Nasal Decolonization Research Articles

Implementation of a Colorectal Surgical Site Infection Prevention Bundle and Checklist: A Quality Improvement Project.

After noting an elevated surgical site infection rate in 2019 associated with colorectal surgeries, leaders at two Central Virginia health system hospitals convened an interdisciplinary team to audit current practices and research infection prevention strategies. After identifying a lack of standardization in care processes for colorectal surgery patients and reviewing the literature on colorectal bundles, the team created a bundle focusing on the use of antibiotics, chlorhexidine gluconate wipes or baths, separate closing instrument trays, nasal decolonization, bowel preparation, and maintaining patient normothermia. After synthesis and stakeholder input, the team implemented the colorectal bundle along with a checklist for all users to complete to ensure compliance and standardization of practice and for auditing purposes. Implementation results were positive: the total number of colorectal infections decreased from nine in 2020 to three in 2021. Education was critical to securing staff member engagement for successful implementation of and compliance with the bundle.

Nasal decolonization: What antimicrobials and antiseptics are most effective before surgery and in the ICU

Staphylococcus aureus colonization is a key risk factor for S. aureus infections in surgical patients and in hospitalized patients. Many studies have assessed various decolonization agents, protocols, and settings. This review summarizes key findings about nasal decolonization for 2 different patient populations: patients undergoing surgery and patients hospitalized in intensive care units. We reviewed major studies related to decolonization of patients colonized with S. aureus and who were either undergoing surgical procedures or were hospitalized in intensive care units. We focused on recent studies, particularly randomized controlled trials and robust quasi-experimental trials. We also reviewed select non-randomized trials when more rigorous trials were limited. Mupirocin is the best-studied agent for decolonization. Its use reduces the risk of surgical site infection following orthopedic surgery (strongest data) and cardiac surgery. Mupirocin decolonization also reduces the incidence of S. aureus clinical cultures in the intensive care unit. Povidone-iodine is less well-studied. Current data suggest that it decreases the risk of surgical site infections after orthopedic surgical procedures. In contrast, povidone-iodine is less effective than mupirocin for reducing the incidence of S aureus clinical cultures in the intensive care unit. Both mupirocin and povidone-iodine have important limitations, highlighting the need for future decolonization research.

Nasal Iodophor Antiseptic vs Nasal Mupirocin Antibiotic in the Setting of Chlorhexidine Bathing to Prevent Infections in Adult ICUs

Universal nasal mupirocin plus chlorhexidine gluconate (CHG) bathing in intensive care units (ICUs) prevents methicillin-resistant Staphylococcus aureus (MRSA) infections and all-cause bloodstream infections. Antibiotic resistance to mupirocin has raised questions about whether an antiseptic could be advantageous for ICU decolonization. To compare the effectiveness of iodophor vs mupirocin for universal ICU nasal decolonization in combination with CHG bathing. Two-group noninferiority, pragmatic, cluster-randomized trial conducted in US community hospitals, all of which used mupirocin-CHG for universal decolonization in ICUs at baseline. Adult ICU patients in 137 randomized hospitals during baseline (May 1, 2015-April 30, 2017) and intervention (November 1, 2017-April 30, 2019) were included. Universal decolonization involving switching to iodophor-CHG (intervention) or continuing mupirocin-CHG (baseline). ICU-attributable S aureus clinical cultures (primary outcome), MRSA clinical cultures, and all-cause bloodstream infections were evaluated using proportional hazard models to assess differences from baseline to intervention periods between the strategies. Results were also compared with a 2009-2011 trial of mupirocin-CHG vs no decolonization in the same hospital network. The prespecified noninferiority margin for the primary outcome was 10%. Among the 801 668 admissions in 233 ICUs, the participants' mean (SD) age was 63.4 (17.2) years, 46.3% were female, and the mean (SD) ICU length of stay was 4.8 (4.7) days. Hazard ratios (HRs) for S aureus clinical isolates in the intervention vs baseline periods were 1.17 for iodophor-CHG (raw rate: 5.0 vs 4.3/1000 ICU-attributable days) and 0.99 for mupirocin-CHG (raw rate: 4.1 vs 4.0/1000 ICU-attributable days) (HR difference in differences significantly lower by 18.4% [95% CI, 10.7%-26.6%] for mupirocin-CHG, P < .001). For MRSA clinical cultures, HRs were 1.13 for iodophor-CHG (raw rate: 2.3 vs 2.1/1000 ICU-attributable days) and 0.99 for mupirocin-CHG (raw rate: 2.0 vs 2.0/1000 ICU-attributable days) (HR difference in differences significantly lower by 14.1% [95% CI, 3.7%-25.5%] for mupirocin-CHG, P = .007). For all-pathogen bloodstream infections, HRs were 1.00 (2.7 vs 2.7/1000) for iodophor-CHG and 1.01 (2.6 vs 2.6/1000) for mupirocin-CHG (nonsignificant HR difference in differences, -0.9% [95% CI, -9.0% to 8.0%]; P = .84). Compared with the 2009-2011 trial, the 30-day relative reduction in hazards in the mupirocin-CHG group relative to no decolonization (2009-2011 trial) were as follows: S aureus clinical cultures (current trial: 48.1% [95% CI, 35.6%-60.1%]; 2009-2011 trial: 58.8% [95% CI, 47.5%-70.7%]) and bloodstream infection rates (current trial: 70.4% [95% CI, 62.9%-77.8%]; 2009-2011 trial: 60.1% [95% CI, 49.1%-70.7%]). Nasal iodophor antiseptic did not meet criteria to be considered noninferior to nasal mupirocin antibiotic for the outcome of S aureus clinical cultures in adult ICU patients in the context of daily CHG bathing. In addition, the results were consistent with nasal iodophor being inferior to nasal mupirocin. ClinicalTrials.gov Identifier: NCT03140423.

