Nasal Iodine Research Articles

CSF Rhinorrhea After Endonasal Intervention to the Skull Base (CRANIAL) — Part 2: Impact of COVID-19

BackgroundDuring the coronavirus disease 2019 (COVID-19) pandemic, concerns have been raised regarding the increased risk of perioperative mortality for patients with COVID-19, and the transmission risk to healthcare workers, especially during endonasal neurosurgical operations. The Pituitary Society has produced recommendations to guide management during this era. We sought to assess contemporary neurosurgical practice and the effects of COVID-19.MethodsA multicenter prospective observational cohort study was conducted at 12 tertiary neurosurgical units (United Kingdom and Ireland). Data were collected from March 23 to July 31, 2020, inclusive. The data points collected included patient demographics, preoperative COVID-19 test results, operative modifications, and 30-day COVID-19 infection rates.ResultsA total of 124 patients were included. Of the 124 patients, 116 (94%) had undergone COVID-19 testing preoperatively (transsphenoidal approach, 97 of 105 [92%]; expanded endoscopic endonasal approach, 19 of 19 [100%]). One patient (1 of 116 [0.9%]) had tested positive for COVID-19 preoperatively, requiring a delay in surgery until the infection had been confirmed as resolved. Other than transient diabetes insipidus, no other complications were reported for this patient. All operating room staff had worn at least level 2 personal protective equipment. Adaptations to surgical techniques included minimizing drilling, draping modifications, and the use of a nasal iodine wash. At 30 days postoperatively, no evidence of COVID-19 infection (symptoms or positive formal testing results) were found in our cohort and no mortality had occurred.ConclusionsPreoperative screening protocols and operative modifications have facilitated endonasal neurosurgery during the COVID-19 pandemic, with the Pituitary Society guidelines followed for most of these operations. We found no evidence of COVID-19 infection in our cohort and no mortality, supporting the use of risk mitigation strategies to continue endonasal neurosurgery in subsequent pandemic waves.

1240. Evaluation of Preoperative Staphylococcus aureus (SA) Decolonization with Nasal Iodine for Hips/Knees and Fusion Surgeries

BackgroundPreoperative decolonization for patients with known nasal carriage of Staphylococcus aureus is recommended in some surgical site infection (SSI) guidelines, however, meaningful implementation is often challenging with poor compliance. We evaluated utilization of nasal iodine with S. aureus polymerase chain reaction (PCR) screening on the day of surgery as an alternative approach.MethodsFor all total hip replacements (THR), total knee replacements (TKR) and fusion patients in a 250-bed community hospital, we implemented day of surgery S. aureus PCR for all patients who had not been screened in the 2 weeks prior in August 2018. Those known to have S. aureus colonization in the 2 weeks prior to surgery as well as those who had no screen in the 2 weeks prior were treated with nasal iodine and received a chlorhexidine (CHG) bath in the preoperative area. Postoperatively any patient found to have (methicillin-resistant S. aureus) MRSA from preoperative screen or who had a history of MRSA in the past year were automatically decolonized with 5 days of intranasal mupirocin and CHG baths in addition. Compliance with S. aureus screening in preoperative area, results of screens and rates of THR, TKR and fusion SSI per National Health Safety Network (NHSN) definitions were monitored throughout the study period. SSI standardized infection ratios (SIR) during the study were compared with data 1 year prior to intervention date.ResultsBetween August 2018 and January 2019, 694 THR, TKR and fusion surgeries were performed. Preoperative nursing compliance with completing the SA screen was 79. 2% and percent compliance with administering/documenting nasal iodine was 77.8%. Of those screened 21.7% (126/578) were found to have SA. Only 15% (n = 19) of SA positive PCRs were positive for MRSA. SSIs decreased in intervention period compared with preintervention (August 2017–July 2018) as shown in Table 1.ConclusionPreoperative nasal iodine has been effective and helped reduce our infection SIR to below 1. These results could be confounded by the presence of other initiatives but looks promising and large-scale studies would be helpful to make these results generalizable. Disclosures All authors: No reported disclosures.

1237. Review of Implant Surgical Site Infections and Staphylococcus aureus Screening Compliance for 2018 at a Large Healthcare System

