Universal Preoperative Antiseptic Nasal and Skin Decolonization for Reduction in SSI and Associated Costs

Abstract

<h3>Background</h3> Preventing surgical site infections (SSI) is more important than ever, as the number and complexity of procedures, the co-morbidities of the patients and antimicrobial resistant pathogens are all increasing over time. Additionally, it has been estimated that as many as half of all SSI are preventable when evidence-based strategies are applied. Given this, one of 7 hospitals in a multihospital system in Florida, planned a trial of universal pre-operative nasal and skin decolonization for all surgical procedures. <h3>Methods</h3> During the trial an alcohol based nasal antiseptic was applied to all pre-operative patients in addition to chlorhexidine bathing already in place, for a period of 6 months. This nasal antiseptic was selected over other nasal decolonizing agents in support of staff satisfaction and antibiotic stewardship goals. Electronic medical record (EMR) audits were performed to confirm compliance with this new protocol. In addition, a staff satisfaction survey was distributed. No other practice change was introduced during this period. <h3>Results</h3> During the 6-month study period, the addition of pre-operative nasal antiseptic to existing CHG bathing for all surgical patients, resulted in a 59% reduction in all cause surgical site infections (SSI) for all procedures, from an average monthly baseline rate of 0.61 to an average monthly rate of 0.25. This reduction represents 22 fewer SSI with an associated estimated cost avoidance of $457,270 ($20,785/infection). The staff survey revealed that 86% of respondents were very or extremely satisfied with efficacy and ease of use of the product, and >80% preferred the nasal antiseptic over mupirocin. <h3>Conclusions</h3> Universal preoperative nasal decolonization with alcohol-based nasal antiseptic, paired with CHG bathing, led to a reduction in the SSI rate and associated costs, while supporting antimicrobial stewardship and increasing staff satisfaction.