Archive March 2017 XVIII, No. 3

Hand Hygiene for Your Nose

Nasal decolonization gave our existing infection control protocols a boost — without using antibiotics.

Anita Mullen, RN, BSN

topical antiseptic NOSE SWAB A pre-op nurse administers a topical antiseptic to a patient at Baylor Orthopedic and Spine Hospital at Arlington.

You've probably been hearing a lot lately about how nasal decolonization is helping hospitals and surgery centers tilt the fight against surgical site infections in their favor. Instead of an antibiotic ointment like mupirocin, you apply a topical antiseptic to reduce the microbial burden in the nares, a reservoir for bacteria that escape typical hygiene protocols such as hand washing. Maybe that's why I call nasal decolonization "hand hygiene for your nose."

We were intrigued enough at the prospect of decolonizing the nose without the risk and complexity of antibiotics that we trialed a nasal antiseptic on our patients (and staff!) here at the Baylor Orthopedic and Spine Hospital at Arlington, an orthopedic treatment and surgical center with 23 beds in 1- or 2-bed rooms. We focus on spine and joint, specialties where surgical site infections can be particularly devastating. Read on to find out how we integrated a nasal antiseptic into our existing infection control protocols and lowered infection rates for MRSA-suspected patients, staff and caregivers.

swabbed the inside of their noses KEEP YOUR NOSE CLEAN When patients undergoing spinal surgery swabbed the inside of their noses with a topical antiseptic before the procedure, there was a dramatic reduction in surgical-site infections.

Trialing a nasal antiseptic
The goal of our trial was to see if nasal decolonization would reduce our Staphylococcus aureus infection rates in our spine surgery patients. We added the nasal antiseptic to our existing practice of hand hygiene and pre-operative skin decolonization using chlorhexidine gluconate bathing and body wipes.

Nasal antiseptics come as either an alcohol-based or povidone-iodine solution. They're packaged in ampules or in pre-moistened, ready-to-use swabsticks. We tested an alcohol-based formulation.

Topical mupirocin applied to the anterior nares has long been the first line of therapy for MRSA carriage reduction, but there is growing evidence of resistance of S. aureus and MRSA to mupirocin. We grow increasingly concerned each time we hear a report about another resistant strain of S. aureus.

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