Financial Analysis of Preoperative Nasal Decolonization With Povidone-Iodine in Closed Pilon Fracture Definitive Fixation

The purpose of this study is to determine the financial practicality for the use of nasal povidone-iodine (NP-I) in the preoperative holding area in attempt to decrease the rate of infection that is associated with operative fixation of closed pilon fractures. Institutional costs for treating postoperative infection following a closed pilon fracture, along with costs associated with preoperative NP-I use, were obtained. A break-even equation was used to analyze these costs to determine if the use of NP-I would decrease the current infection rate (17%) enough to be financially beneficial for routine use preoperatively. The total cost of treating a postoperative infection was found to be $18,912, with the cost of NP-I being $30 per patient dose. Considering a 17% infection rate and utilizing the break-even equation, NP-I was found to be economically viable if it decreased the current infection rate by 0.0016% (Number Needed to Treat=63,051.7). This break-even model suggests that the use of NP-I in the preoperative holding area is financially beneficial for decreasing the rate of infection associated with the treatment of closed pilon fractures.

A Novel Protocol for Nasal Decolonization Using Prolonged Application of an Alcohol-Based Nasal Antiseptic Reduces Surgical Site Infections in Total Joint Arthroplasty Patients: A Retrospective Cohort Study.

Background: Current nasal decolonization strategies utilize pre-operative agents without consideration for short-term re-colonization or de novo colonization. Many strategies utilize an antibiotic-based agent, raising concerns of limited gram-negative antimicrobial coverage and the emergence of resistant bacterial strains. This study evaluated the clinical utility of a non-antibiotic, alcohol-based nasal decolonization agent in decreasing surgical site infection (SSI) rates after total joint arthroplasty. Patients and Methods: We retrospectively compared an 18-month cohort of elective primary total joint arthroplasty patients treated peri-operatively with an alcohol-based sanitizer to historical controls. The alcohol-based agent was administered pre-operatively the day of surgery and for two weeks after surgery. Patients were followed for 90 days and assessed for signs or symptoms of SSI. Patient and caregiver compliance was recorded. There were 779 patients included in the experimental group and 647 included in the historical control group. Results: Patients receiving alcohol-based nasal decolonization had a lower rate of SSI compared with controls not receiving nasal decolonization (0.64% [5/779] vs. 1.55% [10/647]; p = 0.048; odds ratio, 2.43). Utilization of an alcohol-based nasal sanitizer in the pre-operative and prolonged post-operative setting decreased infection rates by 41.3% in our elective total joint arthroplasty setting. Conclusions: When used pre- and post-operatively, alcohol-based nasal decolonization of bacteria in patients undergoing total joint arthroplasty led to a substantial decrease in SSIs.

