Impacts of Coordinated, Hospital-wide Use of Alcohol-based Nasal Decolonization on Infection Rates, Patient Care and Cost Savings

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      To optimize infection rate reduction and increase safety and quality of care in our patients, in April 2016 we initiated a two-phase process to unify Infection Prevention (IP) protocols involving nasal decolonization across our 311-bed Community Hospital. Trial of an alcohol-based nasal decolonizing antiseptic in orthopedic, spine, and breast surgeries transitioned to its use in all surgeries by June 2017. In the second phase, begun in April 2017, alcohol-based nasal decolonization of all adult in-patients was initiated.


      In the year prior to the trial, surgical IP included pre-/post-operative chlorhexidine gluconate (CHG) bathing and pre-operative nasal decolonization with povidone iodine. By June 2017, surgical protocol changes were completed, in which pre-operative iodine was replaced by pre-/post-operative alcohol-based nasal decolonization. Starting in April 2017, all adult inpatients and new admissions received daily nasal decolonization and contact precautions (CP) for methicillin-resistant Staphylococcus aureus (MRSA)-colonized patients were discontinued. Decolonization compliance was monitored through the pre-op checklist and daily work-list.


      In the 17 months following replacement of pre-operative iodine with pre- and post-operative alcohol-based antiseptic starting in June 2017, Staphylococcus aureus surgical site infection (SSI) rates decreased by 50.7% from 0.148/100 to 0.073/100 (P = 0.08), compared to the one-year pre-replacement baseline. In the 19 months following hospital-wide in-patient nasal decolonization, CP use decreased by 39%, while maintaining low rates of MRSA bacteremia. Work-list audits of nasal antiseptic compliance in May-June 2017 and January 2018 showed rates of 96% and 97%, respectively. Annualized savings of $223,150, net of decolonization costs, were estimated from CP, screening and SSI cost reductions.


      Hospital-wide use of the alcohol-based nasal decolonizing agent to reduce the risk of nasal carriage-associated infections resulted in SSI rate reduction beyond the prior iodine-based protocol and improved nursing-care patient accessibility and cost-savings through reduction in CP use.
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