easy to apply, whereas povidone-iodine is a tubed ointment that can
be difficult for patients to apply, notes Sue Barnes, RN, CIC, FAPIC,
an infection prevention consultant. "The iodine product similarly is
not pleasant to use. It stings, and it doesn't smell good," she says.
Indeed, Ms. Schmidt says some patients complain of the "bromide"
odor that subsides after a few minutes. "I've done it to myself," she
says, "and it smells like a swimming pool."
Mupirocin has a fan in Sharon Orrange, MD, associate professor of
clinical medicine at the Keck USC School of Medicine in Los Angeles,
Calif. Dr. Orrange practices internal medicine and performs pre-op
clearances for patients. She shares research to back her facility's deci-
sion to use mupirocin, including one published in the Journal of
Arthroplasty in 2013, which found that mupirocin twice a day and
daily chlorhexidine showers for 5 days before surgery eradicated
MRSA in colonized total joint patients. The other study, released by
the Society for Healthcare Epidemiology of America (SHEA) in 2012,
found that treating all total joint patients with mupirocin and screen-
ing them first and then treating only those who are positive to be
equally more beneficial and equally more cost effective than a no-
treatment strategy.
Researchers concluded that the treat-all and screen-and-treat strate-
gies have similar average cost-effectiveness ratios, with only trivial
differences. A treat-all strategy is simpler to implement and avoids
missing potential carriers because of false-negative test results.
However, facilities with a high prevalence of mupirocin-resistant
strains may prefer a screen-and-treat strategy, concluded the study,
led by Xan F. Courville, MD, from the department of orthopaedics at
Dartmouth Hitchcock Medical Center in Lebanon, N.H.
Last spring, when Mackenzie McCoy, RN, was in nursing school at the
Mayo Clinic in Rochester, Minn., she explored nasal decolonization as a
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