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Nasal Decolonization and HAI Prevention: Applications and Evidence

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The normal flora residing in the nose is wide-ranging and includes Staphylococcus aureus, Corynebacterium diphtheriae, Streptococcus pneumoniae, Haemophilus influenza, Streptococcus, Neisseria, Haemophilus, and Micrococcus.26 Mupirocin is effective active against streptococci and staphylococci, but not corynebacteria, micrococci, and the anaerobic propionibacterium spp. The newer nasal antiseptics containing PVI or alcohol are effective against all organisms found commonly and transiently in the nose including bacteria, virus and fungus.27-28 Studies of nasal decolonization for SSI prevention would be rated as follows: Mupirocin nasal decolonization = High; Antiseptic nasal decolonization = Moderate.

As the quest for zero sustained healthcare associated infections of all types continues, it will be important to become familiar with all products designed to reduce the risk of developing and transmitting HAI.  Alcohol and iodine based nasal antiseptics, may provide opportunities to reduce the environmental burden of nasal pathogens within healthcare settings in ways that have never before been accessible. 

Future areas of evidence-building to strengthen the effectiveness of our infection prevention efforts might potentially include:
- Patient nasal decolonization during post op period with antiseptic bathing for continuing SSI prevention;
- Surgeon and perioperative staff nasal decolonization prior to high risk surgical procedures for further SSI prevention;
- Healthcare provider nasal decolonization prior to high risk non-surgical invasive procedures such as CVC insertion, cardiac catheterization for CRBSI and sepsis prevention;
- Healthcare worker nasal decolonization especially during flu season to help reduce presenteeism (working while sick) and absenteeism;
- Screening to identify asymptomatic carriage of MRSA among healthcare workers and the optimal management (e.g., decolonization therapy, follow-up monitoring) of MRSA-colonized healthcare workers;
- Epidemiology and prevention of MRSA among family members and other close contacts of patients colonized or infected with MRSA.

Sue Barnes is currently the national program leader for infection prevention and control for Kaiser Permanente’s eight regions, 38 hospitals and 630 medical offices. She plans to retire from Kaiser and begin the second chapter of her career in mid-October 2016, as an independent clinical consultant.  She is board-certified in Infection Control and Prevention. She has been in the field of Infection Prevention since 1989.  She has participated in the development of the APIC Guide to Elimination of CRBSI, APIC Guide to the Elimination of Infections in Hemodialysis, APIC Safe Injection Practices Position Paper and APIC Training Program for Infection Prevention in Ambulatory Care. She is a subject matter expert consultant and speaker for organizations including AORN and APIC.  In addition Barnes has been published in journals including AORN Journal, American Journal of Infection Control, the Joint Commission Source for Compliance Strategies and The Permanente Journal. She served on the National APIC Board of Directors from 2010 to 2012, and was selected to represent APIC on the TAP (technical advisory panel) of the National Quality Forum (NQF) on Healthcare Associated Infections (HAI) and the NQF ESRD Steering Committee. She is the 2016 president of the SFBA APIC chapter and the 2016 president of the California APIC Coordinating Council. 