BackgroundSurgical site infections (SSIs) following hip arthroplasty (THA), knee arthroplasty (TKA) and spinal fusions result in substantial morbidity, mortality and increased cost. Guidelines recommend preoperative Staphylococcus aureus (SA) screening and decolonization; however, there are numerous logistical challenges with implementing this process. We reviewed compliance with SA screening and decolonization practices and relation to THA, TKA, and fusion SSI performanceMethodsPreoperative SA screening programs and associated data were reviewed for THA, TKA and fusion procedures between September and December 2018 across 9 hospitals in a large healthcare system. Compliance with preoperative SA screening was counted if SA nares culture or polymerase chain reaction (PCR) was completed at any point in the 28 days prior to surgery. This SA screening compliance snapshot was compared with year end 2018 SSI rates per 100 procedures and National Health Safety Network (NHSN) all SSI Standardized Infection Ratio (SIR). All 2018 SSIs were reviewed to determine whether infection was due to SA and for compliance with preoperative SA surveillance.ResultsOverall preoperative SA screening compliance for September through December 2018 was 49% (32%, 54% and 62% for fusions, THA and TKA respectively). Sixty-nine implant-related SSIs were identified in 2018. 33% were due to SA. 2018 all SSI rate per 100 procedures was 0.78 (1.437 with SIR of 1.05, 0.783 with SIR of 0.67, and 0.315 with SIR 0.45 for fusions, THA and TKA respectively). Only 36% (25/69) of all SSI and 30% (7/23) of SA SSIs had preoperative SA screening completed. (Table 1). While overall preoperative SA screening compliance was poor, day of surgery SA screening with immediate decolonization using nasal iodine was 75% compared with 58% and 44% for those screened at preoperative medical visit or by surgeon order.ConclusionOne-third of our implant surgeries were complicated by SSIs due to SA. Overall compliance with preoperative SA screening was poor however SSI rates trended down with higher preoperative SA screening compliance. Better operationalization of preoperative SA screening programs or further data on impact of day of surgery screening and immediate decolonization are needed. Disclosures All authors: No reported disclosures.

Use of CHG Cloths and Nasal Iodine to Reduce Surgical Site Infections in Orthopedic Infections

BACKGROUND: To reduce total knee and hip arthroplasty surgical site infections by decolonizing patients prior to surgery.

1025Impact of Nasal Decontamination with Nasal Iodine as part of a Preoperative Surgical Site Infection (SSI) Prevention Bundle in Orthopedic Implant Surgeries

Nasal iodine as a bundled approach can be a rapid and effective method for prevention of all Surgical Site Infections (SSIs) and also S. aureus SSIs in orthopedic implant surgeries by decontamination of the nares. The individual effect of nasal iodine in reduction of SSI in orthopedic surgeries will need to be determined in future studies, but this offers an alternative to screening and decolonization with mupirocin. Conclusion  Staphylococcus aureus is the leading cause of surgical site infections. 80 percent of S. aureus infections are caused by the patients own nasal flora. Nasal iodine (3MTM Skin and Nasal Antiseptic ) is effective for 1 to 12 hours post application and can be used for decolonization (reduces organism burden by 99.5% in the nares) Nasal iodine application is quick and generally done as a single application just prior to surgery. Background This study was conducted at Detroit Receiving hospital starting March, 2013.  This approach was used as part of a bundle which included perioperative CHG bathing and addition of vancomycin prophylaxis.  Infection rates for knee and hip surgeries were collected by infection control personnel during routine surveillance for surgical site infections. Infection rates were compared 1 year before and 1 year after intervention. Methods Results Background: Nasal carriage of Staphylococcus aureus (SA) has been shown to be an independent risk factor for SA surgical site infections (SSI), with a SSI rate 2-9 times higher in carriers. Decolonization with nasal mupirocin is often recommended for carriers or high risk individuals, however this process requires preoperative screening and patient compliance with application days prior to surgery. Nasal decontamination with nasal iodine just prior to surgery offers a rapid method of decreasing the nasal burden of SA in high risk joint implant surgeries. Methods: Nasal decontamination with nasal iodine (3MTM Skin and Nasal Antiseptic) of all patients undergoing hip and knee prosthetic joint replacement was implemented pre-operatively since March 2013 at Detroit Receiving Hospital. This intervention was coupled with reinforcement of perioperative CHG bathing and the addition of vancomycin to routine Blactam prophylaxis. Hip arthroplasty (HPRO) and knee arthroplasty (KPRO) infection rates were reviewed for 1 year before and after intervention. Results: There was a 43.25% reduction in HPRO and KPRO infections during this time period. A decrease in the average rate from 2.59 to 1.45 infections per 100 procedures (OR-0.56, p=0.24) was seen. SA infection were reduced from an average rate of 1.29 to 0.63 infections per 100 procedures (OR – 0.48, p=0.30). This resulted in a reduction of 5 infections and an approximate net cost saving of $142,409. Conclusions: Nasal decontamination with iodine offers an alternative to nasal decolonization with mupirocin in the prevention of orthopedic implant infections and was effective as part of a perioperative SSI prevention bundle.  A decrease in the average rate from 2.59 to 1.45 infections per 100 procedures (OR-0.56, p=0.24) was seen. {Rate of HPRO decreased from 2.1 to 1.86 infections per 100 procedures (OR-0.87, p=0.84) and rate of KPRO decreased from 3.07 to 1.12 infections per 100 procedures (OR0.36, p=0.14)}  SA infection were reduced from an average rate of 1.29 to 0.63 infections per 100 procedures (OR – 0.48, p=0.30).  This resulted in a reduction of 5 infections and an approximate net cost saving of $142,409. Surgical site Combined Hip and Knee prosthesis infections / # procedures by OR month x 100