Nasal Decolonization to Reduce Surgical Site Infections

Background: Surgical site infections is one of the most common healthcare-associated infections. Staphylococcus aureus remains the most common etiologic agent causing surgical site infections. Studies confirm Staphylococcus aureus carriage increases the risk of Staphylococcus aureus surgical site infections. The purpose of this paper is to review the strategies to reduce surgical site infections due to Staphylococcus aureus focusing on nasal decolonization. Results: Published studies indicate screening patients for Staphylococcus aureus nasal carriage and decolonizing carriers during the preoperative period decreases the risk of S aureus surgical site infections in cardiac and orthopedic surgery. Most studies use combined chlorhexidene bathing and mupirocin for patients colonized with Staphylococcus aureus since colonization of multiple body sites is common and combination chlorhexidene bathing and intranasal mupirocin has been shown to be more effective at eradicating Staphylococcus aureus colonization. Mupirocin remains the best topical agent at eradicating nasal Staphylococcus aureus. Mupirocin has been shown to eliminate nasal colonization by over 90% with a five-day course, however, concerns over resistance have led to development of alternative agents. Nasal povidone-iodine, alcohol-based nasal antiseptic, and photodynamic therapy are promising new interventions, but more studies are needed. Conclusions: Short term nasal mupirocin is still the most studied and effective topical agent in eradicating Staphylococcus aureus nasal colonization. However, increasing mupirocin resistance remains an ongoing concern and newer agents are needed. Keywords: nasal decolonization, surgical site infections, mupirocin, healthcare-associated infections