and other organisms. Unnecessary antibiotics also impact the
patient's microbiome. Though it's added work, it's truly best to
first test the patient and treat only when necessary.
• Nasal decolonization. Nasal sanitizing swabs promise to help
reduce the number of pathogens in a patient's nose without the risk of
antibiotic use. Pre-op nurses use the swabs to apply an alcohol-based
antiseptic to patients' nostrils just before they enter the OR. A study
published in the American Journal of Infection Control
(osmag.net/9dBXvS) tested the efficacy of an alcohol-based nasal
antiseptic to prevent MRSA infection in 673 patients who underwent
outpatient spine surgery and who did not receive mupirocin as part of
a prevention protocol. Applying the nasal antiseptic in pre-op resulted
in a significant reduction in S. aureus SSIs over the 15-month study.
A povidone-iodine solution can also be applied to patients' nostrils
with a pre-moistened swab. One swab is rotated 4 times in each nos-
tril for 30 seconds. A study in the Journal of Arthroplasty showed the
povidone-iodine solution effectively eliminated nasal S. aureus in
over two-thirds of 429 joint replacement patients
(osmag.net/UX2Sna).
Screening and treating has been proven to reduce SSI rates and is
routine practice in many facilities, but it's labor-intensive and chal-
lenges antibiotic stewardship protocols. Nasal decolonization might
be a more practical approach.
More is needed
When possible, patients with MRSA infections or those who are carri-
ers should be operated on at the end of your schedule, suggests Dr.
Kavanagh. "This way," he explains, "the patient is the last case and
staff can take the time to perform a thorough terminal cleaning."
There are also additional items on the market that may aid in disin-
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