#3689 RELATIONSHIP BETWEEN STAPHYLOCOCCUS AUREUS NASAL CARRIAGE AND URAEMIC PRURITUS IN HAEMODIALYSIS PATIENTS AND ITS INFLUENCE ON INFECTION

Abstract Background and Aims Uraemic pruritus is a common and distressing comorbid disease among patients undergoing haemodialysis (HD). The aetiology of uraemic pruritus is multifactorial and not fully understood. The role of skin microbiota in chronic inflammatory skin disease has long been discussed, but evidence regarding the relationship between uraemic pruritus and Staphylococcus aureus (SA) colonization is limited. The rate of SA nasal carriage in HD patients was more than double that of healthy individuals, and the phage type of SA infection was often the same as the type of SA carried in the HD patients' nares. SA colonization is associated with greater skin barrier disruption, which suggests a possibility to increase the risk of infection in patients with uraemic pruritus. This study aimed to assess the role of SA nasal carriage in uraemic pruritus, as well as the interplay among SA colonization, uraemic pruritus, and SA infection in HD patients. Method We conducted a prospective cohort study to enrol adult HD patients in the Far Eastern Memorial Hospital, a tertiary medical centre in Taiwan, in April 2019. Eligible patients should had received maintenance HD for more than three months. Patients were excluded if they had active infection or primary skin diseases. The intensity of uraemic pruritus was assessed using a visual analogue scale (VAS) from 0 to 10 (0 = no pruritus, 10 = the worst pruritus imaginable). Nasal swab culture was performed to examine the status of SA nasal carriage. Patients were followed until SA infection, death, or January 2020, whichever had occurred earlier. The definition of SA infection should fulfil both the clinical diagnosis and the results of microbiological culture. Multivariate linear regression models were used to assess the potential predictors for a higher pruritus intensity. Multivariate Cox proportional hazard models were used to analyse the risk of SA nasal carriage on SA infection among the HD patients. Results A total of 100 HD patients were enrolled, the mean age was 61.7 years and 69% were men. The mean dialysis vintage was 6.7 years. Among the participants, 55% had uraemic pruritus and the mean VAS score of pruritus intensity was 4.0. The prevalence of SA nasal carriage was higher in patients with uraemic pruritus than that in patients without uraemic pruritus (33% vs 13%, P = 0.024). The multivariate linear regression model showed that SA nasal carriage was an independent predictor of a higher VAS score of pruritus intensity (parameter estimate, 1.18; 95% CI 0.05-2.30; P = 0.04) (Table 1). After follow-up for 10 months, there were four SA infection events in the pruritus patients and one event in the non-pruritus patients. The multivariate Cox proportional hazard model showed that patients with SA nasal carriage had a borderline higher risk for SA infection (adjusted hazard ratio, 50.9; 95% CI, 0.62-3689; P = 0.08) (Table 2). Conclusion SA nasal carriage is independently associated with uraemic pruritus, and is also an independent predictor for a higher pruritus intensity among HD patients. Moreover, SA colonization might predict SA infection in later follow-up period. This study provide evidence for future studies regarding the survey for SA colonization and application of nasal decolonization among HD patients with uraemic pruritus.

Impact of nasal photodisinfection on SARS-CoV-2 infection in an industrial workplace

