Reducing Risk of Healthcare-Associated Infections

Mitigating Staphylococcus aureus colonization risk at a primary source

Protecting patients from healthcare-associated infections (HAI) is a persistent challenge for healthcare professionals. According to a CDC study, about 4% of hospitalized patients develop at least one HAI^[1]. Also called nosocomial infections, HAIs can have wide-ranging impacts, affecting everything from patient outcomes to hospital reputation and loss of revenue. Although HAIs are preventable, many healthcare facilities struggle to find solutions that effectively mitigate risk.

Staphylococcus aureus (S. aureus) is a leading cause of HAIs, responsible for nearly 120,000 HAIs in 2017^[8]. S. aureus is a gram-positive bacterium that can cause a wide variety of potentially serious staph infections. Colonization and transmission of S. aureus continue to pose significant risk of HAIs.

According to the CDC, a systematic strategy for S. aureus risk mitigation is needed to make further progress^[3]. “We know infection prevention and control works but it’s not one-size-fits-all. Additional strategies, including decolonization, for example, may be needed in certain circumstances and patients, to ensure optimal prevention and the best outcome for the patients,” said Athena Kourtis, M.D, PhD, MPH, Associate Director for Data Activities in CDC’s Division of Healthcare Quality Promotion.

Clinical evidence points toward a mitigation strategy that more effectively addresses infection risks posed by S. aureus HAIs by targeting a primary source of colonization: patients’ noses. Colonization risk mitigation is the effort to reduce the risks associated with colonization. Addressing the risk by reducing pathogen levels in the nose helps reduce risk of infections associated with S. aureus including methicillin-resistant S. aureus (MRSA). By reducing pathogen levels in the anterior part of the nose, hospitals are directly reducing the most common and abundant place for S. aureus  to reside in a more effective and less resource-intensive manner than other traditional infection prevention measures that could require surveillance, testing and patient isolation with contact precautions.

This article will describe the risks associated with S. aureus colonization. It will identify challenges associated with existing protocols and share benefits and clinical outcomes that are being achieved through a colonization risk mitigation strategy.

What Can Be Done Today to Reduce risk of Healthcare-Associated Infections?

Nasal colonization risk mitigation is a proven strategy that helps hospitals reduce risk of HAIs through universal nasal decolonization of all patients who enter a facility. At least 20% of the population are permanent carriers of S. aureus nasal colonies, and an additional 30% are transient carriers^[9]. The carrier populations can contribute to the spread of MRSA and methicillin-sensitive S. aureus (MSSA) within healthcare environments and can lead to a greater risk of infection for the carriers themselves^[10]:

• Transient carriers of MRSA are 22.8 times more likely to develop invasive infections, including bacteremia^[10]
• Permanent MRSA carriers are 36.8 times more likely to develop invasive infections^[10]

By addressing a primary source of S. aureus colonization – the nose - hospitals that adopt a colonization risk mitigation strategy are experiencing results that include lower infection rates, improved staff utilization, and reduced costs.

Healthcare experts increasingly recognize the importance of nasal decolonization because the process reduces the chance of transmission by targeting a primary source of  S. aureus pathogens. In fact, several major health groups have updated their guidelines to provide facilities with guidance in addressing nasal colonization:

• The CDC recommends skin and nasal decolonization for ICU patients, those undergoing high-risk surgery, and any patients who have a central venous catheter or midline catheter^[11].
• The Society for Healthcare Epidemiology of America (SHEA) advises facilities to either universally decolonize all high-risk patients, or to screen, isolate, and decolonize surgical or ICU patients^[12].
• The Health Research & Educational Trust (HRET) has also suggested that healthcare organizations screen patients for MRSA and employ contact precautions for MRSA-infected or colonized patients^[13]. In a recent change package, HRET further advised facilities to evaluate whether colonization risk mitigation programs could reduce MRSA infections within their ICUs^[14].

Why Does Reducing S. aureus Infection Risk Remain a Challenge in Healthcare Facilities?

