Reduction of nasal Staphylococcus aureus carriage in health care professionals by treatment with a nonantibiotic, alcohol-based nasal antiseptic

Steed, Lisa L.; Costello, Justin E.; Lohia, Shivangi; Jones, Taylor C.; Spannhake, E. W.; Nguyen, Shaun A.

doi:10.1016/j.ajic.2014.04.008

Cited by 40 publications

(28 citation statements)

References 19 publications

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“…Most alcoholbased hand antiseptics contain either isopropanol or ethanol (86). Steed et al (87) recently published a double-blinded, placebocontrolled RCT testing the effectiveness of an alcohol-based nasal antiseptic in reducing S. aureus nasal colonization in colonized health care workers. Health care workers testing positive for nasal S. aureus colonization were treated three times during the day with a nasal alcohol-based antiseptic or placebo.…”

Section: Alcohol-based Nasal Antisepticmentioning

confidence: 99%

Decolonization in Prevention of Health Care-Associated Infections

2016

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SUMMARYColonization with health care-associated pathogens such asStaphylococcus aureus, enterococci, Gram-negative organisms, andClostridium difficileis associated with increased risk of infection. Decolonization is an evidence-based intervention that can be used to prevent health care-associated infections (HAIs). This review evaluates agents used for nasal topical decolonization, topical (e.g., skin) decolonization, oral decolonization, and selective digestive or oropharyngeal decontamination. Although the majority of studies performed to date have focused onS. aureusdecolonization, there is increasing interest in how to apply decolonization strategies to reduce infections due to Gram-negative organisms, especially those that are multidrug resistant. Nasal topical decolonization agents reviewed include mupirocin, bacitracin, retapamulin, povidone-iodine, alcohol-based nasal antiseptic, tea tree oil, photodynamic therapy, omiganan pentahydrochloride, and lysostaphin. Mupirocin is still the gold standard agent forS. aureusnasal decolonization, but there is concern about mupirocin resistance, and alternative agents are needed. Of the other nasal decolonization agents, large clinical trials are still needed to evaluate the effectiveness of retapamulin, povidone-iodine, alcohol-based nasal antiseptic, tea tree oil, omiganan pentahydrochloride, and lysostaphin. Given inferior outcomes and increased risk of allergic dermatitis, the use of bacitracin-containing compounds cannot be recommended as a decolonization strategy. Topical decolonization agents reviewed included chlorhexidine gluconate (CHG), hexachlorophane, povidone-iodine, triclosan, and sodium hypochlorite. Of these, CHG is the skin decolonization agent that has the strongest evidence base, and sodium hypochlorite can also be recommended. CHG is associated with prevention of infections due to Gram-positive and Gram-negative organisms as well asCandida. Conversely, triclosan use is discouraged, and topical decolonization with hexachlorophane and povidone-iodine cannot be recommended at this time. There is also evidence to support use of selective digestive decontamination and selective oropharyngeal decontamination, but additional studies are needed to assess resistance to these agents, especially selection for resistance among Gram-negative organisms. The strongest evidence for decolonization is for use among surgical patients as a strategy to prevent surgical site infections.

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Section: Alcohol-based Nasal Antisepticmentioning

confidence: 99%

Decolonization in Prevention of Health Care-Associated Infections

2016

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“…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.…”

Section: Continuing Education: Clinical Issuesmentioning

confidence: 99%

“…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. Additional research is needed to evaluate the effects of personnel nasal decolonization and postoperative patient and caregiver nasal decolonization on the patient's SSI outcomes.…”

Section: Continuing Education: Clinical Issuesmentioning

confidence: 99%

“…10 An alternative to nasal decolonization is the use of an antiseptic such as 5% povidone-iodine 13,[16][17][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. Torres et al 16 found that universal application of 5% povidone-iodine in conjunction with preoperative CHG bathing was cost-effective and showed no difference in infection rates when compared with a targeted protocol that included preoperative S aureus screening, nasal mupirocin, and CHG bathing.…”

Section: Answermentioning

confidence: 99%

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Clinical Issues—September 2017

Wood¹

2017

AORN Journal

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Performing Staphylococcus aureus decolonization for urgent procedures Key words: decolonization, Staphylococcus aureus, MRSA, MSSA, mupirocin. Hand hygiene before donning gloves Key words: hand hygiene, glove, personal protective equipment. Hand hygiene before skin prep Key words: hand hygiene, skin prep, sterile task, aseptic task. Scrubbing by stroke versus timed method Key words: surgical hand rub, surgical scrub, stroke method, timed method.

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“…A significant source of nosocomial infection was proposed to be the nasal carriage of S. aureus among the health care personnel. The carriage rates were found to vary from 20-40% [4,5].…”

Section: Introductionmentioning

confidence: 99%