brushes.
Wash all sheets and towels in hot water. Wash sheets every week.
Use towels and wash cloths only once before washing and do not share.
Other intervention name(s): Bactroban; Hibiclens
Intervention MeSH terms: Chlorhexidine; Chlorhexidine gluconate; Mupirocin
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Abscesses; Furunculosis; Staphylococcus aureus colonization; Staphylococcal Skin Infections; MRSA