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BACKGROUND
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.
METHODS
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.
RESULTS
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.
CONCLUSIONS
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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© 2019 Published by Elsevier Inc.
