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Background
Preventing surgical site infections (SSI) is more important than ever, as the number
and complexity of procedures, the co-morbidities of the patients and antimicrobial
resistant pathogens are all increasing over time. Additionally, it has been estimated
that as many as half of all SSI are preventable when evidence-based strategies are
applied. Given this, one of 7 hospitals in a multihospital system in Florida, planned
a trial of universal pre-operative nasal and skin decolonization for all surgical
procedures.
Methods
During the trial an alcohol based nasal antiseptic was applied to all pre-operative
patients in addition to chlorhexidine bathing already in place, for a period of 6
months. This nasal antiseptic was selected over other nasal decolonizing agents in
support of staff satisfaction and antibiotic stewardship goals. Electronic medical
record (EMR) audits were performed to confirm compliance with this new protocol. In
addition, a staff satisfaction survey was distributed. No other practice change was
introduced during this period.
Results
During the 6-month study period, the addition of pre-operative nasal antiseptic to
existing CHG bathing for all surgical patients, resulted in a 59% reduction in all
cause surgical site infections (SSI) for all procedures, from an average monthly baseline
rate of 0.61 to an average monthly rate of 0.25. This reduction represents 22 fewer
SSI with an associated estimated cost avoidance of $457,270 ($20,785/infection). The
staff survey revealed that 86% of respondents were very or extremely satisfied with
efficacy and ease of use of the product, and >80% preferred the nasal antiseptic over
mupirocin.
Conclusions
Universal preoperative nasal decolonization with alcohol-based nasal antiseptic, paired
with CHG bathing, led to a reduction in the SSI rate and associated costs, while supporting
antimicrobial stewardship and increasing staff satisfaction.
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Copyright
© 2020 Published by Elsevier Inc.
