In hospitals, patients preparing to undergo surgery are often given a skin cleanser called chlorhexidine to use at home and again in the operating room to kill bacteria on the skin, reducing the risk of being infected with methicillin-resistant Staphylococcus aureus, or MRSA, during surgery.

Dr. L. Silvia Munoz-Price, infectious disease specialist with Medical Specialists in Munster, says chlorhexidine should get more attention as an effective way of containing the spread of MRSA in the community setting. When used appropriately, she says chlorhexidine can make a longer-term impact as far as widespread decolonization of the bacteria.

Some physicians do advise patients with previous cases of MRSA to buy the over-the-counter product -- a common brand is Hibiclens -- and use it to prevent recurrences of the infection, but Munoz-Price says that many well-intentioned physicians fail to tell patients how to use it correctly for long-term impact.

The label tells users to put it on and rinse it off after a minute or two, which Munoz-Price says is appropriate before surgery. But when it comes to decolonizing individuals to reduce the overall spreadability factor of MRSA, these instructions don't work very well and the product simply needs to be left on longer and not rinsed off.

"For the purpose that we want, which is longer term usage and to decrease the number of bacteria over longer periods of time ... you need to leave chlorhexidine on the skin," she says. "If you rinse it off, you are getting rid of most of the activity. It acts over several hours."

So why doesn't the Food and Drug Administration back this advice and change the labeling? Not because it's bad advice, Munoz-Price says, but because there simply haven't been clinical studies done at the community level that are necessary for the FDA to back the claim.

Munoz-Price had hoped to conduct a study by screening kids at area schools to determine the percentage of MRSA carriers in an effort to learn if chlorhexidine would be an effective preventive measure, but the schools declined to open that Pandora's box.

"We were hoping to look further into the success or not of chlohexidine in a widespread population," she says.

Still, from her experience and knowledge that patients in ICUs and long-term facilities do tolerate chlorhexidine for longer periods of time with no complications, Munoz-Price tells her patients to follow her instructions for decolonization instead.

In short, that means doubling the antiseptic with tap water and applying to clean skin and allow to dry. She says not to rinse off the solution. This should be repeated daily for two weeks, tapering off to once a week and repeated if boils recur again. At the same time, she advises using an over-the-counter intranasal bacitracin, applying to both nostrils twice a day for up to seven days.

Children younger than 1 year and breastfeeding or pregnant women should not use the product.

Munoz-Price says the most bothersome side affect of the antiseptic is skin dryness, and individuals with eczema may not be able to tolerate it. If moisturizers are used to hydrate skin, though, she says be sure the products do not contain lauryl sulfate because it will inactivate chlorhexidine.

Other healthcare providers urge more discretion, emphasizing this is not a preventive measure to be used by the general public without a physician's guidance and certainly never in lieu of frequent hand washing and overall good hygiene practices.

"They are going to have to work with the doctor and have this treatment prescribed for them," says Mary Tipton, infection control coordinator at St. Margaret Mercy Healthcare Center in Dyer. "It's not something they can run out and buy for themselves and do at home. If they know they are colonized they should be working with a physician and have the treatment ordered for them."