ist for surgical services at St. Elizabeth Boardman, which trialed and
implemented nasal antiseptic decolonization to its SSI bundled inter-
ventions a few years ago to address a widespread MRSA problem,
knowing that nasal S. aureus is a major risk factor for a surgical site
infection.
Among the hospital's total joint and colon resection patients, the
MRSA infection rate had been as high as 16.4% in 2013. Yes, nearly 1
of every 6 total joint and colon resection patients contracted a surgi-
cal site infection. The hospital fought back with an infection preven-
tion bundle that included:
• a night before/morning of protocol consisting of cleansing with
antibacterial soap the night before, CHG bath cloths the night
before/morning of surgery, and instructions to don clean pajamas and
to sleep in freshly laundered bedding;
• CHG and isopropyl alcohol skin prep in surgery; and
• MRSA swab testing of patients (if positive result, treatment
ordered).
The 3-pronged plan looked good on paper, but the MRSA infections
persisted among joint and colon resection patients. Turns out, there was
a timing problem. The hospital would swab-test for MRSA during pre-
admission testing, but wouldn't always have MRSA results at the time of
surgery, says Ms. Sliwinski.
The fix was simple: With the advent of povidone iodine and ethanol
nasal decolonization products, the hospital decided to decolonize all
joint and colon patients on the morning of surgery, as well as wash their
skin with a CHG wipe. The one-two punch of nasal and skin decoloniza-
tion worked. By 2017, the infection rate among joint and colon patients
was down to 3.1% throughout St. Elizabeth Boardman and 2 local affili-
ated hospitals, which also implemented universal decolonization with
nasal swabs and CHG wipes as an adjunct to infection control meas-
8 2 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • M A R C H 2 0 1 9
