Issue link: https://beckershealthcare.uberflip.com/i/981659
22 Executive Briefing Intensive care units – lessons from the REDUCE study In 2013, the results of a study of more than 74,000 adult ICU patients addressed a critical question regarding nasal decolonization strategy. Designed with three treatment arms, the study demonstrated that universal nasal and body skin decolonization of patients, without screening for nasal carriage, was more effective than screen-and-isolate as well as screen- and-decolonize protocols in reducing MRSA infection isolates and all-cause blood stream infections. This identification of the most effective decolonization approach would provide the path for most institutions, if it were not for the fact that nasal decolonization was achieved using mupirocin. Because of concerns for an antibiotic use that would unnecessarily treat patients, the substantial majority of whom were neither S. aureus (about 70 percent) nor MRSA (about 95 percent) colonized, the only acceptable option for many hospitals was the less effective, costlier screen-and-treat protocol. With the availability of antiseptics for nasal decolonization, especially the Nozin® antiseptic that was designed for regular daily use, the concerns regarding the development of bacterial resistance to mupirocin are now removed. The Nozin® universal nasal decolonization protocol can be used to optimize infection rate reduction while eliminating the costs of screening. This approach can be expanded to other groups with high susceptibility to infection, including those immunocompromised or critically ill, as well as to use by healthcare staff in contact with patients. Since the Nozin® antiseptic is a pleasant and easily applied option, use by visitors could provide additional safety for these patients. The dilemma of contact isolation precautions There is currently a great deal of discussion surrounding the pros and cons of the elimination of contact isolation precautions. The situation is complex and involves decisions about how best to care for high-risk admissions to the hospital with a history of MRSA colonization and those on the "Hot List" with a high likelihood of carriage based on transfer from long-term care facilities, advanced age, medical conditions, etc. Taking a broad view, the dilemma might be depicted as follows: On the right side are the general admissions to the hospital that are determined to warrant screening for MRSA carriage. For the sake of discussion, we will assume that this group constitutes about 25 percent of those admitted. Of this group, those patients who screen positive will enter CP (perhaps 10 percent in this "enriched" cohort). In many cases, their carriage will go untreated. The other 90 percent will move to standard precautions. Of the large, unscreened group on the left, statistically, about 5 percent can be expected to carry MRSA and 30 percent to carry S. aureus into the hospital. But these carriers are not identified, and the infection risk they pose, which could be comparable to that on the right, is not being addressed. Of those screening positive on the right, many remain colonized, despite our understanding that about 80 percent of the infections they will incur will be through self-inoculation. A straight-forward solution to the infection risk represented on both sides of the diagram would be to decolonize everyone upon admission with a nasal antiseptic and continue to do so for the duration of their stay. By avoiding CP, this would facilitate the flow of admitted patients to their rooms, improve nursing care and increase patient satisfaction. The overall MRSA and MSSA colonization pressure in the facility would be reduced. Staff would be relieved of the fatigue of repeated gownings for the isolation protocol. Significant direct cost savings from eliminating screening and personal protective equipment use in CP would greatly exceed the cost of antiseptic treatments. CP reduction using the Nozin® product represents one of several unique opportunities to reduce the risks of nasal colonization that have never before been considered because of concerns for unnecessary antibiotic use. In a one-year study at Marshall Medical Center, a 113-bed acute care hospital in Placerville, Calif., the goal was to maintain low MRSA infection rates while eliminating CP for all but actively infected patients. In the prior three years at this facility, all patients actively infected, colonized or with a MRSA history were put in CP. The one-year protocol decolonized these patients using the alcohol-based Nozin® antiseptic and bathing with chlorhexidine wipes on a daily basis but isolated only those with active infections. The authors reported direct cost savings totaling more than $64,000 from the prior year. Acquired infection rates for the prior three years and one-year study remained at 0.13/1000 patient days. Conclusions New protocols utilizing nasal decolonization with Nozin® Nasal Sanitizer® provide welcome innovation for better healthcare with lower costs. These clinically proven Nozin programs can lower infection risk associated with nasal carriage in ICUs, ORs and other high-risk situations that could not be addressed in the past. An important program feature includes responsibly reducing screening and contact isolation precautions for MRSA colonization. Future utilization may support reducing colonization pressure throughout healthcare and related community environments. As Nina Deatherage, RN, BSN, CIC and Infection Control Lead at Marshall Medical Center, said, "The use of Nozin® with our MRSA colonized patients enables us to actively reduce the bacterial carriage of those who might be contributing to transmission and to lessen the environmental burden of potential pathogens." n Global Life Technologies Corp. is the leader in nasal decolonization with Nozin® infection prevention programs designed to improve care, lower infection risk and reduce healthcare costs. These programs utilize Nozin® Nasal Sanitizer® antiseptic with clinically supported solutions for healthcare facilities, their patients and the providers who care for them. Visit Nozin.com.