ObjectivesWe aimed to evaluate a quality improvement initiative designed to control SARS-CoV-2 (COVID) using the large-scale deployment of antimicrobial photodisinfection therapy (aPDT) for nasal decolonization in a Canadian industrial workplace (a food processing plant). Study designUsing a retrospective chart review of treatment questionnaires, linked to COVID laboratory testing results, a quality improvement assessment was analyzed to determine treatment effectiveness and safety. MethodsThis voluntary aPDT intervention involved the administration of a light-sensitive liquid to the nose followed by nonthermal red-light irradiation on a weekly basis. Employees in food processing industries are at increased risk for COVID infection due to the nature of their work environments. In an effort to mitigate the transmission and consequences of the disease among such workers and the community at large, aPDT was added to a well-established bundle of pre-existing pandemic safety measures (e.g., mask-wearing, testing, contact tracing, workplace-engineered barriers, increased paid sick leave). ResultsFrom December 2020 to May 2021, we found high interest in and compliance with aPDT treatment, along with a statistically significant lower PCR test positivity rate in the study population in comparison to the case rates for the local Canadian province. Treatment safety monitoring and outcomes of the aPDT program demonstrated no serious adverse events. ConclusionsThis study suggests nasal photodisinfection provides safe and effective COVID viral suppression when deployed across the majority of workers in an industrial workplace setting.

238 Projected Annual Reductions in Central Venous Catheter (CVC)-Related S. aureus Bloodstream Infections (SA-BSIs) and Healthcare Costs (HCs) Associated With SA Nasal Decolonization (SA-ND) in SA Nares Colonized Hemodialysis Patients (SA-NC HD Pts)

238 Projected Annual Reductions in Central Venous Catheter (CVC)-Related S. aureus Bloodstream Infections (SA-BSIs) and Healthcare Costs (HCs) Associated With SA Nasal Decolonization (SA-ND) in SA Nares Colonized Hemodialysis Patients (SA-NC HD Pts)

Dissemination of Methicillin-Resistant Staphylococcus aureus Sequence Type 764 Isolates with Mupirocin Resistance in China.

Mupirocin, a topical antimicrobial agent, is an important component in the eradication of methicillin-resistant Staphylococcus aureus (MRSA) colonization. The molecular characteristics of 46 mupirocin-resistant MRSA (MR-MRSA) clinical isolates were analyzed by multilocus sequence typing (MLST), staphylococcal cassette chromosome mec element (SCCmec) typing, spa typing, and analysis of virulence genes. All 26 MRSA isolates with low-level mupirocin resistance possessed a V588F mutation in ileS. Among 20 MRSA isolates with high-level resistance to mupirocin, all carried mupA; 2 isolates also possessed the V588F mutation in ileS, and 1 possessed the V631F mutation in ileS (isoleucyl-tRNA synthetase). The majority of MR-MRSA isolates were resistant to erythromycin, clindamycin, tetracycline, ciprofloxacin, and gentamicin, but the rates of resistance to rifampin and fusidic acid were 8.7% and 6.5%, respectively. Eight sequence types (STs) were found among the 46 MR-MRSA isolates, of which ST764 was the most prevalent (76.1%). The most frequent spa type identified was t1084 (52.2%). The SCCmec type most frequently found was type II (80.4%). The most common clone among low-level MR-MRSA isolates was ST764-MRSA-SCCmec type II-t1084 (23 isolates), while ST764-MRSA-SCCmec type II-t002 (9 isolates) was the most common clone among high-level MR-MRSA isolates. Additionally, all toxin genes except the seb gene were not identified among ST764 isolates. Among clonal complex 5 (CC5) isolates, immune evasion cluster (IEC)-associated genes (chp, sak, and scn) and seb were present in ST764 but absent in ST5, while sec, sel1, tsst-1, and hlb genes were identified in ST5 but absent in ST764. In conclusion, the spread of CC5 clones, especially a novel ST764-MRSA-SCCmec type II-t1084 clone with high-level resistance to mupirocin, was responsible for the increase in mupirocin resistance. These findings indicated that the emergence of the ST764 MR-MRSA clone involves a therapeutic challenge for treating serious MRSA infections. IMPORTANCE Mupirocin, a topical antibiotic that is commonly used for the nasal decolonization of MRSA and methicillin-sensitive Staphylococcus aureus in hospital settings and nursing homes, was introduced as a highly effective antibiotic against MRSA. Mupirocin acts by competitively binding isoleucyl-tRNA synthetase, thereby disrupting protein synthesis. This drug shows bacteriostatic and bactericidal activity at low and high concentrations, respectively. However, with the increase in mupirocin use, low-level and high-level resistance during nasal mupirocin treatment has been reported. In a previous study, the proportion of MRSA strains with high-level mupirocin resistance in a Canadian hospital increased from 1.6% in the first 5 years of surveillance (1995 to 1999) to 7.0% (2000 to 2004).

