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Alcohol-based Nasal Antiseptic as Part of a Bundle to Reduce the Incidence of Contact Precautions and Surgical Site Infections

Heather Stegmeier, MSN, RN, CIC – Manager of Infection Prevention and Control, AdventHealth Wesley Chapel


Background :

A 145 bed hospital embarked on a 12-month project to reduce contact precautions (CP) for colonized methicillin resistant Staphylococcus aureus (MRSA) patients, and to reduce surgical site infections (SSI) for orthopedic patients.  Prior to the project all high-risk patients were screened using nasal polymerase chain reaction (PCR) test for MRSA, and if positive, placed on CP.  Orthopedic surgical patients were also screened for MRSA, and if positive, received preoperative chlorhexidine (CHG) bath and nasal mupirocin.

Methods :

Starting in January 2017, all high-risk patients received twice daily alcohol-based nasal antiseptic and a daily chlorhexidine (CHG) bath, in place of targeted screening and CP. In addition, an SSI prevention bundle was instituted, comprised of alcohol-based nasal antiseptic in place of mupirocin, retraining perioperative staff on skin preparation, and UV-C disinfection added to manual cleaning in the operating room. Preoperative CHG bathing was already in place and was continued. During this period, there was a total of 868 orthopedic surgery patients.  Patients who remained in the hospital post-operatively received twice daily nasal antiseptic and daily CHG bathing.

Results :

There was a reduction in the incidence of CP from 16% to 10% per day, while maintaining a rate of zero MRSA bacteremia.  Reduction of gloves, gowns and nasal PCR tests, resulted in an estimated total cost reduction of $200,000. Additionally, there was a statistically significant reduction in total hip SSI from a 2016 baseline of 1.15 infections per 100 procedures to 0.017 infections per 100 procedures (98% reduction, p = 0.014.), and the rate of zero SSI in total knee replacement patients was maintained.

Conclusion :

Universal decolonization in place of targeted screening and CP forcolonized MRSA patients, reduced costs without increasing MRSA bacteremia. Replacement of mupirocin with a nasal alcohol-based antiseptic, as one component of an SSI prevention bundle, resulted in a marked reduction in SSI after total hip procedures.

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