Traditionally, preventive measures in hospitals have included strategies like active surveillance testing (AST) – where patients are screened, and those that are MRSA colonized are isolated with necessary precautions to try to limit the spread of MRSA colonization. However, these traditional screen-and-isolate programs can be costly, and MSSA and MRSA infections nevertheless persist in the healthcare system. One reason for this is that patients infect themselves – studies have found that up to 80% of surgical site infections can be traced back to DNA in the patients’ own nasal colonies^[21].

Other infection prevention methods hospitals implement can include CHG bathing of patients, hand hygiene, environmental cleaning, proper use of personal protective equipment (PPE), following expert guidelines, and increased antibiotic stewardship initiatives^{[5, 6, 7]}. Efforts to curb S. aureus HAI decreased infection rates by 17.1% between 2005 and 2012. However, during subsequent years, the rate of decline has stagnated^[8].

Data also shows that hospital-acquired MSSA infection rates have not significantly changed from 2012-2017, while community-transmitted MSSA has increased by 3.9%^[8]. In 2017 alone, nearly 20,000 people died from S. aureus bloodstream infections^[3].

Given this data, it is clear that current infection prevention practices are not sufficiently reducing rates for the most common healthcare-associated infections^[3]. Facilities need to address S. aureus infections with a new paradigm that delivers better results.

The Solution: A Mitigation Program That Reduces HAIs

The Nozin NOVA^SM Colonization Risk Mitigation Program is a clinically proven approach that helps facilities reduce nasal S. aureus colonization in patients by offering a systematic way to understand and address the colonization risks throughout the facility.

Nozin NOVA^SM programs target the nose and reduce infection risk at this source, helping to prevent S. aureus transmission. Addressing the risk by reducing pathogen levels in the nose is Active Source Control™ strategy. Through nasal decolonization of all patients, the Active Source Control™ strategy helps to reduce patient risk by removing potential sources of infection and decreasing the potential environmental pathogen burden.

NOVA achieves results through implementation of use of Nozin^® Nasal Sanitizer^® antiseptic, an alcohol-based antiseptic solution. Nozin^® Nasal Sanitizer^® antiseptic has been proven to reduce S. aureus colonization by 99% and protects for up to 12 hours^[15].

Clinical studies have demonstrated the Nozin NOVA approach can lead to many benefits:

1. Help lower HAIs: The Nozin NOVA program approach has helped facilities drop surgical site infection rates by 51-100% and reduce MRSA bacteremia by 75-100%^{[15, 16, 17, 18, 19, 20]}.
2. Lower risk of secondary bacterial infections (SBIs): SBIs are a concern in those with viral respiratory infections. S. aureus colonization increases a person’s risk of developing an SBI^[21]. Decolonization measures may help prevent SBIs and improve the outcomes of patients with viral infections.
3. Reduce healthcare costs: Implementation of these programs often leads to direct cost savings for facilities, even after factoring in the cost of buying Nozin^® Nasal Sanitizer^® antiseptic. One 145-bed hospital saved $200,000 per year after implementing universal decolonization, while a 536-bed short-term acute care hospital saved nearly $1.4 million^[22].
4. Reduce PPE: A NOVA program can allow facilities to significantly reduce contact precautions such as gowns. In one study, decolonization measures allowed a facility to reduce contact precaution days for MRSA-colonized patients by 91% without increasing transmission^[23].
5. Improve healthcare worker satisfaction: Reducing the need for contact precautions lessens the burden on healthcare workers, which is especially important in times of limited resources such as the pandemic. Studies also show that healthcare workers prefer using alcohol-based antiseptics over antibiotics, such as mupirocin, for nasal decolonization ^[23].
6. Support antibiotic stewardship: Alcohol-based antiseptics do not contribute to the rise of bacterial antibiotic resistance.
7. Can be implemented today: Nozin has achieved consistently high client satisfaction and will support you each step of the way. Introduction of the Nozin NOVA^SM program requires little to no additional resources from a facility. With the partnership of a Nozin NOVA expert you can receive support for internal education tools, planning, training, implementation, and reporting. 
8. Promote sustainable compliance: NOVA^SM minimizes complexity and supports consistent compliance. The program provides facilities with tools and expertise for ongoing on-site auditing and compliance estimation.

