Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.
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ter informing your facility's nasal decolonization regimen. Remember, as an outpatient facility, you possess an advantage: procedures are elective. That means you have the ability to plan ahead for each patient's nasal decolonization — a process that can take several days to complete before surgery. • Mupirocin. For procedures that involve high risk for S. aureus infec- tions — primarily when implants are inserted — the classic treatment with the highest volume of supporting liter- ature has been to swab the nares pre- operatively for MRSA and MSSA (which has received less attention recently than MRSA, but is making an alarming comeback). If either organ- ism is present in the nares, a clinician or the patient applies mupirocin to the anterior nares two times a day for five days, in conjunction with daily chlorhexidine bathing, ending the day before the procedure. The challenge with mupirocin is that it requires screening at least a week in advance, and then the patient has to strictly follow the regimen at home for five days, which presents the risk of noncompliance or incomplete compliance. There's also growing con- cern about mupirocin resistance, resulting from its wide use over a long period of time. Mupirocin's colonization eradication rate typically is extremely high — 93% to 95% — but if there's high-level mupirocin resistance, you often get no reduction in colonization. With intermediate or low-level resist- ance, there may be a transient reduction in the number of organisms, but a quick rebound takes place at the end of the first week. In terms of surgi- cal prophylaxis, we still don't know if a transient reduction is good enough. I don't believe there's been a major shift away from mupirocin yet, but there's a trend toward try- ing to find something better and easier to use. In the next year or two, a number of studies should be published that help clarify whether we're seeing increased mupirocin resistance. Meanwhile, there's renewed interest in evaluating newer nasal agents that can serve as alternative methods of nasal decolonization. The action centers around PI, alco- hol-based swabs and an interesting technique being used in Canada called photodynamic therapy. • Povidone-iodine (PI). At least three peer- reviewed articles have investigated using PI for nasal decolonization. One advantage of PI is that no resistance to S. aureus has yet been reported. Another is the way the PI regimen is designed. You don't need to worry about screening days in advance. You simply administer PI in the pre-op area before surgery — two applications in each nos- tril twice before the patient goes into the OR. Studies have indicated that PI reduces SSIs, and the literature around it is growing. It doesn't have the 3 6 • O U T P A T I E N T S U R G E R Y M A G A Z I N E • O C T O B E R 2 0 2 0 EASY TO APPLY Alcohol-based nasal decolonization is inexpensive and effective, and a patient-friendly option in the outpatient setting. Pamela Bevelhymer, RN, BSN, CNOR