The application is simple to perform, which belies its importance.
Research has shown that one-third of the general population is colo-
nized with nasal S. aureus and 80% of surgical site infections are
caused by bacteria that originates in the nose.
Treating patients with the sanitizer is inexpensive — about $3 per
patient. We crunched the numbers and predicted we'd need to spend
$18,000 for a year's worth of product. Compare that to upwards of
$30,000 for treating a single SSI and the cost-benefit is abundantly
clear.
Before adding the nasal swab to our pre-op routine, we explored
other nasal decolonization methods, most notably topical antibiotics.
Screening patients for S. aureus colonization weeks before surgery
and treating carriers with mupirocin is an effective way to decolonize
patients before they enter your ORs, but this approach comes with
inherent drawbacks. Patients must apply mupirocin over 5 consecu-
tive days, making compliance a significant challenge. It's also costly,
requires a prescription and raises concerns of potential antibiotic
resistance (see "Don't Do Away With Mupirocin Just Yet").
More than 60% of our patients simply weren't complying with the at-
home mupirocin decolonization protocol. Some found the application
unpleasant or didn't comprehend its importance. Others were too
busy and forgot, didn't have the time or didn't perform the regimen
fully. Put all of those mitigating factors together and the big picture
wasn't good: Patients' non-compliance put them at increased risk of
surgical site infection.
If you want something done right
We eventually stopped asking patients to treat their nares at home,
deciding instead to do it ourselves on the day of surgery when we
could make sure it's done, and done right.
6 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 • M A Y 2 0 1 9