Association between nasal colonization of Staphylococcus aureus and surgical site infections in spinal surgery patients: a systematic review and meta-analysis.

The study aimed at examining the relationship between nasal colonization of Staphylococcus aureus (SA) or methicillin-resistant Staphylococcus aureus (MRSA) and the risk of SSI after spinal surgeries MATERIALS AND METHODS: PubMed, CENTRAL, Scopus, Web of Science, and Embase databases up to 24th September 2022 for articles on nasal colonization of SA/MRSA and spine surgeries. Ten studies were included. Meta-analysis revealed that the incidence of SSI was not significantly different between SA-positive and SA-negative patients (RR: 0.75, 95% CI: 0.47, 1.18 I2=2% p=0.21). It was noted that when no decolonization was done, there was no statistically significant difference in the risk of SSI between MRSA positive and MRSA negative patients, but a tendency of higher SSI in MRSA carriers (RR: 2.40, 95% CI: 0.91, 6.32, I2=37% p=0.08). However, in the subgroup analysis with decolonization, the risk of SSI was significantly higher in the MRSA-positive group (RR: 2.99, 95% CI: 1.27, 7.03, I2=24% p=0.01). Specifically, the risk of MRSA-SSI was significantly higher in MRSA carriers with (RR: 6.05, 95% CI: 1.14, 31.99, I2=43% p=0.03) and without decolonization (RR: 7.54, 95% CI: 1.43, 39.85, I2=38% p=0.02). Evidence from observational studies indicates that only MRSA nasal colonization increases the risk of SSIs in spinal surgery patients. Nasal decolonization was unable to reduce the risk of overall or MRSA-specific SSIs in MRSA carriers. Evidence was biased due to the extremely small number of MRSA-positive patients in the studies and the lack of adjustment of confounding factors.

1199. Implementation of a Nasal Antiseptic Decolonization Program Reduces the Occurrence of Healthcare-Associated Infections in the Adult Intensive Care Unit Setting

Abstract Background Universal decolonization programs effectively reduce methicillin-resistant Staphylococcus aureus (MRSA) infections, bloodstream infections, and healthcare costs. However, universal decolonization programs that utilize mupirocin may promote antimicrobial resistance. Non-antibiotic interventions, such as nasal antiseptic decolonization, can contribute to the prevention of healthcare-associated infections (HAIs). A large hospital system sought to evaluate the impact of a universal nasal antiseptic program on HAIs in the adult intensive care unit (ICU) setting. Methods A nasal antisepsis decolonization quality improvement project (QIP) was implemented to reduce ICU HAIs by applying a 62% nasal antiseptic swab with emollients bilaterally to the nares every 12 hours for all adult ICU patients. The program was piloted across nine ICUs at three large hospitals from November 2021 to January 2022 and captured data from 12,404 patient days and 4,058 treatment days. Central line-associated blood stream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and MRSA bacteremia rates were compared a) between treated and non-treated patients during the QIP period and b) to rates during a three-month period prior to the QIP. Results The results of the pilot program indicated that patients who received treatment with the 62% nasal swab developed fewer HAIs than patients who did not receive the treatment. Two HAIs occurred in the treatment group (two CAUTIs) compared to 14 HAIs in the non-treatment group (three CAUTIs, nine CLABSIs, and two MRSA bacteremia). Figures 1 and 2 below demonstrate HAI rates in the non-treatment and the treatment groups. Figure 1Figure 2 Conclusion Based on pilot results, the system approved implementation of a universal nasal antisepsis program using the 62% alcohol based nasal swab with emollients for expansion to all adult critical care units. Considerations for the future implementation of the program include broadening patient inclusion and performing ongoing HAI surveillance of treated and untreated patient groups. Disclosures All Authors: No reported disclosures.

A quality improvement study on the relationship between intranasal povidone-iodine and anesthesia and the nasal microbiota of surgery patients.

