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J U N E 2 0 1 8 • O U T PAT I E N TS U R G E R Y. N E T • 1 7 S taph aureus nasal colonization is a primary risk factor for hospital acquired infections (HAIs). Surgical Site Infections (SSIs) and device associated infections can result from bacterial contamination of the surgical wound and other portals of entry (central line, urinary catheter, endotracheal tube). 1 Studies have shown that >80% of SSIs and bacteremias were caused by the bacteria in the patient's own nose. 2,3 In considering these points, and the high cost of treating HAIs, nasal decolonization presents a well founded intervention and effective infection prevention strategy in the OR, the ICU and other high risk areas in the healthcare facility. However, in response to concerns about emerging bacterial resistance to topical mupirocin, effective antiseptic alternatives to antibiotic use for nasal decolonization have been developed. Nasal antiseptic use in surgery not only makes sense from the perspective of antibiotic stewardship, but also provides a safe, immediately effective nasal decolonization approach. While mupirocin use typically requires a multi-day course prior to surgery, a nasal antiseptic offers better control of the decolonization process by assuring compliance through staff application day of surgery for scheduled and unscheduled procedures. An alcohol-based nasal antiseptic also allows for continued use to reduce regrowth of pathogens during post-operative wound healing. 1 The effectiveness of this approach was demonstrated in a study of total joint arthroplasty patients with nasal decolonization in pre-op and maintained during recovery post-op using the alcohol-based Nozin® Nasal Sanitizer® antiseptic. When compared to matched controls in the prior period, in which only chlorhexidine gluconate body wash was used, all-cause SSIs were reduced by 79%. 2 As noted, research supporting nasal decolonization demonstrates that up to 80% of SSIs can be traced to the patient's own nasal flora. 3,4 In considering the significance of this, one also realizes that still leaves 20% of infections that may come from other sources such as staff attending to patients. The alcohol-based nasal antiseptic is an easy to apply product that is well tolerated for patient pre-op and post-op application, as well as for use by surgeons and healthcare workers. In a study of spine patients in which pre-op, post-op and staff nasal decolonization were added to an existing bundle, an 81% reduction of Staph aureus SSIs was demonstrated. 5 Nozin® Nasal Sanitizer® antiseptic utilizes a patented alcohol-based formula to accomplish decolonization of nasal pathogens including methicillin-resistant and methicillin-susceptible Staphylococcus aureus (MRSA and MSSA). Nozin® Nasal Sanitizer® provides up to 12 hours of decolonization persistence and includes moisturizing emollients resulting in a pleasant application. Because it is alcohol based, the Nozin® product acts quickly and does not promote antibiotic resistance. In vitro tests show Nozin® works as effectively as ethyl alcohol by itself. A hospital clinical study demonstrated a 99% knockdown of nasal Staph aureus when the Nozin product was used by colonized nurses active in a hospital environment. 6 If your infection prevention program does not utilize nonantibiotic nasal decolonization, or does not have the option to include patients post-operatively and caregivers in contact with patients, you may benefit from an alcohol based nasal decolonization program. 1 Cassir N, De La Rosa S, Melot A, et al. Risk factors for surgical site infections after neurosurgery: A focus on the postoperative period. Am J Infect Control 2015;43:1288-1291. 2 Bostian P, Murphy TR, Klein AE, Frye BM, Dietz MJ,. Lindsey BA. A Novel Protocol for Nasal Decolonization Using Prolonged Application of an Alcohol Based Nasal Antiseptic Reduces Surgical Site Infections. West Virginia School of Medicine, Dept of Orthopedics. Poster presented AAOS 2018. 3 Coates T, Bax R, Coates A. Nasal decolonization of Staphylococcus aureus with mupirocin: strengths, weaknesses and future prospects. J Antimicrobe Chemother. 2009;64:9-15. 4 von Eiff C, Becker K, Machka K, Stammer H, Peters G. Nasal carriage as a source of Staphylococcus aureus bacteremia. Study Group. N Engl J Med. 2001;344(1):11-6. 5 Mullen A, Wieland HJ, Wieser ES, Spannhake EW, Marinos RS. Perioperative participation of orthopedic patients and surgical staff in a nasal decolonization intervention to reduce Staphylococcus spp surgical site infections. Am J Infect Control. 2017;45(5):554-556. 6 Steed LL, Costello J, Lohia S, Jones T, Spannhake EW, Nguyen S. Reduction of nasal Staphylococcus aureus carriage in health care professionals by treatment with a nonantibiotic, alcohol-based nasal antiseptic. Am J Infect Control. 2014 Aug;42(8):841-6. The Importance of Alcohol-Based Nasal Decolonization for Infection Prevention Sponsored by SPECIAL ADVERTISING SUPPLEMENT