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Archive February 2021 XXII, No. 2

Nasal Decolonization Slashed Our SSI Rates

The simple pre-op practice eliminated infections and saved our hospital several hundred thousand dollars.

Susan Franklin

Susan Franklin, RN


Pamela Bevelhymer
DOLLARS AND SENSE Standardized nasal decolonization is a cost-effective alternative to treatment with mupirocin ointment.

The couple minutes you spend applying a nasal antiseptic to joint replacement patients before they undergo surgery is well worth your time. I tested the impact nasal decolonization had on my hospital's hip and knee arthroplasty outcomes and discovered the easy-to-apply method improved an already low SSI rate — and resulted in more than $400,000 in avoided costs associated with treating post-op infections. Before achieving these impressive results, we had to reassess how patients were prepped for procedures and determine the best approach moving forward.

A new method

Through periodicals and other infection prevention resources, the infection prevention department at the hospital became aware of several products that were available to reduce the intranasal colonization of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA). It has been estimated that MRSA is the responsible pathogen in 63% of SSIs occurring after total joint replacements. We discovered that up to one-third of the population is colonized with MSSA or MRSA on their skin and in their nose, and that it could possibly cause them to have an infection in the site where they have surgery. We also learned that none of the hospitals in our health system were using nasal decolonization as an SSI prevention tool, but the practice was in place at other facilities in our region.

I wanted to keep our hospital in line with the others in the area, so I looked at how Emory University Hospital — one of the top facilities in the Atlanta area — managed their joint replacement patients. Patients scheduled to undergo joint replacements there undergo nasal cultures to test for the presence of MSSA or MRSA and carriers are prescribed mupirocin ointment to treat the nares leading up to surgery. However, our hospital was unable to conduct the nasal cultures — for several reasons. Surgeons indicated they did not want to be responsible for ordering the screenings, and the hospital's lab said they didn't want to process the cultures due to insurance reimbursement concerns. Plus, mupirocin is very expensive; even with insurance, patients pay more than $100 for the treatment. We live and work in a community where people don't have a lot of disposable income, so I looked for a more economical option.

Patients are thankful for the decolonization protocol because it shows we're willing to go the extra mile to keep them safe.

That's when our care team decided to trial the nasal antiseptic, which we selected based on cost, an overall lack of allergy concerns related to alcohol-based products, the simple and easy-to-use applicator, and reported staff and patient preference. The manufacturer of the nasal antiseptic also provided the product free of charge for the first eight months of the trial. Povidone-iodine is another safe nasal decolonization alternative that can protect patients against MRSA. There is some evidence that this agent may also reduce nasal MSSA and MRSA in the nares of surgical patients.

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