But it's expensive to screen patients with active surveillance cul-
tures from the nares. Studies show mixed results as to whether it's
even economically viable. Researchers at the Los Angeles Biomedical
Research Institute once concluded that the "economic burden may be
too much for hospitals to bear." Orthopedic patients were the excep-
tion, however. Studies repeatedly showed that screening for S. aureus
and decolonizing patients who were about to undergo elective ortho-
pedic surgery reduced SSIs and was cost effective.
Still, there are several issues related to the use of mupirocin: Not
only is it costly, but its effects aren't permanent. Studies of healthcare
workers who were nasally decolonized with it have found that fewer
than 50% remained MRSA-free after a year.
And of course prescribing it feeds the potential for ongoing and
increased antibiotic resistance. The Centers for Disease Control and
Prevention recommends against using mupirocin routinely, suggesting
instead that it be limited to "outbreak or other high-prevalence situa-
tions."
All in all, the addition of new preps that decolonize without cultur-
ing and antibiotics have to be considered a welcome addition to our
arsenal.
One is an iodine, the other an alcohol. Both do an immediate decol-
onization that lasts for a number of hours, and both can be used on
any patient (or staff member) at any time. They're much less expen-
sive than swabbing for cultures and using mupirocin. Additionally,
and increasingly importantly as we move forward, there's little or no
concern that they'll contribute to the development of bacterial resist-
ance. After all, we use alcohol over and over in hand sanitizers and we
don't build up resistance.
These nasal antiseptic products are already being used in a variety
of hospitals and acute-care facilities.
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