M A Y 2 0 1 9 • O U T PA T I E N T S U R G E R Y. N E T • 6 5
concentration of MRSA in the nose returned to the pre-application
baseline.
"Additional studies are needed to determine if repeated applica-
tions and more alcohol doses are needed to get rid of MRSA,"
says Dr. Kanwar. "Even though you're able to stop [MRSA] tran-
siently [with alcohol], if it's coming right back, you're not achiev-
ing the desired outcome."
He says alcohol-based nasal antisepsis provides instant treat-
ment, but patients are still at risk of developing SSIs when the
sanitizing effects wear off in 2 to 6 hours. Mupirocin's action, on
the other hand, is prolonged. "What we want is a permanent
reduction in the MRSA colony count in the nose," he explains.
"We're not at that point yet with alcohol."
Dr. Kanwar adds that resistance to mupirocin is a concern, but
it's not a major concern, at least not yet. He says povidone-iodine
nasal treatment has exciting possibilities, but it's too early to con-
clude that it will replace mupirocin.
The bottom line, he says: "We need to see more data from
head-to-head comparisons of all the options before we decide if
one is better than the others." — Joe Paone
and 0.2% in 2018. So far this year, it's 0.17%.
Clearly, effective pre-op nasal decolonization can reduce SSI rates.
Just as clearly, there are significant barriers to patient compliance.
For us, finding a simple and cost-effective method of administration
has helped us clear those barriers and has been a positive addition to
our continuing efforts to prevent avoidable infections.
OSM
Ms. Epstein (jepstein@che-east.org) is surgical services educator at Saint
Francis Hospital in Wilmington, Del.
