Fran Lowry

May 15, 2015

ORLANDO, Florida — When patients undergoing spinal surgery swabbed the inside of their noses with a topical antiseptic before the procedure, there was a dramatic reduction in surgical-site infections, researchers report.

"I don't know why use of this antiseptic has not been more widely taken up. Certainly our results are very compelling," said Nicholas Flynn, MD, from the University of Tennessee in Nashville. "This may be because there have been no randomized trials."

Dr Flynn presented the results here at the Society for Healthcare Epidemiology of America Spring 2015 Conference.

"Healthcare-associated infection is one of the 10 leading causes of death in the United States, and nasal carriers of Staphylococcus aureus make up a good percentage of those infections," Dr Flynn reported.

In fact, 80% of the people who experience surgical-site infections are nasal carriers of S aureus, he told Medscape Medical News.

The study involved 9135 patients who underwent spinal surgery. Patients were instructed to swab their nostrils with a 5% povidone–iodine solution (3M Skin and Nasal Antiseptic) 1 hour before surgery, under the supervision of a nurse.

The antiseptic "kills locally on the skin 99.5% of the S aureus species that are lurking in the nasal mucosa, but for some reason, it is not commonly used in this regard," said Dr Flynn.

I don't know why this has not been more widely taken up. Certainly our results are very compelling.

Rates were compared in patients who underwent spinal surgery before and after the intervention.

The decrease in the rate of postoperative infection — from 63 of 5154 patients (1.22%) in the preintervention group to 18 of 3981 patients (0.45%) in the postintervention group — was significant (P = .0029).

There was no trend in the infection rate prior to the intervention. In all, the infection rate for any month was 1.04 times the infection rate in the previous month (95% confidence interval, 0.98 - 1.10), Dr Flynn reported.

"I would like to see this studied more broadly in other surgical realms, not in just spinal surgeries, and in larger populations to see if the results we were able to achieve can be duplicated," he told Medscape Medical News.

The findings "are quite interesting and compelling," said session comoderator Kalpana Gupta, MD, from the Veterans Administration Health System in West Roxbury, Massachusetts.

"The main advantages I see are that it's relatively easy to apply and it can be given in the acute perioperative setting rather than requiring a preoperative visit with 5 days of decolonization. That helps improve compliance, and also improves the feasibility and logistics of getting the decolonization protocol underway," Dr Gupta told Medscape Medical News.

"I'd like to see some more outcomes in terms of long-term findings," she added. Dr Gupta also questioned whether the researchers are going to conduct a randomized controlled trial.

Dr Flynn and Dr Gupta have disclosed no relevant financial relationships.

Society for Healthcare Epidemiology of America (SHEA) Spring 2015 Conference: Abstract 1809. Presented May 14, 2015.


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