The composition of the nasal microbiota in surgical patients in the context of general anesthesia and nasal povidone-iodine decolonization is unknown. The purpose of this quality improvement study was to determine: (i) if general anesthesia is associated with changes in the nasal microbiota of surgery patients and (ii) if preoperative intranasal povidone-iodine decolonization is associated with changes in the nasal microbiota of surgery patients. One hundred and fifty-one ambulatory patients presenting for surgery were enrolled in a quality improvement study by convenience sampling. Pre- and post-surgery nasal samples were collected from patients in the no intranasal decolonization group (control group, n = 54). Pre-decolonization nasal samples were collected from the preoperative intranasal povidone-iodine decolonization group (povidone-iodine group, n = 97). Intranasal povidone-iodine was administered immediately prior to surgery and continued for 20 minutes before patients proceeded for surgery. Post-nasal samples were then collected. General anesthesia was administered to both groups. DNA from the samples was extracted for 16S rRNA sequencing on an Illumina MiSeq. In the control group, there was no evidence of change in bacterial diversity between pre- and post-surgery samples. In the povidone-iodine group, nasal bacterial diversity was greater in post-surgery, relative to pre-surgery (Shannon's Diversity Index (P = 0.038), Chao's richness estimate (P = 0.02) and Inverse Simpson index (P = 0.027). Among all the genera, only the relative abundance of the genus Staphylococcus trended towards a decrease in patients after application (FDR adjusted P = 0.06). Abundant genera common to both povidone-iodine and control groups included Staphylococcus, Bradyrhizobium, Corynebacterium, Dolosigranulum, Lactobacillus, and Moraxella. We found general anesthesia was not associated with changes in the nasal microbiota. Povidone-iodine treatment was associated with nasal microbial diversity and decreased abundance of Staphylococcus. Future studies should examine the nasal microbiota structure and function longitudinally in surgical patients receiving intranasal povidone-iodine.

Nasal microbiome disruption and recovery after mupirocin treatment in Staphylococcus aureus carriers and noncarriers

Nasal decolonization procedures against the opportunistic pathogen Staphylococcus aureus rely on topical antimicrobial drug usage, whose impact on the nasal microbiota is poorly understood. We examined this impact in healthy S. aureus carriers and noncarriers. This is a prospective interventional cohort study of 8 S. aureus carriers and 8 noncarriers treated with nasal mupirocin and chlorhexidine baths. Sequential nasal swabs were taken over 6 months. S. aureus was detected by quantitative culture and genotyped using spa typing. RNA-based 16S species-level metabarcoding was used to assess the living microbial diversity. The species Dolosigranulum pigrum, Moraxella nonliquefaciens and Corynebacterium propinquum correlated negatively with S. aureus carriage. Mupirocin treatment effectively eliminated S. aureus, D. pigrum and M. nonliquefaciens, but not corynebacteria. S. aureus recolonization in carriers occurred more rapidly than recolonization by the dominant species in noncarriers (median 3 vs. 6 months, respectively). Most recolonizing S. aureus isolates had the same spa type as the initial isolate. The impact of mupirocin-chlorhexidine treatment on the nasal microbiota was still detectable after 6 months. S. aureus recolonization predated microbiota recovery, emphasizing the strong adaptation of this pathogen to the nasal niche and the transient efficacy of the decolonization procedure.

Antimicrobial Photodynamic Therapy in the Nasal Decolonization of Maintenance Hemodialysis Patients: A Pilot Randomized Trial