References:
1. Goat GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008; 336(7650):924–926.
2. George S, Leasure AR, Horstmanshof D. Effectiveness of decolonization with chlorhexidine and mupirocin in reducing surgical site infections: A systematic review 2016 Dimensions of Critical Care Nursing 35 (4), pp 204-222.
3. Kalra L, Camacho F, Whitener CJ, Du P, Miller M, Zalonis C, Julian KG.  Risk of methicillin-resistant Staphylococcus aureus surgical site infection in patients with nasal MRSA colonization.  Am J Infect Control. 2013 Dec; 41(12):1253-7.
4. Coates T, Bax R, Coates A. Nasal decolonization of Staphylococcus aureus with mupirocin: Strengths, weaknesses and future prospects. 2009 Journal of Antimicrobial Chemotherapy 64 (1), pp 9-15.
5. Cookson BD (January 1998). "The emergence of mupirocin resistance: a challenge to infection control and antibiotic prescribing practice". J. Antimicrob. Chemother. 41 (1): 11–8.
6. Sai N, et al. Efficacy of the decolonization of methicillin-resistant Staphylococcus aureus carriers in clinical practice.  Antimicrob Resist Infect Contr (2015) 4:56.
7. Bactroban Prescribing Information FDA: http://www.accessdata.fda.gov/drugsatfda_docs/label/2014/050591s032,050703s015,050746s018lbl.pdf 
8. Bebko SP, Green DM, Awad SS. Effect of a preoperative decontamination protocol on surgical site infections in patients undergoing elective orthopedic surgery with hardware implantation 2015 JAMA Surgery 150 (5), pp 390-395.
9. Anderson MJ et al. Efficacy of skin and nasal povidone-iodine preparation against mupirocin-resistant methicillin-resistant Staphylococcus aureus and S. aureus within the anterior nares. 2015 Antimicrobial Agents and Chemotherapy 59 (5), pp. 2765-2773.
10. GRADE. Canadian Task Force on Preventive Health Care website http://canadiantaskforce.ca/methods/grade/
11. Beydoun, K, Bearman, G. Prevention of healthcare-associated infections in staff and patients (Book Chapter) 2015 Clinical Infectious Disease, Second Edition pp.698-702. © Cambridge University Press (2008) 2015.
12. Hidaka H, Miura M, Masunaga K, Qin L, Uemura Y, Sakai Y, Hashimoto K, Kawano S, Yamashita N, Sakamoto T, Watanabe H. Infection control for a methicillin-resistant Staphylococcus aureus outbreak in an advanced emergency medical service center, as monitored by molecular analysis. J Infect Chemother. 2013 Oct; 19(5):884-90.
13. Baratz MD, et al. Twenty Percent of Patients May Remain Colonized With Methicillin-resistant Staphylococcus aureus Despite a Decolonization Protocol in Patients Undergoing Elective Total Joint Arthroplasty. Clin Orthop Relat Res (2015) 473:2283-2290.
14. Schmid H, et al. Persistent nasal methicillin-resistant staphylococcus aureus carriage in hemodialysis outpatients: a predictor of worse outcome. BMC Nephrology (2013) 14:93.
15. Haill C, Fletcher S, Archer R, Jones G, Jayarajah M, Frame J, Williams A, Kearns AM, Jenks PJ. Prolonged outbreak of methicillin-resistant Staphylococcus aureus in a cardiac surgery unit linked to a single colonized healthcare worker. J Hosp Infect. 2013 Mar; 83(3):219-25.
16. Gidengil CA1, Gay C2, Huang SS3, Platt R4, Yokoe D5, Lee GM6. Cost-effectiveness of strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in an intensive care unit.  Infect Control Hosp Epidemiol. 2015 Jan; 36(1):17-27. 
17. Septimus E, Hickok J, Moody J2, Kleinman K, Avery TR, Huang SS, Platt R, Perlin J. Closing the Translation Gap: Toolkit-based Implementation of Universal Decolonization in Adult Intensive Care Units Reduces Central Line-associated Bloodstream Infections in 95 Community Hospitals. Clin Infect Dis. 2016 Jul 15; 63(2):172-7.  
18. Lachapelle JM. Antiseptics in the era of bacterial resistance: a focus on povidone iodine Clin. Pract. (2013) 10(5), 579–592.
19. Zimlichman E, et al. Healthcare associated infections a meta-analysis of costs and financial impact on the US healthcare system. JAMA Intern Med published online Sept 2, 2013.
20. Gray D, Foster K, Cruz A, Kane G, Toomey M, Bay C, Kardos P2, Ostovar GA4.  Universal decolonization with hypochlorous solution in a burn intensive care unit in a tertiary care community hospital.  Am J Infect Control. 2016 Apr 11. pii: S0196-6553(16)00159-0.
21. Karanika S, Zervou FN, Zacharioudakis IM, Paudel S, Mylonakis E.  Risk factors for methicillin-resistant Staphylococcus aureus colonization in dialysis patients: a meta-analysis.  J Hosp Infect. 2015 Nov; 91(3):257-63.
22. Ziakas PD, Zacharioudakis IM, Zervou FN, Mylonakis E. Methicillin-resistant Staphylococcus aureus prevention strategies in the ICU: a clinical decision analysis.  Crit Care Med. 2015 Feb;43(2):382-93.
23. Deatherage N. Impact of reduced isolation and contact precaution procedures on infection rates and facility costs at a nonprofit acute care hospital. American Journal of Infection Control 2016 44:6 (S101-S102). 
24. Lee, BY, Bartsch SM, Wong KF, Miller LG, Huang SS. Beyond the Intensive Care Unit (ICU): Countywide impact of universal ICU Staphylococcus aureus decolonization. American Journal of Epidemiology 2016. Mar 1; 183(5):480-9.
25. Sporer SM, Rogers T2, Abella L.  Methicillin-Resistant and Methicillin-Sensitive Staphylococcus aureus Screening and Decolonization to Reduce Surgical Site Infection in Elective Total Joint Arthroplasty.  J Arthroplasty. 2016 Sep; 31(9 Suppl):144-7. 
26. Kerr, McHale. Flora of the Nose and Throat. Applications in General Microbiology. 2003. Edition 6. p.331-335.
27. Maslow J, Hutzler L, Cuff G, Phillips M, Bosco J. Patient experience with mupirocin or povidone-iodine nasal decolonization. Orthopedics 37 (6), pp. e576-e581. 
28. Steed LL, Costello J, Lohia S, Spannhake EW, Nguyen S. Reduction of nasal Staphylococcus aureus carriage in health care professional by treatment with a non-antibiotic alcohol-based nasal antiseptic. 2014 American Journal of Infection Control 42 (8), pp 841-846.





 

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