THIS WEEK'S ARTICLES
Nasal Decolonization Helps Stop the Spread of MRSA
The technique is a simple way to lower infection rates.
A major cause of surgical site infections is Methicillin-resistant Staphylococcus aureus (MRSA). It is critical that your facility prevents its spread by applying topical antibiotics or antiseptics to the noses of patients before their operations.
"One of the key parts of MRSA prevention protocols is screening for those infected or carrying the pathogen, and decolonizing those who are," says Kevin T. Kavanagh, MD, MS, FACS, a healthcare policy researcher and patient safety advocate based in Lexington, Ky. "Some providers think this protocol should only be applied to certain patient groups — those undergoing joint replacements, for example — but by performing this surveillance on all patients, you are much more likely to prevent the spread of MRSA in your facility."
Nasal decolonization helps to reduce the number of pathogens in a patient's nose without the risk of antibiotic use. Utilizing a povidone-iodine solution is another viable solution. It is applied to patients' nostrils with a pre-moistened swab. A recent study in the Journal of Arthroplasty showed povidone-iodine solution effectively eliminated nasal S. aureus in over two-thirds of 429 joint replacement patients.
When possible, notes Dr. Kavanagh, operate on patients with MRSA infections or those who are carriers at the end of the day's schedule. "This way, the patient is the last case of the day and staff can take their time to perform a thorough terminal cleaning," he says. Screening and treating patients at pre-op visits before their surgery should be part of your facility's written protocol, he adds.
How One Facility Slashed Its SSI Rates
Utilizing nasal decolonization helped eliminate infections and saved this hospital hundreds of thousands of dollars.
Susan Franklin, RN, a retired infection preventionist at WellStar Cobb Hospital in Austell, Ga., wanted to test the impact nasal decolonization had on her hospital's hip and knee arthroplasty outcomes. She discovered was that this simple intervention not only improved the facility’s already low surgical site infection (SSI) rate, but it also resulted in more than $400,000 in avoided costs associated with treating post-op infections.
The average incidence of SSIs after total joint arthroplasty is 2% to 2.4%, while the average cost associated with a postoperative prosthetic joint infection is estimated to exceed $100,000. “As an infection preventionist, my goal is to reduce the number of hospital-acquired infections,” says Ms. Franklin.
By applying a nasal decolonization protocol, Ms. Franklin reports that the hospital’s total knee SSI rate declined from 0.36 to 0.00 per 100 procedures. The facility experienced similar results with total hip arthroplasties, lowering the SSI rate from 0.91 to 0.00 per 100 cases.
”The results of our study equate to the prevention of four total joint infections every year, an estimated associated total cost avoidance of more than $400,000 annually,” boasts Ms. Franklin. Her story is another indication that the miniscule cost of nasal decolonization can pay maximum dividends when applies consistently and correctly.
Putting Guidelines into Practice for Preoperative Nasal Decolonization
A successful program specific to your facility can be developed with education, resources and tools for SSI prevention and positive patient outcomes.
Nasal decolonization continues to be an ongoing hot topic in the ASC community as surgical teams around the country coordinate their efforts to keep patients safe during surgical experiences, no matter what the procedure or the facility's location. Education is an important way to learn how to reduce the chances of infections, which can lead to complications post-surgery.
Recently, PDI partnered with AORN to host a webinar about the impact of nasal decolonization on reducing skin flora and surgical site infections in two live AORN Hot Topic Virtual Forums on June 8 and June 17. "Nasal Decolonization: Who Nose the New Guidelines Best?" was a lively discussion with a special focus on the newly-released AORN Guideline for Preoperative Patient Skin Antisepsis as well as the benefits of PDI's Profend® Nasal Decolonization Kit.
Speakers Karen deKay, MSN, RN, CNOR, CIC, Perioperative Practice Specialist at AORN, Deva Rea, MPH, BSN, RN, CIC, Clinical Science Liaison at PDI and Marc-Oliver Wright, MT (ASCP), MS, CIC, FAPIC, Clinical Liaison at PDI, presented the attendees important information and practical tips on how to navigate risk-based decisions for developing preoperative nasal decolonization programs at their facilities.
The lively virtual forums reminded attendees why decolonization is so significant as part of an SSI prevention program and offered advice on how to implement a program at their own surgery facilities.