Infections are an important cause of mortality among patients receiving maintenance hemodialysis. Staphylococcus aureus is a frequent etiological agent, and previous nasal colonization is a risk factor for infection. Repeated antimicrobial decolonization reduces infection in this population but can induce antibiotic resistance. We compared photodynamic therapy, a promising bactericidal treatment that does not induce resistance, to mupirocin treatment among nasal carriers of Saureus. Randomized controlled pilot study. 34 patients receiving maintenance hemodialysis who had nasal carriage of S aureus. Patients were randomly assigned to decolonization with a single application of photodynamic therapy (wavelength of 660nm, 400mW/cm2, 300 seconds, methylene blue 0.01%) or with a topical mupirocin regimen (twice a day for 5 days). Nasal swabs were collected at time 0 (when the carrier state was identified), directly after treatment completion, 1 month after treatment, and 3 months after treatment. Bacterial isolates were subjected to proteomic analysis to identify the species present, and antimicrobial susceptibility was characterized. All 17 participants randomized to photodynamic therapy and 13 of 17 (77%) randomized to mupirocin were adherent to treatment. Directly after treatment was completed, 12 participants receiving photodynamic therapy (71%) and 13 participants treated with mupirocin (77%) had cultures that were negative for S aureus (risk ratio, 0.92 [95% CI, 0.61-1.38]; P=0.9). Of the patients who had negative cultures directly after completion of photodynamic therapy, 67% were recolonized within 3 months. There were no adverse events in the photodynamic therapy group. Testing was restricted to assessing nasal colonization; infectious complications were not assessed. Photodynamic therapy is a feasible approach to treating nasal carriage of S aureus. Future larger studies should be conducted to determine whether photodynamic therapy is equivalent to the standard of care with mupirocin. Government grant (National Council for Scientific and Technological Development process 3146682020-9). Registered at ClinicalTrials.gov with study number NCT04047914.

Identifying barriers to compliance with a universal inpatient protocol for Staphylococcus aureus nasal decolonization with povidone-iodine.

Academic hospital nurses were surveyed to assess adherence barriers to a universal povidone-iodine nasal decolonization protocol to prevent Staphylococcus aureus infection. Low training rates, inadequate supplies, documentation and tracking challenges, patient refusal, and burnout contributed to suboptimal adherence. Prioritizing education is essential but alone is insufficient for successful protocol adoption.

Surgical site infection in adult patients after heart procedures: an integrative review

Objective: to identify the risk factors for surgical site infection in patients after heart procedure. Methods: integrative literature review by searching the Medical Literature Analyses and Retrieval System online, Latin American and Caribbean Literature on Health Sciences, Scientific Electronic Library Online, Nursing Database. The search for the articles occurred during the month of February 2022. Results: 24 articles were eligible for the review. In all studies, the population was mostly male, aged between 51 and 70 years, who underwent elective myocardial revascularization surgery. The main comorbidities presented were diabetes mellitus, hypertension, and obesity. The infection rates ranged from 2.4% to 38.9%, and the main pathogen identified was Staphylococcus aureus. Conclusion: the main comorbidities present in patients who manifested surgical site infection were diabetes, hypertension, obesity, and smoking. The risk factors were gender, age, and prolonged preoperative hospitalization. Antibiotic prophylaxis, trichotomy, nasal decolonization, and adequate skin antisepsis were the most adopted prophylactic measures. Contributions to practice: knowing the profile of patients who developed infection may favor planning risk control actions.

Mupirocin susceptibility of staphylococci 2022: Is it time for a change in MRSA decolonization protocols?

Nasal decolonization with mupirocin has been a common strategy for the prevention of surgical site infections (SSIs) and recurrent skin and soft tissue infections due to Staphylococcus aureus (SA). We recently noted an increase in SSIs due to SA, including a case of post-operative mupirocin-resistant methicillin-resistant SA (MRSA) infection despite attempted preoperative decolonization with mupirocin. We therefore evaluated the mupirocin susceptibility of SA at our hospital to determine the optimal regimen for decolonization. SA isolates were recovered from clinical and screening samples received in the microbiology laboratory. Mupirocin susceptibility was determined using e-tests and isolates were categorized as susceptible or resistant using a breakpoint MIC value of 4mcg/ml. 223 unique SA isolates from 218 patients were tested. Twenty-four SA isolates (10.8%) were resistant to mupirocin (20 MRSA and 4 methicillin-sensitive SA [MSSA]). MRSA strains were more likely to be resistant to mupirocin than MSSA strains (22.5% vs 3.0%, P < .001). The emergence of drug resistance makes the policy of decolonization with nasal mupirocin a suboptimal strategy for the prevention of MRSA infections. In our study, less than 80% of MRSA strains were mupirocin susceptible. In patients colonized with MRSA at high risk for infection (eg, total joint replacement), other regimens such as intranasal povidone iodine may be preferable to mupirocin for patient decolonization.

Strategies for the implementation of a nasal decolonization intervention to prevent surgical site infections within the Veterans Health Administration.

