Putting the New AORN Guidelines into Practice with Profend® Nasal Decolonization Kit and Prevantics® Skin Products
In May 2021, AORN released the e-publication of their newly updated Guideline for Preoperative Patient Skin Antisepsis (with book publication sometime in 2022)1. Along with skin antisepsis, this update includes a recommendation for nasal decolonization, a comprehensive review of program implementation, and the recommendation for skin antisepsis. This is exciting news as the PDI Prevantics® skin products and Profend® Nasal Decolonization Kit fit nicely within the guideline recommendations to keep patients safe and reduce the risk of surgical site infection (SSI).
Preventing SSI’s Through Nasal Decolonization
The primary objective of decolonization is to decrease the bacterial load of both the body and the nares.
Highlighting the risk our flora can play in developing an SSI, 30% of healthy adults have Staphylococcus aureus on their skin and in their nares2, and 80% of S. aureus SSIs can be attributed to the patient’s own flora3,4. It is important to note that S. aureus is a leading causative pathogen of SSI per the National Healthcare Safety Network (NHSN) reporting5 and nasal colonization with this organism increases the risk of SSI development up to 9 times2, 6-7. While mupirocin (a topical antibiotic) has historically been the gold standard for nasal decolonization, concerns with resistance and patient compliance have driven the science to support antiseptic efficacy. Povidone-iodine is now considered a viable option for successful nasal decolonization.
For many facilities, implementation of a nasal decolonization program is no small task! The guidelines outline the considerations for successful implementation (complete with supporting reference materials): from convening of an interdisciplinary team to assess patient/procedure risk to deciding on product type (antibiotic versus antiseptic), then to the selection of implementation strategy (universal, targeted, or blended), determination of protocol, and the selection of patient population and educational needs for sustainable use and compliance.
Profend® Nasal Decolonization Kit, a 10% povidone-iodine (PVP-I) product for nasal decolonization, fits nicely into the updated guideline recommendations to provide an effective and efficient patient safety intervention for the prevention of SSI. Profend® swabsticks are a broad-spectrum antiseptic providing gram-positive, gram-negative coverage and Candida sp. (antimicrobial) efficacy8. Following a 60 second application, Profend® antiseptic kills 99.7% of S. aureus at 10 minutes and 99.9% at 12 hours9– providing adequate/ample coverage during the patient’s most high-risk peri-operative period. Profend® Nasal Decolonization Kit fits into all strategy types mentioned, can quickly be applied with standing physician order or nurse-driven protocols, and efficiently fits into preoperative workflow. Profend® swabsticks will proactively defend patients from infection while also providing protection to patients with urgent surgical needs. Implementation of Profend Nasal Decolonization Kit includes robust education of staff, as well as materials for patient education, to drive compliance and sustainable use of this important intervention.
Along with meeting AORN guidelines for nasal decolonization, povidone-iodine is also supported by the Centers for Disease Control and Prevention (CDC) Strategies10 published in 2019 and provides anti-staphylococcal coverage per the Society for Healthcare Epidemiology of America/Infectious Disease Society of America (SHEA/IDSA) 201411 recommendation.
