orm_june-2024 - 6

Antiseptic nasal decolonization noses ahead
STERILIZATION & INFECTION PREVENTION
O
ver 20 years ago, an article from
Johns Hopkins published in The
New England Journal of Medicine
showed that Staphylococcus aureus
decolonization of the nares can
decrease risk of surgical site infections
(SSI). Since then, nasal decolonization-the
application of a topical antimicrobial
or antiseptic agent to the
nares-has been adopted as a wellregarded
infection prevention practice.
And with upwards of 70% to 95% of all
SSIs originating in the microbiome of
the patient's own skin or nares, it is no
wonder that medical professionals are
embracing this easy, low-risk approach
to reduce the risk of healthcare-associated
infections (HAI).
Backed by 3 decades of evidence,
nasal decolonization is recommended by
organizations including the Centers for
Disease Control and Prevention (CDC),
AORN, and the Society for Healthcare
Epidemiology of America, which categorizes
it as essential practice. However,
some debate has arisen around the
various products available-particularly
mupirocin, an antibiotic and historically
the most common solution, versus the
newer povidone-iodine, an antiseptic.
Either option can effectively shield
patients from potentially dangerous infections.
Yet in an era of increasing microbial
resistance and increasing costs
for care, the case for antiseptic treatment
is growing stronger.
Deciding factors
Research into the comparative benefits
and limitations of mupirocin and povidone-iodine
is ongoing. For example,
one recent study showed mupirocin
could be more effective in the intensive
care unit (ICU). In short, there is
no one-size-fits-all solution to infection
prevention. It is increasingly important
for organizations to consult experienced
clinical teams about the best processes
and practices for a particular facility.
However, patients often must pay
out-of-pocket for mupirocin. This treat6
OR
Manager | June 2024
The ambulatory difference
Povidone-iodine nasal decolonization
is particularly attractive for ambulatory
surgery centers (ASCs). After all, the
60-second disinfection window undeniably
reduces the risk of SSIs while
aligning with the fast pace of the ASC
setting.
Additionally, evidence of povidoneiodine's
efficacy is unlikely to change
in the nonacute space. This is a critical
concern because the number of surgical
procedures performed in nonacute care
ment also requires a high degree of
patient compliance, with 5 days of twicedaily
ointment application needed to be
fully effective. Additionally, recent research
is concerning for medical professionals
who embrace antimicrobial stewardship.
One recent study showed mupirocin
tolerance increasing by up to 65%
among all strains of methicillin-resistant
Staphylococcus aureus (MRSA) isolated
from patients in a 625-bed public teaching
hospital. Even in the absence of
resistance or patient compliance issues,
nasal decolonization with mupirocin can
fail up to 26% of the time.
In contrast, povidone-iodine has not
been shown to increase microbial tolerance
(often mistakenly termed " resistance " ).
It is also easier to apply than
antibiotics. Rather than relying on patients
to self-administer the treatment,
clinicians apply the product immediately
before a procedure-affording similar
efficacy in minutes rather than days. In
fact, Duke Raleigh Hospital investigators
recently found a 60% reduction in
elective orthopedic patients who developed
SSIs with the use of a 10%
povidone-iodine nasal antiseptic agent.
In light of the evidence, CDC guidelines
suggest povidone iodine is a viable
alternative to mupirocin for preventing
infection. AORN recommends utilizing an
interdisciplinary team to establish facility
protocols for decolonization, but those
using mupirocin should " include surveillance
for antibiotic resistance. "
BY MARC-OLIVER WRIGHT
settings has grown significantly over the
past quarter century. According to a recent
market research report, more than
65% of procedures occur in an ASC. As
a result of this growth, medical professionals
have sought out ways to transition
traditional infection prevention
practices to these high-volume, timesensitive
environments-often with a
lack of demonstrated evidence that they
will succeed in ambulatory settings.
Yet, it is important to note that the
risk of SSIs is incurred at an individual
patient level. The patient's colonized
state will not vary depending on the setting
of the surgical procedure. Although
not every practice will readily transfer
to the ASC space, translating universally
accepted truths in infection prevention-such
as hand hygiene or, in this
case, nasal decolonization-does not
require reinventing the wheel.
Patient resistance, COVID-19
The COVID-19 pandemic has also made
its mark on the practice of nasal decolonization-fortunately,
for the better.
Prior to 2020, patient resistance
was a major roadblock to the efficacy
of nasal decolonization. But having already
experienced the mild discomfort
of swabbing for a COVID-19 test given
pandemic precaution measures, many
patients are now more comfortable with
the process. Also, clinician-administered
povidone-iodine swabs are applied
lower in the nares-a factor that
could reduce patient apprehension. In
the case of at-home mupirocin decolonization,
patients should be familiar with
the comparable steps of home COVID19
tests.
Still, patient education is essential
to overcoming these challenges. Clinicians
should continue to inform patients
about the " why " behind nasal
decolonization, the importance of presurgical
infection prevention, and, for
mupirocin, the steps to self-administer
the treatment.
www.ormanager.com
http://www.ormanager.com

