Archive August 2018 XIX, No. 8

Keep Your Nose Clean

What's your nasal decolonization strategy?

Jeannette Sabatini, Associate Editor


INTRANASAL INTERVENTION If you're looking for a way to reduce your MRSA SSI rate, it might be right under your nose. Actually, your patients' noses.

Infection prevention’s new rallying cry: Just a little swab will do you.

Yes, we’re hearing more and more about how nasal swabsticks magically decolonize the nares of pathogens and reduce MRSA SSI rates.

The VA Portland Health Care System has quite a success story to share. A couple years ago, a nurse of 19 years embarked on an ambitious evidence-based project for her clinical nursing leader master’s thesis: lower MRSA infections through nasal decolonization before surgery. Melissa S. Schmidt, MSN, RN, CNL, CPAN, CAPA, PACU, had her work cut out for her. In 2016, the VA reported 13 MRSA-related SSIs, more than 1 a month. Ms. Schmidt set a modest goal to reduce infections by 10%. She underestimated herself.

She didn’t know a whole lot about Methicillin resistant Staphylococcal aureus (MRSA) and nasal decolonization. She learned fast that:

  • 80% of wound infections are traced to the patients’ own nasal flora;
  • most patients who develop MRSA infection will have been colonized before infection;
  • 30% of people are colonized with Staphylococcus aureus, the leading cause of surgical site infections (SSI), when they reach the OR; and
  • you can reduce MRSA SSIs through nasal decolonization.

Treat all or screen and treat?

Despite the VA’s best efforts to reduce infections, SSI rates among veterans had been on the rise, Ms. Schmidt discovered. A few things struck her when she examined the VA’s old protocol. One to 4 weeks before surgery, cardiac and orthopedic patients were screened for MRSA colonization via nasal swab. Patients who were MRSA-positive were treated with mupirocin ointment to the nares and chlorhexidine showers. At least that was the plan.

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