Author Archives: Caroline Johnson, RN, BSN, Technical Service Specialist

Aug 2, 2016

3M™ Skin and Nasal Antiseptic effectively reduces S. aureus in the nares.

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S. aureus, nasal decolonization

Photo credit: Centers for Disease Control and Prevention

How can you, as a health care provider select an effective skin antiseptic product?

How can you help reduce the risk of surgical site infection for each of your patients?

And how can you do all this in a cost-effective way?

We know that surgical skin prepping is a critical step in reducing the risk of surgical site infection – but it may not be enough. There is rising concern that surgical site infections can be caused by bacteria in the nares of surgical patients and colonization with Staphylococcus aureus (S. aureus) is a well-documented risk factor. By reducing S. aureus in the nares before surgery, we can help reduce the risk of surgical site infection and other complications.

This is why we at 3M have developed an innovative product to reduce bacteria in the nares – 3M™ Skin and Nasal Antiseptic, (Povidone-Iodine Solution 5% w/w [0.5 available iodine] USP) Patient Preoperative Skin Preparation. Our product contains a 5% povidone-iodine solution that was specially formulated for use in the nose. A simple one-time application prior to surgery is sufficient to effectively reduce bacteria in your patients’ nares.

Here is what I think you may ask: “Why not just use a standard 10% povidone-iodine solution? It would be inexpensive and it even contains double the amount of iodine.” Good question, but in this case, more is not always better!

Even though off-the-shelf 10% povidone-iodine solution has been used for decades as an effective surgical skin prep, it may not be the product you should consider as a first choice for prepping of the nares. The unique environment of the nose with its constant build-up of mucus tends to wash out a standard povidone-iodine solution. This may make it difficult for you to achieve an effective and long-lasting reduction of bacteria in the nares of your patients.

The special formulation of 3M™ Skin and Nasal Antiseptic combines 5% povidone-iodine with a film-forming polymer that helps povidone-iodine adhere to the inner lining of the nose and, you guessed it, prevents it from being flushed out. The solution is also formulated to be pH-balanced. This makes it is less irritating and improves your patients’ comfort and acceptability.

But how can you be assured that our product works in the clinical setting; that our nasal antiseptic swabs are more effective than standard povidone-iodine?

A prospective randomized controlled clinical trial in 429 total joint arthroplasty patients was conducted to answer this question (Rezapoor et al., 2015). The patients were randomized into 1 of 3 groups, each receiving a different treatment to evaluate its efficacy in reducing S. aureus in the nares:

1) Off-the-shelf 10% povidone-iodine solution

2) 3M™ Skin and Nasal Antiseptic

3) Saline solution (control)

Baseline cultures were obtained and the nares were swabbed for culture again at 4 and 24 hours after treatment to determine the remaining S. aureus.

Our 5% povidone-iodine vs. 10% povidone-iodine study achieved the results we had expected – 3M™ Skin and Nasal Antiseptic was significantly more effective (p=0.003) at reducing S. aureus in the nares over the 4 hour time interval than standard 10% povidone-iodine solution. Standard povidone-iodine was similar in efficacy to the saline control.

The study results are visualized in the graph below.

Negative Nasal S. Aureus Cultures Post Treatment

These results at 4 hours demonstrate that 3M™ Skin and Nasal Antiseptic reduces S. aureus significantly better than standard 10% povidone-iodine solution to provide the assurance you need that by choosing 3M™ Skin and Nasal Antiseptic, you use the best products for your patients.

Here are some additional benefits of the 3M™ Skin and Nasal Antiseptic you may want to consider when selecting an antiseptic for the nares:

  • The broad-spectrum, fast-acting povidone-iodine antiseptic fits easily into your preoperative process
  • The film-forming formula was designed to work within one hour and maintain at least 12 hours of persistence (3M Study 05-011100)
  • It is effective against antibiotic resistant strains of S. aureus (in vitro*) (3M Study 05-010944)
  • No resistance has been shown (in vitro*) (3M Study 05-011322)
  • Compliance is not an issue because you as the caregiver apply the solution to the patient’s nares
  • The one-time application an hour before surgery makes the procedure very quick and easy
  • Surgical site infections are associated with increased health care cost, so using an effective product to reduce nasal carriage of bacteria may be a cost-effective addition to your preoperative protocol

So, in summary, the 3M™ Skin and Nasal Antiseptic is the only 5% povidone-iodine product that has been shown in a clinical study to be significantly more effective in reducing S. aureus in the nares than standard 10% povidone-iodine. Due to the adherent polymer, the 5% povidone-iodine remains in the nares for a longer period, which explains the better efficacy of this product. This confirms what I had mentioned in the beginning – that more is not always better.

As you can see, by choosing the 3M™ Skin and Nasal Antiseptic as part of a comprehensive preoperative protocol, you can help to safely and effectively reduce the risk of surgical site infections in your patients – and all in a budget-conscious manner!

References:

Rezapoor M, Nicholson T, Patel R, et al. Do iodine-based solutions differ in their effectiveness for decolonizing intranasal Staphylococcus aureus? Presented at the MSIS Annual Meeting, Cleveland, OH, August 2015.

