Staphylococcus aureus (S. aureus) is a leading cause of hospital-acquired infections. These infections are difficult to treat when there is evolved resistance to penicillin, known as meticillin-resistant Staphylococcus aureus (MRSA). Patients who carry S. aureus in the nose and skin are prone to developing infections and many patients admitted to hospital are routinely decolonised to reduce this risk. The current standard treatment for nasal decolonisation is the antibiotic nasal mupirocin. There are concerns about over-reliance on a single treatment and the risk of mupirocin resistant MRSA. Robust evidence for alternatives to mupirocin is required.

We aim to investigate whether there are effective and cost-effective alternatives to mupirocin for early nasal decolonisation of MRSA amongst adult hospital in-patients.

The objectives are to undertake:

(i) A multi-centre, three-arm parallel group, non-inferiority randomised controlled trial to determine whether nasal polyhexanide gel (an antiseptic) or chlorhexidine with neomycin cream (an antibiotic) plus chlorhexidine body wash is not inferior to nasal mupirocin ointment plus chlorhexidine body wash for early nasal decolonisation of MRSA amongst adult hospital in-patients. (ii) A 9-month internal pilot to confirm trial feasibility (iii) An analysis of secondary outcomes (iv) A cost-effectiveness analysis of the three interventions from the NHS perspective

Main Funding Body