ClinicalTrials.gov, identifier: NCT02216227.

Evaluation of the Antimicrobial Efficacy of Novel Antiseptic Nasal Swab Applied to Subject's Nares Colonized with Staphylococcus Aureus

<h3>Background</h3> Alcohol-based nasal antiseptics have recently been developed as an alternative to antibiotics. With the emergence of antibiotic resistant organisms and an effort towards antibiotic stewardship, the use of topical antiseptics for nasal decolonization of Staphylococcus aureus (S. aureus) has become a subject of interest in healthcare. This study evaluated the antimicrobial efficacy of an alcohol-based antiseptic nasal swab for the reduction of S. aureus and total bacteria in the nares of human subjects. <h3>Methods</h3> Baseline samples were taken by swabbing both nares and pooling the samples. The S. aureus and total bacteria levels were determined by plating the samples on HardyCHROM™ and/or Tryptic Soy Agar for 24 and 48 hours respectively. Subjects had both nares randomly treated with a test (62% Ethanol) or control (Saline) nasal swab. Bacterial samples were taken from both nares 30 seconds post-application. S. aureus and total bacteria levels were similarly determined. Reductions in bacterial counts were calculated for each subject by subtracting the CFUs after treatment from the baseline CFUs. <h3>Results</h3> Data from 58 subjects (38 test and 20 control) who were screened for ≥ 3.7 log10 colony forming units (CFUs) of S. aureus and total bacteria was analyzed. Antiseptic treatment reduced S. aureus colony forming units from baseline by 98.8% compared to a 39.7% reduction in nares treated with the control swab. Antiseptic treatment reduced total bacteria colony forming units from baseline by 91.9% compared to a 32.4% reduction in nares treated with the control swab. <h3>Conclusions</h3> This alcohol-based antiseptic was shown to be effective in reducing S. aureus and total bacteria levels in the human nares after only one application. Nasal decolonization with alcohol-based antiseptic swabs may provide an effective and safe alternative to povidone-iodine (PVP) or antibiotic treatment to reduce nasal bacterial levels.

Alcohol-based Nasal Decolonization and Chlorhexidine Bathing to Reduce Methicillin-resistant Staphylococcus Aureus Hospital-acquired Infections in Critical Patients

<h3>Background</h3> Infections associated with multi-drug resistant organisms [MDRO] are difficult to treat due to antibiotic resistance, increased mortality, prolonged length of stay, and hospitalization costs. Patients severely immunocompromised, such as patients in the intensive care unit [ICU], are often at higher risk. The purpose of this pilot study was to evaluate the effectiveness of a universal decolonization protocol within the critical care population of a large academic medical facility. The approach utilized an alcohol-based nasal decolonization agent and chlorhexidine gluconate [CHG] bathing to reduce hospital-acquired laboratory identified (LabID) methicillin-resistant Staphylococcus aureus (MRSA) blood infections. <h3>Methods</h3> The pilot included admitted ICU patients meeting inclusion criteria from February 2021 to July 2021. Education and integration of orders occurred in January 2021. Patients received nasal decolonization twice daily, along with daily CHG bathing. LabID MRSA blood events were recorded in the National Healthcare Safety Network [NHSN]. Infections were tracked pre-and-post implementation to evaluate intervention effectiveness. Baseline data was collected from July 2020 to December 2020 from the NHSN database. <h3>Results</h3> There was a noted reduction of LabID MRSA hospital-associated infection [HAI] events, decreasing from eight events pre-implementation (July 2020 – December 2020) to three events post-implementation (February 2021-July 2021). While not deemed statistically significant for this short study period as indicated by a two-tailed t-test (p-value 0.19, CI 95% [-0.56,2.23]), the overall reduction in HAI should be considered relevant to patient outcomes and overall infection prevention considerations. <h3>Conclusions</h3> The use of decolonization protocols has consistently been associated with improved outcomes and reduction of MRSA infections within literature. Reduction of infection is crucial for patient safety and quality outcomes. This pilot study noted a 62.5% decrease in hospital-associated LabID MRSA infection events after implementation of an alcohol-based nasal decolonization agent in combination with CHG bathing for ICU patients. This is in alignment with other published studies.