Staphylococcus aureus Patient Education Booklet

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1 Staphylococcus aureus Patient Education Booklet

2 Routine Skin Care General Principles Our skin is a very important barrier against infection! People with kidney disease on dialysis are more likely than others to suffer from skin disease and infection. It is possible to reduce problems by taking some simple precautions. Most of us overuse soap and shower more frequently than required. Both of these may damage the skin by removing important oils that cannot be replaced, except via the usual diet. As well, the action of roughly drying the skin with a towel may actually remove some of the top layers of the skin that protect it from infection and other problems. The recommended approach to reduce dry skin, skin inflammation and infection is: Reduce the use of soap when bathing or showering; completely avoid soap over your fistula arm or on the skin near your central dialysis catheter (if present). DO NOT routinely use antiseptic soaps. When drying with a towel, be gentle - avoid rubbing the skin, especially over your fistula arm. Reduce the overall frequency of bathing or showering. A short shower is better than a bath in terms of its effect on the skin. Use a simple sorbolene-based barrier cream (Hydraderm is ideal) on the skin of your fistula arm prior to showering and immediately after drying. DO NOT use barrier cream with a Vaseline base perfume, or other additives - as some people are allergic (react) to these parts of the cream.

3 Make sure that you clean and cover any skin cuts or grazes that occur. Try to avoid picking or biting fingernails or the skin around the nails! If your skin becomes dry, red or damaged, obtain advice from your Doctor or Dialysis Nurse at your next visit. Simple Options for Itchy Skin Think about the general principles of skin care above and practice them - these can make a real difference to itchiness! Gently massage Hydraderm into an itchy area instead of scratching it. Consider trying Evening Primrose Oil capsules- these have natural skin fats in them which can help to replace lost skin oils, improving the skin s function. If these measures are unsuccessful, consult your Medical Practitioner or the Dialysis Nurse at your next visit. Collection of Staph Screening Swabs Most people in the community carry Staphylococcus aureus (Staph) in their nose and sometimes on their skin. Generally this does not cause any problems. Renal patients who have a Permacath, Vascath, fistula, graft or PD catheter are more likely to develop infections which can grow Staph if it is already on their body. We will be taking screening swabs from our patients and if they are carrying this bacteria, we will treat them accordingly to prevent this becoming a problem if an infection ever occurred.

4 Your pack will contain: 1. Two bacterial swabs 2. HAPS Request form: request is for Renal Staph Screening If a Nurse is taking the swabs, he or she will ensure the procedure is explained to you and that you have given consent. If you do not want to have a perineum swab taken, you may have just a groin swab taken. If this is unacceptable, then you may have just the nose swab alone. Clean your hands with Aqium gel or an antibacterial handwash such as Dettol first. Nose swab 1. Remove the transport medium cap and discard. 2. Take the swab and dip it into the tube of medium

5 3. Using the moistened swab, gently swab the anterior nostril in a circular motion, taking care not to insert too far. 4. Ensure that you have 5 seconds contact time with the inside mucosa, especially against the nose septum (the midline). 5. Swab each nostril in turn using the same swab. 6. Place the swab back into the transport tube and close firmly. Use a tissue to remove the residual moisture from the nose. Perineum swab 1. Remove trousers or skirt, leaving underwear in place. The swab can be sampled either standing or reclining on a bed. 2. Take the second swab and pre-moisten as for the nose swab 3. Swab from front to back starting in the area behind the scrotum in the male and below the vaginal entrance in the woman. The underwear needs to be moved slightly to one side whilst the swab is taken. 4. Place the swab back into the transport tube and close firmly.

6 5. Place both swabs into a Pathology Transport Bag with the request form 6. Clean your hands with Aqium gel or antibacterial handwash again. 7. Once completed, your swabs will need to be taken to the nearest HAPS collection centre. The closest centre to you will be listed on the back of the request form. Decolonisation for Staph Carriers Your recent pathology swabs were tested and showed that you are carrying a strain of Staphylococcus aureus (Golden Staph) that occasionally causes serious infection. At the present time this bacteria is just on your skin or in the nose and is not likely to cause an immediate problem. The treatment that you are to take should completely remove the Staph from your body for a period of several months. In around half of the people treated in this way, the Staph does not return for a long time. This reduces the chance of you getting a serious Staph infection.

7 If the initial treatment does not work, then you may need to be treated again. You will receive a Staph Pack which will contain the information required for your treatment (including a script to take to pharmacy). The Treatment 1. Where possible choose a period of 5 days in which to do the treatment when you will be uninterrupted by going away or other distractions. Purchase a new toothbrush and discard the old one. 2. Place a match head size dollop of Mupirocin (Bactroban ) ointment onto a cotton bud and massage gently around the inside of the nostril on one side, not going too deep. Repeat for other nostril. 3. Repeat this process three times each day for 5 days. 4. Apply antiseptic soap (such as Sapoderm ) or body wash (triclosan) in the shower every day of the program. 5. Take care to wash hair, under the arms and into the groins (see body wash instruction sheet).

8 Tablet Antibiotics: In some patients, tablet antibiotics are also given. This consists of two types of antibiotics, which are each taken twice a day for 5 days. Please make sure that all the tablets are taken. If you develop a reaction or become sick on the stomach while taking them, then make sure you contact your Dialysis service straight away. If you wear dentures, remove these every evening of the 5 days and clean them before leaving them to soak overnight in Steradent. Cleaning of home: On day 3 of treatment, spring clean your household, especially the bedroom. If possible, use a vacuum cleaner and vacuum the floors as well as soft furnishings such as lounges. Make sure to dust all surfaces also. Wash your clothes, pyjamas and bed linen on days 3 and 5 of the treatment; a hot wash with laundry detergent is best. Some patients will be seen in the MRSA clinic at the John Hunter Hospital also.

9 Body Wash Procedure It is most important that this procedure is performed correctly to ensure maximum effectiveness in reducing skin bacteria. Commence by thoroughly wetting your face and body in the shower or bath Using antiseptic soap or body wash, first wash your face. Special attention is needed around the area of your nose. DO NOT GET SOLUTION IN YOUR EYES

10 Using a sponge of flannel to apply soap, and working downwards, wash your armpits and navel thoroughly Working downwards cover all the important areas again, face and nose, armpits, navel, groin and buttocks. It is important that the entire body surface is washed but these areas identified require special attention After washing all these important areas, carefully and thoroughly rinse your body well When finished rinsing body well, wash your hair thoroughly with the same soap

11 Next, wash very well around the genital and anal region. It is especially important for man to wash well around the penis and under the scrotum. Equal care and attention is needed for the skin folds of the vulva in women Finally, rinse your body well and using a clean towel, dry yourself thoroughly. Clean clothes should then be worn

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