Additional Intervention Methods to Prevent SSI’s
Nasal decolonization is not the sole intervention to prevent SSI; it is part of a larger group of interventions included in the new AORN guideline: preoperative bathing, surgical site hair removal (when indicated), and selection and application of surgical site antiseptic. Specifically, regarding skin antisepsis, the following recommendations around product selection are included:
- Select an alcohol-based antiseptic based on the patient assessment, and the surgical anatomic site.1 [Recommendation]
- Purchase selected skin antiseptic products packaged in single-use containers. [Recommendation]
- In November 2013, the FDA issued a Drug Safety Communication requesting that manufacturers package antiseptics indicated for preoperative skin preparation in single-use containers to reduce the risk of infection from improper antiseptic use and contamination of products during use.1
- No recommendation can be made for selection of surgical skin preparation products labeled as sterile. [No Recommendation]
- The FDA Drug Communication issued in November 2013 encouraged manufacturers of OTC topical antiseptics for preoperative skin preparation to label their products as sterile or nonsterile. The Drug Communication clarifies that the term nonsterile on the product label does not indicate that the product contains harmful bacteria but designates that the product did not undergo a manufacturing process to eliminate all potential microorganisms. The FDA communication does not require manufacturers to produce sterile products or consumers to use only sterile products. Instead, the FDA continues to monitor and evaluate risks related to microbial contamination and recommends that health care professionals not dilute the products or use them beyond their expiration dates.1
Antiseptic Coverage to Prevent SSI’s
PDI Prevantics® skin swabsticks are ideal for vascular access device (VAD) placement/ care/maintenance and minor surgical procedures. The Prevantics® Swabstick and Maxi Swabstick have a 7-day continued antimicrobial activity on the skin (aligning nicely with central line dressing change schedules and during the postoperative period), and pre-saturated swabsticks do not require cracking of a glass ampule. The dual-sided nature of the Swabstick’s applicator tip, in addition to a low profile with squared edges, makes it easy to navigate around an insertion site during VAD maintenance without fear of dislodging the catheter; the soft applicator tip is also gentle on the skin. The Prevantics® Maxi Swabstick provides ample solution to give antiseptic coverage to minor surgical procedures.
- E-release of AORN Guideline for Preoperative Patient Skin Antisepsis: https://aornguidelines.org/
- Anderson MJ, David ML, Scholz M, et al. Efficacy of skin and nasal povidone-iodine preparation against mupirocin-resistant methicillin-resistant staphylococcus aureus and S. aureus within the anterior nares. Antimicrob Agents Chemother. 2015;59(5):2765-2773 [IIB].
- Global guidelines for the prevention of surgical site infection. Geneva, Switzerland: World Health Organization; 2016 [IVB].
- Schweizer M, Perencevich E, McDanel J, et al. Effectiveness of a bundled intervention of decolonization and prophylaxis to decrease gram positive surgical site infections after cardiac or orthopedic surgery: Systematic review and meta-analysis. BMJ. 2013;346:f2743. http://www.bmj.com/content/346/bmj.f2743.abstract. doi: 10.1136/bmj.f2743 [IIA].
- Weiner-LastingerLM, Abner S, Edwards JR, et al. Antimicrobial-resistant pathogens associated with adult healthcare-associated infections: Summary of data reported to the National Healthcare Safety Network, 2015-2017. Infect Control Hosp Epidemiol. 2020 Jan;41(1):1-18.
- Moroski NM, Woolwine S, Schwarzkopf R. Is preoperative staphylococcal decolonization efficient in total joint arthroplasty. J Arthroplasty. 2015;30(3):444-446 [IIIB].
- Rezapoor M, Nicholson T, Tabatabaee RM, Chen AF, Maltenfort MG, Parvizi J. Povidone-iodine-based solutions for decolonization of nasal staphylococcus aureus: A randomized, prospective, placebo-controlled study. J Arthroplasty. 2017;32(9):2815-2819 [IB].
- PDI in vitro Study PDI-0113-KT1
- PDI in vivo Study PDI-0113-CTEV01.
- Strategies to prevent hospital-onset staphylococcus aureus bloodstream infections in acute care facilities. Healthcare-associated Infections Web site. https://www.cdc.gov/hai/prevent/staph-prevention-strategies.html#. [IVB].
- Compendium of strategies to prevent healthcare-associated infections in acute care hospitals: 2014 update. The Society for Healthcare Epidemiology of America (SHEA): Practice Resources Web site. https://www.shea-online.org/index.php/practice-resources/41-current-guidelines/417-compendium-of-strategies-to-prevent-healthcare-associated-infections-in-acute-care-hospitals-2014-update