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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Patients scheduled to undergo joint replacements there undergo nasal cultures to test for the pres- ence of MSSA or MRSA and carri- ers are prescribed mupirocin ointment to treat the nares lead- ing up to surgery. However, our hospital was unable to conduct the nasal cultures — for several reasons. Surgeons indicated they did not want to be responsible for ordering the screenings, and the hospital's lab said they didn't want to process the cultures due to insurance reimbursement con- cerns. Plus, mupirocin is very expensive; even with insurance, patients pay more than $100 for the treatment. We live and work in a community where people don't have a lot of disposable income, so I looked for a more economical option. That's when our care team decided to trial the nasal antisep- tic, which we selected based on cost, an overall lack of allergy concerns related to alcohol- based products, the simple and easy-to-use applicator, and reported staff and patient prefer- ence. The manufacturer of the nasal antiseptic also provided the product free of charge for the first eight months of the trial. Povidone-iodine is another safe nasal decolonization alternative that can protect patients against MRSA. There is some evidence that this agent may also reduce nasal MSSA and MRSA in the nares of surgical patients. Down to zero We selected the universal approach of applying the nasal 3 4 • 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 • F E B R U A R Y 2 0 2 1 Povidone-iodine is viable alternative to mupirocin for nasal decolonization because it has potent and rapid activity against Staphylococcus aureus. It's also an effective nasal decolonization method for preventing surgical site infections in patients who undergo orthopedic procedures, according to a study published in the American Journal of Infection Control (osmag.net/vPpDP9). Researchers applied 10% povidone- iodine to the circumference of patients' nostrils and anterior nares. The application resulted in a statistically significant reduction in average methicillin-resistant Staphylococcus aureus (MRSA) one and six hours after application, but not 12 or 24 hours later, which suggests a single preoperative nasal application of povidone-iodine suppresses S. aureus long enough during surgery to prevent surgical site infections and is a more cost-effective option than a five-day treatment of mupirocin. Additionally, note the researchers, concerns about strains of S. aureus becoming resistant to mupirocin highlight another potential benefit of using povidone-iodine as a nasal decolonization agent. — Outpatient Surgery Editors Swab Your Way to Fewer Infections BY A NOSE Treating the nares and nostrils with povidone-iodine eliminates growing concerns of mupirocin resistance. SHORT-TERM SUCCESS Patients are thankful for the decolonization protocol because it shows we're willing to go the extra mile to keep them safe.