Conclusion: Improve Patient Care and Outcomes with Nozin NOVA Colonization Risk Mitigation Strategies

S. aureus colonization remains a primary source of patient risk contributing to HAIs. Colonization risk mitigation programs that use the Nozin NOVA^SM approach powered by Nozin Nasal Sanitizer antiseptic are clinically proven to help lower infection rates, improve staff utilization, and save costs.  A customized Colonization Risk Mitigation Program can be implemented kn your facility with existing resources, leading to cost savings and improved patient outcomes.

Contact Nozin to learn more about NOVA programs. You can get started today with a free, customized hospital risk assessment.

References:

1. Monegro AF, Muppidi V, Regunath H. Hospital Acquired Infections. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2021 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441857/
2. Centers for Disease Control and Prevention. Methicillin-resistant Staphylococcus aureus (MRSA): General Information. Reviewed 2019 June 26. Available from: https://www.cdc.gov/mrsa/community/index.html
3. Centers for Disease Control and Prevention. Staph Infections Can Kill. Reviewed 2019 March 22. Available from: https://www.cdc.gov/vitalsigns/staph/index.html
4. Siddiqui AH, Koirala J. Methicillin Resistant Staphylococcus Aureus. [Updated 2020 Jul 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482221/
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6. Centers for Disease Control and Prevention. Healthcare Environmental Infection Prevention and Control. Reviewed 2020 Oct 14. Available from: https://www.cdc.gov/hai/prevent/environment/index.html
7. Global Alliance for Infections in Surgery. 7 Strategies to Prevent Healthcare-Associated Infections. Available from: https://infectionsinsurgery.org/7-strategies-to-prevent-healthcare-associated-infections/
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11. Centers for Disease Control and Prevention. Strategies to Prevent Hospital-onset Staphylococcus aureus Bloodstream Infections in Acute Care Facilities. Reviewed 2019 December 16. Available from: https://www.cdc.gov/hai/prevent/staph-prevention-strategies.html
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16. Reeves L, Barton L, Nash M, et al. Effectiveness of an Alcohol-Based Nasal Antiseptic in Reducing MRSA Bacteremia in an Adult Intensive Care Population. Infec Control Hospital Epidemiol. 2020;41(S1):s206-s206. doi:10.1017/ice.2020.748
17. Franklin S. A safer, less costly SSI prevention protocol-Universal versus targeted preoperative decolonization. Am J Infect Control. 2020;48(12):1501-1503. doi:10.1016/j.ajic.2020.02.012
18. Arden S. 567. Does Universal Nasal Decolonization with an Alcohol-Based Nasal Antiseptic Reduce Infection Risk and Cost?. Open Forum Infect Dis. 2019;6(Suppl 2):S268. Published 2019 Oct 23. doi:10.1093/ofid/ofz360.636
19. Landis-Bogush K, Belani A. Impacts of coordinated, hospital-wide use of alcohol-based nasal decolonization on infection rates, patient care and cost savings. Am J Infect Control. 2019;47(6):S39. doi:10.1016/j.ajic.2019.04.091
20. Stegmeier H. 1238. Alcohol-Based Nasal Antiseptic as Part of a Bundle to Reduce the Incidence of Contact Precautions and Surgical Site Infections. Open Forum Infect Dis. 2019;6(Suppl 2):S446. Published 2019 Oct 23. doi:10.1093/ofid/ofz360.1101
21. Sakr A, Brégeon F, Mège JL, Rolain JM, Blin O. Staphylococcus aureus Nasal Colonization: An Update on Mechanisms, Epidemiology, Risk Factors, and Subsequent Infections. Front Microbiol. 2018;9:2419. doi:10.3389/fmicb.2018.02419
22. Abelenda-Alonso G, Rombauts A, Gudiol C, et al. Influenza and Bacterial Coinfection in Adults With Community-Acquired Pneumonia Admitted to Conventional Wards: Risk Factors, Clinical Features, and Outcomes. Open Forum Infect Dis. 2020;7(3):ofaa066. doi:10.1093/ofid/ofaa066
23. Christie J, Wright D, Liebowitz J, Stefanacci P. Can a nasal and skin decolonization protocol safely replace contact precautions for MRSA-colonized patients? Am J Infect Control. 2020;48(8):922-924. doi:10.1016/j.ajic.2019.12.016