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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. 

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