The need for a suitable alternative
to antibiotic agents led to the development of an alcohol
based nasal antiseptic (Nozin) specifically designed
for daily decolonization,
the alcohol based nasal antiseptic
can immediately kill 99 percent of Staph aureus organisms
in the nares, which is the main reservoir for MSSA
and MRSA.
Alcohol based nasal antiseptics have
been found to be well tolerated by both patients and staff.
They demonstrate a 12 hour persistence
and they really offer an ideal solution
to all the problems associated with antibiotic use.
So what does adoption of a universal nasal decolonization
strategy yield in terms of clinical outcomes
for our patients and the economic benefits
for our health care organizations?
You are about to hear from these pioneering colleagues who
represent hundreds of innovative hospitals
across the country that have implemented
universal decolonization programs using an alcohol based
nasal antiseptic.
They are going to share their real world success stories
and tell you how this programmatic approach impacted
the incidence of MSSA and MRSA infection rates
on their ICU patients, their general ward patients
and their surgical patients.
And furthermore, they are going to tell you
how it impacted patient satisfaction, health care
providers' satisfaction and the hospital budget.
If these alcohol based nasal antiseptics
had been available during my days in public health
we could have in good conscience recommended
universal decolonization to our providers.
And that would have released them
of the burden of maintaining MRSA colonized patients
in contact precautions.
You know, these types of results are vital for any provider
organization that seeks to thrive
in this value based health care environment that we
live in today.
There is no doubt we are in an ongoing battle
with this old enemy.
This is very significant health care pathogen but the good news
is we have gotten a winning battle plan.
We can do this and we have to do this
for the sake of our patients.
There are two types of nasal antiseptics the povidone
iodine and the alcohol.
And we chose the alcohol based on its published evidence
of efficacy, clean and really easy
application lower cost and really positive feedback
from staff and patients.
So we designed a 12 month project
to assess the impact of universal nasal decolonization
as a replacement for targeted screening and contact precautions
20% to 40% of the general population
is colonized so really targeted screening
misses a significant number of patients who were colonized
and potentially spreading staph throughout the facility.
So compared to baseline between April 2018 and March 2019
we had a reduction in MRSA bacterimia
from 3 per 1,000 patient days to zero per 1,000 patient days.
A reduction in contact precautions from 3.78 to 1.53
per 1,000 patient days.
That's more than a 50% reduction and a reduction
in nasal screens.
This one amazes me, we had 3,874 the year prior. 605 five.
We had a reduction of all cause both gram negative
and gram positive bacteria SSIs after surgical procedures
from three and 4,318 to zero and 4,872 procedures.
And after accounting for the cost of the nasal antiseptic
the reduction in gowns, and gloves and the nasal screening
tests,
we had $104,100 in savings.
There is an average of about $18,000
is the cost of treatment.
So if we add that to our savings we realize over
$600,000 in cost avoided.
So with that
universal decolonization we did an alcohol
based nasal antiseptic twice daily and then CHG bathing.
Well, after we did that, after a year, our results
we saw a 38% reduction in the incidence of contact precautions.
And we also had savings of $200,000,
which was the reduction of our gowns gloves and PCR testing.
And again this is the hard costs.
This isn't any potential of infections
that we'd have to treat.
We had some really, really amazing results.
So during the study period we had 186 orthopedic surgeries
and we thought a 98 percent reduction in total hip SSIs
from 1.15 infections per 100 procedures
to 0.017 infections per 100 procedures.
So given that success we're going to continue doing this
process and I cannot imagine not doing it because as Scott was
saying you have the satisfaction of your staff you decrease that
isolation fatigue and you really bring back that importance
of why we put patients on precautions to begin with.
So in the 17 months following the new protocol Staphylococcus
aureus surgical site infection rates for orthopedic spine
and breast procedures decreased by 50.7 percent
from 0.148 per 100 procedures, which
was with the PVI nasal antiseptic, to zero points,
I'm sorry, 0.073 per 100 procedures with the alcohol
nasal antiseptic.
This was statistically significant decrease
with P value of 0.08.
We subsequently expanded the new preoperative universal decolonization
to all surgical patients.
So all our patients when they come in they
receive the alcohol based nasal antiseptic and the CHG bathing.
So building on our success and our nasal decolonization journey
we have provided our patients with a cleaner, more pleasant
and cost effective product.
Our leadership was excited by annualized savings
of $223,000 which was achieved as a result of reducing
the incidence of nasal screening, the contact
precautions and associated with the prevented SSIs.
This is a refreshing way to treat our patients.
We just have positive feedback.
I actually spent about six months
researching different products and came up
with alcohol based and nasal antiseptic product
and I said OK what population do I want to use this on.
And I felt like going with every single patient in our facility
would be the best approach. With that particular execution
initiation of that protocol,
we've been able to maintain a low MRSA bloodlet ID rate
of 0.07 per 1,000 patient days.
We were able to reduce our isolation
days by 42% and our PCR test cost by 74%.
And so with a total cost savings of $1.3 million.
We are 560 something bed facility
so we are a large facility with a high admission rate.
Yeah, we've been able to really see the success of that
and had very good feedback from all the practitioners.