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(567) Does Universal Nasal Decolonization with an Alcohol-Based Nasal Antiseptic Reduce Infection Risk and Cost?


Scott Arden, RN, BSN – Infection Prevention Practitioner, AdventHealth North Pinellas


Presenting Author: Scott Arden, RN, BSN – Infection Prevention Practitioner, AdventHealth North Pinellas


Background : Nasal decolonization with mupirocin to reduce infection risk, has been associated with mupirocin resistant Staphylococcus aureus (SA).  A community hospital identified two patients colonized with methicillin and mupirocin resistant SA (MRSA), one scheduled for surgery, one for inpatient IV antibiotic therapy. Instead of mupirocin, an alcohol based nasal antiseptic was applied to these patients twice daily for 5 days, resulting in a negative MRSA nasal screening test in both patients. Neither patient developed an infection during or after treatment.  Building on this success, a plan was made to assess the impact of universal nasal decolonization to replace screening and contact precautions for MRSA colonized patients, and to reduce surgical site infections (SSI).

Methods : A 12-month project using a before and after design, was initiated in April 2018.  The project involved twice daily application of alcohol based nasal antiseptic for all inpatients, and preoperatively for all surgical patients in addition to existing preoperative chlorhexidine bathing. No other practice change was made during this period. Assessment of impact was planned by comparing incidence of MRSA bacteremia and SSI at baseline (2017) and after project implementation, in addition to costs avoided with reduction of nasal screening and CP.

Results : Compared to baseline, between April 2018 and March 2019, there was a decrease in MRSA bacteremia from 3/1,000 patient days to 0/1,000 patient days, a reduction in CP from 3.78 to 1.53/1,000 patient days, a reduction in nasal screens from 3,874 to 605, and a reduction of all cause (Gram negative and Gram positive) SSI after all surgical procedures from 3/4,313 procedures to 0/4,872 procedures. After accounting for the cost of the nasal antiseptic, the reduction in gowns, gloves and nasal screening tests resulted in $104,099.91costs avoided.

Conclusion : House-wide application of alcohol-based nasal antiseptic in place of screening and contact precautions, resulted in a reduced incidence of both MRSA bacteremia and SSI for all types of surgical procedures, in addition to significant costs avoided. 

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