Skin decolonisation pre-procedure - guide to prescribing for patient 1 month or over post term age
Infants under 1 months post-term age: Discuss with Infection Prevention and Control Team and Paediatric ID team with reference to neonatal unit decolonisation regime.
Patients on the neonatal unit: Treat according to the neonatal decolonisation regime (even if patient is over 1 month post-natal age).
Patients 1 month or over post term age:
- 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 with moderate/severe eczema or psoriasis should not use the Chlorhexidine skin cleanser/washcloths or Octenisan® wash lotion/wash mitts. In this situation the appropriate nasal ointment/cream should still be used.
- Avoid contact of chlorhexidine and octenisan® skin cleansers with eyes, and ears if patients have perforated eardrums. If any of the products comes into contact with the eyes, wash out promptly and thoroughly with water.
Skin decolonisation treatment should consist of a nasal ointment/cream AND a skin wash, unless contraindicated
Nasal product - 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.
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 or second line product
Speak to infection prevention and control team
Skin wash - First line
Chlorhexidine gluconate 4% in a surfactant solution (Hydrex® or Hibiwash® or Hibiscrub®) skin cleanser or 2% washcloths.
Wash skin AND hair the night before and the morning of surgery or procedure.
- All of the chlorhexidine preprations: 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.
- 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. Dry with a clean towel.
Chlorhexidine washcloths:
- Restricted for use on PICU
- Warm washcloths prior to use for patient’s comfort and to prevent hypothermia.
- Let the skin dry and do NOT rinse
Skin wash - Second line
Octenisan® (Octenidine hydrochloride) wash lotion or wash mitts
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 chlorhexidine skin cleanser onto a clean damp wash cloth to cover the body.
- 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. Dry with a clean towel.
Octenisan® wash mitts:
- Restricted for use on PICU
- Warm washcloths prior to use for patient’s comfort and to prevent hypothermia.
- Let the skin dry and do NOT rinse
Skin wash - Where unable to use first or second line product
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.
- The licensing of Octenisan® wash lotion has changed to exclude children under 3 years old. The composition of the product has not changed and it has been used safely in children under 3 years old. There is more data to support the use of Octenisan® wash lotion in neonates compared to chlorhexidine so a decision was made to continue using it in children under 3 years old. The Octenisan® wash mitts do not have an age restriction.
Trust MRSA protocol
The Trust MRSA protocol can be accessed here