orm_june-2024

Table of Contents for the Digital Edition of orm_june-2024

orm_june-2024 - 1
orm_june-2024 - 2
orm_june-2024 - 3
orm_june-2024 - 4
orm_june-2024 - 5
orm_june-2024 - 6
orm_june-2024 - 7
orm_june-2024 - 8
orm_june-2024 - 9
orm_june-2024 - 10
orm_june-2024 - 11
orm_june-2024 - 12
orm_june-2024 - 13
orm_june-2024 - 14
orm_june-2024 - 15
orm_june-2024 - 16
orm_june-2024 - 17
orm_june-2024 - 18
orm_june-2024 - 19
orm_june-2024 - 20
orm_june-2024 - 21
orm_june-2024 - 22
orm_june-2024 - 23
orm_june-2024 - 24
orm_june-2024 - 25
orm_june-2024 - 26
orm_june-2024 - 27
orm_june-2024 - 28
https://www.nxtbook.com/accessintelligence/ORManager/orm_july-2024
https://www.nxtbook.com/accessintelligence/ORManager/orm_june-2024
https://www.nxtbook.com/accessintelligence/ORManager/orm_may-2024
https://www.nxtbook.com/accessintelligence/ORManager/ormc_brochure_march-2024
https://www.nxtbook.com/accessintelligence/ORManager/orm_april-2024
https://www.nxtbook.com/accessintelligence/ORManager/orm_asc_march-2024
https://www.nxtbook.com/accessintelligence/ORManager/orm_march-2024
https://www.nxtbook.com/accessintelligence/ORManager/orm_february-2024
https://www.nxtbook.com/accessintelligence/ORManager/orm_january-2024
https://www.nxtbook.com/accessintelligence/ORManager/orm_november-2023
https://www.nxtbook.com/accessintelligence/ORManager/orm_october-2023
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-september-2023
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-august-2023
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-july-2023
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-june-2023
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-may-2023
https://www.nxtbook.com/accessintelligence/ORManager/ormc-brochure-march-2023
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-april-2023
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-march-2023
https://www.nxtbook.com/accessintelligence/ORManager/orm-february-2023
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-january-2023
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-november-december-2022
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-october-2022
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-september-2022
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-august-2022
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-july-2022
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-june-2022
https://www.nxtbook.com/accessintelligence/ORManager/ormc-brochure-may-2022
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-may-2022
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-april-2022
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-march-2022
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-february-2022
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-january-2022
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-november-december-2021
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-october-2021
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-september-2021
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-august-2021
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-july-2021
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-june-2021
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-may-2021
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-April-2021
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-march-2021
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-february-2021
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-january-2021
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-december-2020
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-october-2020
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-september-2020
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-august-2020
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-july-2020
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-june-2020
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-may-2020
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-april-2020
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-march-2020
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-february-2020
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-january-2020
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-december-2019
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-november-2019
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-october-2019
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-september-2019
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-august-2019
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-july-2019
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-june-2019
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-may-2019
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-april-2019
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-march-2019
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-february-2019
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-january-2019
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-december-2018
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-november-2018
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-october-2018
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-september-2018
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-august-2018
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-july-2018
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-june-2018
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-may-2018
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-april-2018
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-march-2018
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-february-2018
https://www.nxtbook.com/accessintelligence/ORManager/or-manager-january-2018
https://www.nxtbookmedia.com