to self-administer mupirocin twice a day for 5 days and shower with
chlorhexidine for 5 days.
"Would you rather self-administer nasal mupirocin twice a day for
5 days or have a nurse administer [povidone iodine] within 2 hours
of surgery?" asks Ms. Schmidt, now the clinical nurse leader at the
Portland VA. "The outcomes are about the same. That's why no one's
using the mupirocin protocol."
Research supports Ms. Schmidt's views of the antibiotic-based anti-
septic. One study found that a single treatment of nasal PI yields supe-
rior results to 7 to 10 mupirocin treatments over 5 days. Another
found that PI is less expensive than nasal mupirocin, with comparable
SSI outcomes.
Keep it simple
Ms. Schmidt knew she had to design a decolonization protocol that was
both easy to administer and effective. So she scaled back from her initial
plan to treat all pre-op patients with chlorhexidine washcloths, oral
chlorhexidine rinse and intranasal PI the evening before and the day of
surgery.
The modified protocol simply calls for a nurse to swab the nares of
every patient with povidone iodine 2 hours before surgery. Since they
started doing that about a year ago, they've had 0 SSIs. Bonus: It only
takes 2 minutes — there are 4 swabs per bottle, each used to wind-
shield-wipe the vault and point of each nostril in 30-second sequences
— for a pre-op nurse (or the patient) to swab and the PI costs $14 per
patient. Most times the nurse handles the swabbing. If, for example,
the patient is ticklish in his nose, he'll swab himself under a nurse's
supervision.
Not only do they treat every patient for MRSA. With the exception
of ophthalmic and GI procedures, and patients who are allergic to
3 2 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • A U G U S T 2 0 1 8
