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Nasal Decolonization in Pre-Operative Protocols: An Antiseptic Alternative to Antibiotics

by Rosie D. Lyles, MD, MHA, MSc; Head of Clinical Affairs, Clorox Healthcare

The Burden of Surgical Site Infection

In today’s dynamic healthcare environment, preventing surgical site infections (SSIs) is one of the greatest challenges. SSIs continue to rank as one of the most common types of healthcare-associated infections1, and are associated with significant direct and indirect financial and emotional costs to healthcare facilities and to patients. The majority of SSIs are caused by Staphylococcus aureus (S. aureus),2 and patient colonization with S. aureus is a major risk factor for SSIs.2

Decolonization Strategies to Reduce SSIs

Patient decolonization prior to surgery may help to reduce the risk of SSIs.3,4 Preadmission bathing or showering with chlorhexidine gluconate (CHG) is most commonly used to cleanse the skin. For nasal decolonizataion, the antibiotic mupirocin (brand name Bactroban) applied by the patient to the anterior nares twice daily for the five consecutive days prior to surgery has typically been used. However, concerns that resistance to mupirocin and low compliance may lead to decolonization failure has prompted the search for non-antibiotic alternatives.

Povidone iodine can be an effective antiseptic alternative to mupirocin for nasal decolonization when used as part of preoperative bundle that includes CHG bathing. In patients undergoing orthopedic surgeries, povidone iodine is as effective as mupirocin for nasal decolonization,4 and a bundle including nasal decolonization with povidone iodine, CHG bathing and a CHG oral rinse resulted in lower rates of SSIs compared to patients not decolonized.3 Universal decolonization with CHG and povidone iodine has also been shown to be as clinically effective but more cost effective than screening and decolonization with CHG and mupirocin.5 Studies have also shown that bacteria do not develop resistance to povidone iodine.6

An Antiseptic Alternative

Clorox Healthcare™ Nasal Antiseptic Swabs are pre-saturated with a sterile povidone iodine gel and can be used for nasal decolonization. The swabs are applied by the healthcare provider one hour prior to surgery which can increase the likelihood of compliance. The gel reduces 99.4% of S. aureus at 1 hour and maintains persistence through 12 hours.7 In a safety and tolerance study, 96% of patients experienced no discomfort and were satisfied with the overall experience.8

An effective decolonization protocol that includes skin bathing and nasal decolonization has been demonstrated to be effective in reducing the risk of SSIs. Clorox Healthcare™ Nasal Antiseptic Swabs, are an antiseptic alternative for nasal decolonization that eliminates the risk and complexity of antibiotic usage.

For more information about nasal decolonization, visit www.CloroxHealthcare.com/NasalAntisepticSwabs

References

  1. Sievert DM et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009-2010. Infect Control Hosp Epidemiol. 2013 Jan;34(1):1-14.
  2. Kalmeijer MD et al. Nasal carriage of Staphylococcus aureus: Is a major risk factor for surgical-site infections in orthopedic surgery. Infect Control Hosp Epidemiol. 2000;21:319-323.
  3. Bode LG, Kluytmans JA,Wertheim HF, et al. Preventing surgicalsite infections in nasal carriers of Staphylococcus aureus. N Engl J Med 2010;362(1):9–17.
  4. Phillips M et al. Preventing surgical site infections: a randomized, open-label trial of nasal Mupirocin ointment and nasal povidone-iodine solution. Infect Control Hosp Epidemiol. 2014 Jul;35(7):826-32.
  5. Torres EG et al. Is Preoperative Nasal Povidone-Iodine as Efficient and Cost-Effective as Standard Methicillin-Resistant Staphylococcus aureus Screening Protocol in Total Joint Arthroplasty? J Arthroplasty. 2016 Jan;31(1):215-8.
  6. Lanker Klossner B et al. Nondevelopment of resistance by bacteria during hospital use of povidone-iodine. Dermatology. 1997;195 Suppl 2:10-3.
  7. Clorox Study #9550-005 (in vitro)
  8. The Clorox Services Company Study Number: 2015-002/2015-003.

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