Every location in the country and each surgery center will have different needs, so their administrators will want to customize their program and protocols. Based on the updated AORN Guideline for Preoperative Patient Skin Antisepsis, released in May 2021 (Book publication release in 2022), the risk factors and specific needs of certain populations need to be considered. Screening for resistance, for example, and studies of the local patient population are encouraged. The PDI speakers offered specific advice about the timing and protocols that would make a nasal decolonization program effective. This included having it become a standing physician order, with no prescription needed, or making it part of a regular nurse-driven protocol.
Deva and Marc-Oliver both defined the elements for successful product implementation and demonstrated that Profend® swabsticks work for all decolonization strategies, including Universal and Targeted. Apply before any type of surgery. Profend® nasal decolonization swabs kill S. aureus immediately and continue protecting for 12 hours achieving 99.9% reduction.1 The 60 second Profend® nasal decolonization swab application is a simple part of the surgical or ICU routine.
Since educating the OR team is so important, PDI offers educational support for the healthcare team through onsite/virtual training, an online training module video, as well as a written Profend® Nasal Decolonization Kit IFU. Each facility can plan for its own protocols as they train staff, integrate a nasal decolonization program into the workflow, and monitor the results. Ultimately, it's the positive patient outcomes that count the most in the long run as patient safety and infection prevention are key for a nasal decolonization program's success.
1. PDI in vivo Study PDI-0113-CTEV01.
Study Finds Povidone-Iodine Effective in Reducing COVID-19 Infection
The nasal antiseptic plays important role in diminishing viral transmission.
While transmission reduction of the COVID-19 virus has long focused on the use of personal protective equipment and face masks, a recent study recommends intranasal use of povidone-iodine among both patients and healthcare workers alike.
Povidone-iodine has proven in vitro efficacy against SARS-CoV and Middle East Respiratory Syndrome at concentrations as low as 0.23%, note the study authors, who published their results in JAMA Otolaryngology-Head & Neck Surgery. They say in vitro efficacy of an oral povidone-iodine antiseptic solution was recently demonstrated specifically against SARS-CoV-2 at concentrations as low as 0.5% for contact times as short as 15 seconds. "These findings are consistent with those of a previous study investigating efficacy of an oral solution in the same class of [povidone-iodine] antiseptics against SARS-CoV-2," the authors wrote.
They added that clinical studies have shown that lower concentrations of povidone-iodine can be administered over a period of months with no undesirable effects. "Repeated use of dilute 0.08% [povidone-iodine] every other day in patients with chronic rhinosinusitis for up to seven weeks did not result in any adverse effects on mucociliary clearance or olfaction," note the authors. When PVP-I is administered intranasally in humans, the formulation dilutes effectively and immediately combines with existing nasal secretions," they say.
The study says that widespread use of povidone-iodine nasal antiseptic in patients prior to intranasal procedures could significantly decrease risk of virus transmission via droplet and aerosol spread. The authors also suggest healthcare professionals consider instructing patients to perform nasal decontamination with povidone-iodine prior to presenting for procedures in order to further decrease intranasal viral load and prevent spread in waiting areas and other common areas.
Assistant College Professor Improves Delivery of Antiseptic Nasal Spray
Proper positioning of bottle could help prevent the spread of COVID-19.
South Dakota State University assistant professor Saikat Basu, PhD, recently paid a visit to his family in India, which has been hit hard by COVID. As a result of the trip, the Department of Mechanical Engineering faculty member devised a method to improve the delivery of an antiseptic nasal spray that can help reduce the risk of infection.
Dr. Basu studied how aerosols are transported, including virus-carrying droplets, in the human respiratory tract. "To become infected, you must first inhale the virus, so inhalation patterns are important," he told the Brookings (S.D.) Register. From there, he developed a template that uses breathing rates to track which droplet sizes are likely to reach the nasopharynx. Funded by the National Science Foundation, Dr. Basu also collaborated with Boston University and Fractal Therapeutics in Cambridge, Mass.
"The project determined that the spray bottle must be held in a near-horizontal position to deliver the virus-fighting povidone-iodine solution into the nasopharynx," says Dr. Basu, who noted the antiseptic's use as an antimicrobial for more than 20 years. Getting the spray to the nasopharynx is critical, he says, because the ciliated cells that line the nasopharynx contain a surface receptor known as ACE2, which the novel coronavirus uses to enter them. "From there, the infection spreads into the lungs," he says.
Dr. Basu says there is "growing experimental evidence that the povidone-iodine solution works against SARS-CoV-2," the virus that causes COVID-19. He is recommending this prevention technique to those who are hesitant about or unable to be vaccinated. His proposed dose is three squirts of spray in each nostril "before you are likely to be exposed" as well as just after any possible exposure.