429. Identifying Barriers to Compliance with a Universal Inpatient Protocol for Staphylococcus aureus Nasal Decolonization with Povidone-Iodine

Abstract

Abstract Background Intranasal povidone-iodine (PI) is a recommended strategy for universal decolonization in high-risk patients (ICU and those with central venous or midline catheters) to reduce hospital-associated Staphylococcal infections. Few studies have evaluated implementation challenges and barriers to successful performance of inpatient intranasal decolonization programs. Methods We surveyed adult acute care unit nurses at an academic medical center in March 2022, approximately 14 months after implementation of a universal decolonization standard operating procedure (SOP). The anonymous, voluntary REDCap® survey evaluated domains focused on patient identification, education, training, resources, application, and patient acceptance using Likert scale ratings. Results Among 248 respondents, most were new to nursing (54.4% with 0-4 years of experience) and worked in non-ICU units (61.5%). Only 60.5% reported receiving training on how to perform intranasal PI (hands-on 48.6%, computer/electronic module 25.7%, both 20.9%). Nurses who received training indicated moderate to strong confidence in their ability to perform intranasal PI decolonization (89.2%). A majority cited a good understanding of the rationale for use and identified patients appropriately. Low rates were reported for performing decolonization per the SOP (49%), with barriers including inadequate supplies (35.1%), lack of a readily available copy of the SOP (69%), difficulty swabbing with nasal devices in place (41.5%) and time constraints from other patient duties. Nurses perceived that only 49.2% of patients had a moderate or strong understanding of why PI decolonization was performed, and most were unwilling to undergo intranasal PI (59.1%). Other issues included tracking PI application within the electronic medical record (EMR), limited nurse knowledge of PI effectiveness, patient refusal despite education, and overall frontline personnel burnout. Conclusion Gaps in nursing and patient education should be prioritized during and after implementation to improve fidelity, particularly with frontline burnout from COVID-19. Streamlined tracking and ordering of PI on the EMR may ease nursing workflow. Disclosures Thomas R. Talbot, III, MD, MPH, OmniSolve: Board Member.