Adult

Skin decolonisation pre-procedure

Warning

Skin decolonisation is recommended for:

  • All patients who undergo procedures within the following specialities; cardiac, thoracic, orthopaedic/trauma, vascular, transplant, neurosurgery and head and neck cancer surgery.
  • All patients with a planned procedure involving device implantation e.g. Hickman line, implantable cardiac device, breast implant, mesh implant. List is not exhaustive. If in doubt contact IPC team.

 

  • Contact the Infection Prevention and Control Team for advice if there are any queries about skin decolonisation.
  • Patients who have previously shown a hypersensitivity reaction to any ingredient in any of these products must not receive that particular product.
  • Do not use chlorhexidine skin cleanser/washcloth or Octenisan® wash lotion on surgical wound sites, damaged skin or beyond superficial skin layers.
  • Patients with open wounds or broken skin should still use chlorhexidine skin cleanser/washcloth or Octenisan® wash lotion but should avoid using it on these areas.
  • Do not use chlorhexidine skin cleanser/washcloth in patients with head or spinal injuries.
  • Avoid contact of chlorhexidine and octenisan® skin cleansers with eyes, and with ears if patients have perforated eardrums. If any of the products comes into contact with the eyes, wash out promptly and thoroughly with water.   
  • Patients with myasthenia gravis: Naseptin® cream should not be applied to broken skin to minimise absorption of neomycin.

Skin decolonisation treatment should consist of a nasal ointment/cream AND a skin wash, unless contraindicated

First Line

Bactroban (mupirocin (2% w/w mupirocin free acid)) nasal ointment

Apply a small amount (about the size of a match head) to both nostrils TDS for 24 hours before the surgery or procedure

  • Contra-indicated if resistance to mupirocin or if patient (or carer) has allergy to mupirocin or another ingredient in the product. 

AND

Chlorhexidine gluconate 4% in a surfactant solution (Hydrex® or Hibiwash® or Hibiscrub®) skin cleanser

Wash skin AND hair the night before and the morning of surgery or procedure. 

  • All of the chlorhexidine preparations: Contra-indicated if patient (or carer) has allergy to chlorhexidine.
  • Hibiscrub®: Contra-indicated if patient (or carer) has allergy to chlorhexidine, peanuts or soya. 

Using skin cleanser:

  • Pour enough chlorhexidine skin cleanser onto a clean damp wash cloth to cover the body. Usually approximately 25ml (~2 tablespoons) of skin cleanser for adult patients. 
  • Apply to the body (beginning with the face and working downwards paying particular attention to areas around the nose, axillae, umbilicus, groin and perineum).
  • Do not use the skin cleanser on any cuts or areas of broken skin.
  • Leave skin cleanser in contact with skin for at least 60 seconds. Then rinse off with plenty of water. 
  • Repeat but this time including the hair.
  • Dry with a clean towel.

Chlorhexidine wipes are available and could be used in ICU where clinically indicated.

Nasal product - Second line

Naseptin® (chlorhexidine + neomycin) nasal cream

Apply a small amount (about the size of a match head) to both nostrils QDS for 24 hours before the surgery or procedure

  • Contra-indicated if patient (or carer) has allergy to peanuts, soya, chlorhexidine or neomycin.

Note: Naseptin Nasal Cream (neomycin sulphate, chlorhexidine dihydrochloride) is undergoing a formulation change to remove the excipient Arachis oil (peanut oil). Both the original formulation containing Arachis oil and the revised formulation without Arachis oil will be in circulation in the supply chain until November 2025.

For patients that require Naseptin but have a soya/peanut allergy: speak to pharmacy as it may be possible to access the Naseptin formulation that does not contain arachis oil.

Nasal product - Where unable to use first and second line

Speak to infection prevention and control team

Skin cleanser - Second line

Octenisan® (Octenidine hydrochloride) wash lotion

Wash skin AND hair the night before and the morning of surgery or procedure. 

  • Contra-indicated if patient (or carer) has allergy to octenidine or coconut

Using skin cleanser:

  • Pour enough Octenisan® (Octenidine hydrochloride) wash lotion onto a clean damp wash cloth to cover the body. Usually approximately 30ml (~2 tablespoons) of skin cleanser for adult patients.  
  • Apply to the hair and to the body (beginning with the face and working downwards paying particular attention to areas around the nose, axillae, umbilicus, groin and perineum).
  • Do not use the skin cleanser on any cuts or areas of broken skin.
  • Leave skin cleanser in contact with skin for at least 60 seconds. Then rinse off with plenty of water. 
  • Repeat but this time including the hair.
  • Dry with a clean towel.

Skin cleanser - Where unable to use first and second line

Speak to infection prevention and control team.

Additional Information

  • Skin reactions to chlorhexidine and Octenisan® preparations can occasionally occur. If a skin irritation occurs or worsens, wash off any remaining chlorhexidine/Octenisan® solution thoroughly with water.  Discontinue use of that product. 
    • Contact the Infection Prevention and Control Team for advice if necessary. 
    • If the chlorhexidine cleanser causes or worsens a skin irritation, switch to Octenisan® wash lotion instead. 

Editorial Information

Next review date: 16 Dec 2025