3M Study 05-011100

3M Study 05-010944

3M Study 05-011322

*The clinical significance of in vitro data is unknown

Jul 20, 2015

13 Things to Know About Surgical Site Infections

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Nasal antiseptic application video
Click to watch

1. Surgical site infections increase healthcare costs
2. The risk of surgical site infections can be reduced during the preoperative period
3. The source for most surgical site infections is the endogenous flora of the patient’s skin, mucous membranes or hollow viscera (i.e. gastrointestinal tract)1
4. Reducing the patient’s bacterial load before surgery helps reduce the risk of surgical site infections
5. There are significantly higher numbers of bacteria in moist areas of the body: axilla, skin folds, webs of the feet, perineal area and the peri-anal area
6. Preoperative bathing is a CDC recommended practice1
7. Shaving with a razor during the pre-operative hair removal process can cause nicks, cuts and microscopic epidermal injuries, which can lead to surgical site infections2
8. If pre-operative hair removal is necessary, it should be done with a surgical clipper as close to the surgery time as possible3
9. Infection rates are lowest when clipping is done as close to the surgery time as possible3
10. S. aureus is the leading cause of surgical site infections4
11. Approximately 30% of the population is colonized with S. aureus in the nares5
12. 80% of the S. aureus infections are caused by the patient’s own (clonal) nasal flora6-8
13. Reducing S. aureus in the nares may help reduce the risk of surgical site infections

Learn more about surgical site infections, take a perioperative on-demand CE learning webinar.

Jun 12, 2015

Nasal Antiseptic: An Innovative Approach to Reducing Surgical Site Infection (SSI)

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3M(TM) Skin and Nasal Antiseptic Summary of Clinical Evidence

Treating S. aureus

Despite evidence based infection prevention practices, surgical site infection remains a frequent and often preventable clinical problem associated with increased mortality and healthcare costs.1  S. aureus is the leading cause of surgical site infections and nearly half of these infections are caused by methicillin-resistant Staphylococcus aureus (MRSA).2  Addressing surgical site infection modifiable risk factors such as bacterial colonization with S. aureus is an essential component of surgical site infection prevention and skin preparation is a routine aspect of surgical care. Nasal colonization is also a well documented risk factor for infection.3,4 However, addressing the surgical site infection risk factor of  nasal colonization with S. aureus may sometimes be overlooked.

Treating S. aureus colonization on the skin and in the nares has demonstrated to improve outcomes in surgical patients.  In fact, several studies have shown the benefit of this approach.8,9 This strategy is also discussed and proposed in evidence based guidelines and recommended practices,1, 5-7 particularly for high risk procedures.

The treatment of choice to address nasal colonization with S. aureus has been a topical antibiotic dosing regimen (mupirocin calcium, 2%) applied to the nares.  This approach has been utilized for decades14 and its effect on surgical site infection outcomes has been demonstrated in two systematic reviews.10,11  Other randomized controlled studies have failed to demonstrate a significant reduction in surgical site infections.12,13  Challenges associated with this approach may pose barriers to effective risk reduction.

There is increasing evidence of resistance and treatment failure associated with the use of mupirocin.15, 16  Due to antibiotic resistance, mupirocin is not recommended without active surveillance and identification of S. aureus carriers.1 There is no standardized protocol for screening specific patient populations. In addition, screening will not identify all carriers, which may leave some patients at risk. In fact, MRSA detection from nasal swabs by culture is only 48-66% sensitive 17,18 and by rapid PCR test 62% sensitive.17 Therefore, screen and treat protocols may be ineffective for S. aureus carriers who are not identified.

Treatment failure can occur due to an incomplete dosing regimen or patient noncompliance.20  The recommended dosing for mupirocin is twice daily for five days.19  This can be difficult to complete prior to certain non-elective procedures.  Decolonization efficacy is dose dependent12 and outpatient compliance rates of 62-86% to a preoperative intranasal mupirocin dosing regimen have been reported.20, 21 Treatment failure, mupirocin resistance and challenges associated with the screen and treat decolonization approach led to the need for an alternative solution to help reduce the risk of S. aureus surgical site infection due to nasal colonization.

Addressing the Challenges

To address these challenges, a novel antisepsis strategy for reducing bacterial colonization in the nose has been developed. The evidence is mounting for this safe and effective alternate approach to help reduce the risk of surgical site infection.  3M™ Skin and Nasal Antiseptic (povidone-iodine solution 5% w/w (0.5% available iodine)USP) Patient Preoperative Skin Preparation was specially formulated to address the rising concern of surgical site infections associated with bacteria in the nares and to address the challenges associated with traditional decolonization strategies.  The proprietary formula demonstrates broad spectrum bactericidal activity22,23 and no resistance has been shown (in vitro*).24 Because it is an antiseptic and not an antibiotic, potentially fewer concerns for long-term resistance may be advantageous for standardization of the preoperative process and treating all patients.  This horizontal treatment approach to reducing nasal colonization as part of a comprehensive preoperative protocol has been effective in helping to reduce the risk of surgical site infections in several quasi-experimental studies 25-28 and may lead to cost savings.25,27  

*Clinical significance of in vitro data is unknown

An Innovative Yet Simple Solution

A simple, one-time directly observed preoperative application ensures patient compliance.21 It may also be an effective “just in time” therapy when the duration of a decolonization regimen is undesirable, impractical or impossible to complete.   The use of 3M™ Skin and Nasal Antiseptic has consistently and repeatedly been effective in helping to reduce the risk of surgical site infection when used as part of a multifaceted infection prevention approach.21, 25-30   It has helped to reduce S. aureus infection rates below those in studies in which mupirocin was used as the treatment of choice.21,28 Furthermore, in a prospective randomized trial versus mupirocin in an orthopedic population, there was a significant reduction of deep S. aureus infections in the Skin and Nasal Antiseptic group.  This group was also associated with significantly fewer adverse events.21

S. Aureus Infection Rate Reduction

This approach provides a simple, standardized solution to address the risk factor of nasal colonization with S. aureus and ameliorates many of the challenges associated with the conventional approach.  It is an innovative, safe and effective strategy to help reduce the risk of surgical site infections.

Read a summary of the clinical evidence