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3 6 • O U T P A T I E N T S U R G E R Y M A G A Z I N E • F E B R U A R Y 2 0 2 1 antiseptic to all total hip and knee patients in pre-op. The universal approach is easier to implement. It might prove a little more expen- sive than targeted decolonization, but it does ensure that no one is missed. During the trial, patients received three ampules of the alcohol-based nasal antiseptic swabbed in each of the nares in the preoperative department one hour prior to surgery, and one ampule twice daily post-operative- ly for several days. Our SSI rate was already extremely low before conducting the trial due to the implementation of other infection prevention pro- tocols, including CHG bathing in the days leading up to surgery, pre- and post-opera- tive teaching on how to care for the surgical wound and requiring infection preventionists to report SSI rates directly to the surgeons. However, we were thrilled with the results: The new nasal decoloniza- tion protocol resulted in a reduction in the total knee SSI rate from 0.36 to 0.00 per 100 procedures. We had similar results with total hip arthroplasties, lowering the SSI rate from 0.91 to 0.00 per 100 cases. The average incidence of SSIs after total joint arthroplasty is 2% to 2.4% and the average cost asso- ciated with a postoperative prosthetic joint infec- tion has been estimated to exceed $100,000. The results of our study equate to the prevention of four total joint infections every year, an estimated asso- ciated total cost avoidance of more than $400,000 annually. The reduction in cost to our facility was greater than anticipated. Treating joint infections is a significant expense for the hospital, and it's seri- ous issue for patients, because it delays their ability to return to life routines or work, not to mention the pain caused by the infection and the inconve- nience of a revision surgery. During the trial, the hospital's infection prevention team sent recurring emails and held regular in-per- son meetings to discuss the trial's progress. The team provided monthly written updates via email to the Ms. Franklin (sfranklin1943@yahoo.com) is recently retired from her role as an infection preven- tionist at WellStar Cobb Hospital in Austell, Ga. staff and at the end of the trial, emailed an online sur- vey to team members to gauge their thoughts of the results. Over 90% of respondents were satisfied with the ease of use of the alcohol-based nasal antiseptic and said they would recommend it to colleagues in other departments and hospitals within the health system. Overall, staff members reported that the anti- septic was easy to apply and took little time to administer. As a result, my hospital decided to imple- ment a standing order for preoperative application of the nasal antiseptic instead of requiring and relying on individual surgeon orders. Proof positive An unanticipated and encouraging benefit that we discovered after standardizing the use of the nasal antiseptic was the appreciation patients expressed about our proactive approach to infection preven- tion. They're thankful for the decolonization protocol because it shows that we're willing to go the extra mile to keep them safe. Identifying ways to save money while also improving patient safety and satis- faction are significant benefits worth exploring. OSM FAST-ACTING Staff and patients appreciate the easy application method of an alcohol-based antiseptic. Kate Johnston, St. Francis Hospital