Perioperative participation of orthopedic patients and surgical staff in a nasal decolonization intervention to reduce Staphylococcus spp surgical site infections

Abstract

With the goal of reducing rates of surgical site infections in our spine patients, we initiated a trial to investigate the impact of adding perisurgical nasal decolonization involving patients and surgical and nursing staff. We combined immediate presurgical application of a nonantibiotic alcohol-based nasal antiseptic with existing chlorhexidine bath or wipes in a comprehensive pre- and postoperative decolonization protocol. Mean infection rates were significantly decreased by 81% from 1.76 to 0.33 per 100 surgeries during the 15-month trial, when compared with the prior 9-month baseline.

Clinical Issues—September 2017

“…An alternative to nasal decolonization is the use of an antiseptic such as 5% povidone‐iodine 13,16‐18 or an alcohol‐based antiseptic (eg, 70% ethanol) 19,20 . Use of an antiseptic may be advantageous for universal decolonization because there is less concern for antibiotic resistance.…”

“…Alcohol‐based nasal antiseptics also may be an option for nasal decolonization. Mullen et al 19 investigated a universal decolonization protocol of alcohol‐based nasal antiseptic and CHG bathing in patients undergoing spine surgery. This study protocol also included nasal decolonization of surgical and nursing personnel.…”

“…The study patients and their family members were encouraged to continue the nasal alcohol‐based antiseptic application postoperatively for five to seven days. Researchers found that mean infection rates were reduced 81% when compared with the baseline period before the intervention 19 . In another study on alcohol‐based nasal antiseptics, Steed et al 20 found that S aureus and total bacterial carriage were effectively reduced in health care personnel who underwent nasal decolonization with the nasal antiseptic.…”

Transmission of methicillin‐resistant Staphylococcus aureus in an acute care hospital in Japan

“…Methicillin‐resistant S. aureus infections typically occur in individuals who are colonized with MRSA . Implementing contact precautions for MRSA carriers is essential for preventing healthcare‐associated infections.…”

General Assembly, Prevention, Operating Room - Personnel: Proceedings of International Consensus on Orthopedic Infections

“…By introducing these precautionary measures, the SSI rates dropped from 5.9% to 3.0%, the MRSA infection rates from 1.2% to 0.3%, and the MRSA PJI rates from 9.7% to 1.0%. Mullen et al [89] implemented a decolonization protocol of colonized staff and patients and reported a decreased rate of SSIs from 1.76% to 0.33%. Despite reporting the highest staff colonization rates (31% of theater staff), Portigliatti Barbos et al [94] showed a reduction of the already low SSI rates of 0.6% to 0% after a 5-day decolonization course of intranasal mupirocin ointment for affected orthopedic surgical team members.…”