Nasal decolonization is a medical practice that aims to reduce the number of germs, particularly bacteria, residing in the nasal passages. This involves using specific agents to cleanse the inside of the nose, lowering the bacterial load. The goal is to prevent these microorganisms from causing infections elsewhere in the body or spreading to other individuals. This intervention is a targeted approach to infection prevention.
Why Nasal Decolonization is Performed
Nasal decolonization reduces the risk of certain infections, especially those acquired in healthcare settings. A common target is Staphylococcus aureus, a bacterium frequently found in the nasal passages of healthy individuals without causing symptoms. This includes Methicillin-resistant Staphylococcus aureus (MRSA), a strain resistant to several common antibiotics.
While Staphylococcus aureus can live harmlessly in the nose, its presence increases the risk of serious infections if it enters other parts of the body, particularly during surgical procedures. Nasal carriage of S. aureus is directly linked to a higher likelihood of developing surgical site infections (SSIs). Decolonization minimizes this risk by reducing the bacterial population in the nose, preventing its transfer to surgical incisions or other vulnerable areas.
Healthcare-associated infections (HAIs), including SSIs, pose challenges to patient safety and recovery. By reducing the reservoir of bacteria in the nose, decolonization helps prevent these bacteria from causing infections in the patient or spreading to others. This approach supports broader infection prevention efforts in hospitals and other medical environments.
Common Methods Used for Decolonization
Nasal decolonization involves applying topical treatments directly inside the nostrils. One widely used agent is mupirocin ointment, often prescribed as Bactroban Nasal. This antibiotic ointment works by inhibiting bacterial protein synthesis, reducing the bacterial population in the nasal passages. It is applied twice daily for five days.
Another common agent is povidone-iodine (PVP-I) nasal solution. Povidone-iodine is an antiseptic that rapidly destroys a broad spectrum of microorganisms, including bacteria, fungi, and viruses, through an oxidative process. Unlike mupirocin, povidone-iodine is an antiseptic rather than an antibiotic, which may reduce concerns about bacterial resistance development. It is applied as a swab inside the nostrils, and its action is immediate.
For mupirocin, a small, pea-sized amount or half of a single-use tube is applied to the inside of each nostril using a cotton swab. After application, the nostrils are pressed together and massaged for about one minute to ensure even distribution of the ointment. Povidone-iodine can be applied similarly with a swab, as a single application before a procedure.
When and For Whom Decolonization is Recommended
Nasal decolonization is recommended in specific clinical scenarios and for patient populations where the risk of infection is elevated. A common application is as part of pre-surgical preparation, especially for procedures like orthopedic surgeries (e.g., hip and knee replacements), cardiac surgeries, and certain general surgeries. The goal is to reduce the chance of surgical site infections originating from the patient’s own nasal bacteria.
Decolonization may also be considered for patients who experience recurrent Staphylococcus aureus infections, even outside of a surgical context. Reducing the nasal bacterial load can help break the cycle of repeated infections. Additionally, in some healthcare settings, universal nasal decolonization protocols are implemented for all patients in certain units, such as intensive care units, to broadly reduce the prevalence of healthcare-associated infections.
The decision to recommend decolonization is based on an assessment of the individual patient’s risk factors or specific institutional guidelines. Some protocols involve screening patients for Staphylococcus aureus colonization before treatment, while others adopt a universal approach without prior testing.
Important Considerations for Nasal Decolonization
Individuals undergoing nasal decolonization must follow medical instructions carefully to ensure effectiveness and minimize potential issues. This includes adhering to the prescribed dosage, frequency, and duration of the treatment, which lasts for a few days, such as five days for mupirocin. Deviating from these instructions can reduce the treatment’s success and potentially lead to recolonization or resistance.
Patients might experience minor, temporary side effects, such as nasal irritation, dryness, or a stinging sensation, particularly with povidone-iodine. It is important to avoid getting the decolonization agents into the eyes. If accidental contact occurs, the eyes should be rinsed thoroughly with cool water. While well-tolerated, any significant discomfort or unexpected reactions should be reported to a healthcare provider.
Nasal decolonization offers a temporary reduction in bacterial load and does not provide permanent immunity against future colonization or infection. Recolonization can occur, with some studies indicating that between 30% and 60% of patients may be recolonized within 7 to 18 months. Decolonization is a specific medical intervention for reducing immediate infection risks.