Soap and water or more aggressive antibacterials (e.g., chlorhexidine) are effective at reducing skin bacterial colonization. The effectiveness of these measures has not been tested specifically for limiting the spread of impetigo, but this approach seems a sensible way of preventing contagious spread. There is good evidence that such hygiene measures are effective for the fomite spread component of respiratory infections.[19]Jefferson T, Dooley L, Ferroni E, et al. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database Syst Rev. 2023 Jan 30;1(1):CD006207.
https://www.doi.org/10.1002/14651858.CD006207.pub6
http://www.ncbi.nlm.nih.gov/pubmed/36715243?tool=bestpractice.com
[20]Luby SP, Agboatwalla M, Feikin DR, et al. Effect of handwashing on child health: a randomised controlled trial. Lancet. 2005 Jul 16-22;366(9481):225-33.
http://www.ncbi.nlm.nih.gov/pubmed/16023513?tool=bestpractice.com
Nasal colonization with Staphylococcus aureus and recurrent infections with this bacterium can be eliminated by applying topical antibiotics (e.g., mupirocin) to the nares.[21]Scully BE, Briones F, Gu JW, et al. Mupirocin treatment of nasal staphylococcal colonization. Arch Intern Med. 1992 Feb;152(2):353-6.
http://www.ncbi.nlm.nih.gov/pubmed/1739366?tool=bestpractice.com
[22]Raz R, Miron D, Colodner R, et al. A 1-year trial of nasal mupirocin in the prevention of recurrent staphylococcal nasal colonization and skin infection. Arch Intern Med. 1996 May 27;156(10):1109-12.
http://www.ncbi.nlm.nih.gov/pubmed/8638999?tool=bestpractice.com
This approach is applicable to both affected individuals and close family members (who may be affected or only have nasal bacterial colonization).
Contact should be avoided with infected patients. This practice is implemented by many schools as they exclude children from attending until the affected child no longer has crusty or bullous lesions, i.e, their infection is resolved. While evidence for contact avoidance is not strong with impetigo, extrapolation from other disease containment strategies can be used to support this approach.[19]Jefferson T, Dooley L, Ferroni E, et al. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database Syst Rev. 2023 Jan 30;1(1):CD006207.
https://www.doi.org/10.1002/14651858.CD006207.pub6
http://www.ncbi.nlm.nih.gov/pubmed/36715243?tool=bestpractice.com
[20]Luby SP, Agboatwalla M, Feikin DR, et al. Effect of handwashing on child health: a randomised controlled trial. Lancet. 2005 Jul 16-22;366(9481):225-33.
http://www.ncbi.nlm.nih.gov/pubmed/16023513?tool=bestpractice.com
Zinc supplementation in pregnant women with potential malnutrition in developing countries has been shown to almost halve the rate (from approximately 20% to 10%) of impetigo in infants under 6 months of age.[23]Darmstadt GL, Osendarp SJ, Ahmed S, et al. Effect of antenatal zinc supplementation on impetigo in infants in Bangladesh. Pediatr Infect Dis J. 2012 Apr;31(4):407-9.
http://www.ncbi.nlm.nih.gov/pubmed/22189527?tool=bestpractice.com