Course Access
Hi Michael,
Exactly, if it causes a temporary 10-h (or so) drop in S. aureus numbers in the nose in the perioperative phase, and the nose is a seeding source for SSIs, then it would be useful for the purpose of SSI prevention. But let us see if this is confirmed/supported in further investigations.
In the Mullen et al. paper that Glenys sent, I do notice a 81% reduction in SSI incidence allegedly due mostly to the nasal treatment protocol, which is a big number, and this just seems a bit on the high side to be caused by nasal decolonisation alone.
A remaining concern clearly is the claim of sustained decolonization (see below). This is clearly an exaggerated claim, given that only 10 hours have been examined. Now, in my opinion, exaggerated claims of any kind, particularly associated with the impetus to sell/market products, should raise alarm bells in any of us from the medical/scientific community. Such matters should not be downplayed or taken as trivial offences.
Best regards, Matthias.
—
Matthias Maiwald, MD, FRCPA
Senior Consultant in Microbiology
Adj. Assoc. Prof., Natl. Univ. Singapore
Department of Pathology and Laboratory Medicine
KK Women’s and Children’s Hospital
100 Bukit Timah Road
Singapore 229899
Tel. +65 6394 8725 (Office)
Tel. +65 6394 1389 (Laboratory)
Fax +65 6394 1387
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Michael Wishart
Sent: Monday, 23 October, 2017 1:40 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Nasal Decolonisation
Hi Matthias
In regard to an attempt to minimise self-inoculation with Staph aureus in the peri and early post-operative phase, would not 10 hours be a reasonable target?
I dont disagree with your terminology assessment, but, terminology aside, if we are attempting to prevent early-onset SSI with Staph aureus, would not this claim be reasonable in that context?
One of the posters cited on that website also suggested that peri-operative staff use of this product (voluntary, of course!) also could result in lower incidence of Staph aureus SSI. If there any biological plausibility in that concept?
Just wondering if this product does have a use, albeit not as a decoloniser.
Cheers
Michael
Michael Wishart
Infection Control Coordinator
A 627 Rode Road, Chermside QLD 4032
P (07) 3326 3068 | F (07) 3607 2226 | E michael.wishart@svha.org.au | W http://www.hsnph.org.au
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P Please consider the environment before printing this email
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Matthias Maiwald (SingHealth – PATH)
Sent: Monday, 23 October 2017 3:11 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Nasal Decolonisation
Hi Cath, hi Michael,
Thank you so much!
It was in fact exactly the Steed et al. 2014 paper and also the Infection Control Today White Paper that I had seen earlier (a while ago see my comment) and that I found unconvincing.
Similarly, what is written on the Nozin webpage is unconvincing.
Most of us, when we talk about, or read about decolonisation, we understand or imply that the effect is sustained for some time, e.g. weeks or months, or ideally permanently in the absence of external re-exposure. If I am not wrong, I think the historical origins of the modern S. aureus or MRSA decolonisation lie in the 1960s and 1970s in efforts to (a) reduce S. aureus infections affecting neonates in nurseries, and (b) to end the cycle of endogenous reinfection that is driving furunculosis.
The Steed paper is astonishing in its claims. It tests a reduction of S. aureus nasal bacterial counts up to 10 hours after application, but not any follow-up beyond these 10 hours. That is not what most of us in the profession would understand as decolonisation.
Neither the ICT White Paper nor the Website nor the Steed article seems to provide any data that go beyond these 10 hours, and yet, claims are made (e.g. page 5, White Paper) of sustained decolonization. The website describes it as long lasting and unlike the fleeting effect of hand sanitizers. Again, there is nothing to support this claim.
Combined with the problems of applying alcohol to mucous membranes (see my earlier e-mail), I would say that biological plausibility of how this agent is supposed to provide sustained decolonisation in the sense of what we usually understand as decolonisation is not established.
Best regards, Matthias.
—
Matthias Maiwald, MD, FRCPA
Senior Consultant in Microbiology
Adj. Assoc. Prof., Natl. Univ. Singapore
Department of Pathology and Laboratory Medicine
KK Women’s and Children’s Hospital
100 Bukit Timah Road
Singapore 229899
Tel. +65 6394 8725 (Office)
Tel. +65 6394 1389 (Laboratory)
Fax +65 6394 1387
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Michael Wishart
Sent: Monday, 23 October, 2017 12:24 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Nasal Decolonisation
Hi Cath
This product is not available in Australia, either. I would be surprised if there are any centres in Australia using formulations of ethanol or povidone iodine for nasal decolonisation currently, but would love to hear from anyone that can source appropriate nasal decolonisation products of this type in Australia.
Cheers
Michael
Michael Wishart
Infection Control Coordinator
A 627 Rode Road, Chermside QLD 4032
P (07) 3326 3068 | F (07) 3607 2226 | E michael.wishart@svha.org.au | W http://www.hsnph.org.au
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P Please consider the environment before printing this email
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Cathryn Murphy
Sent: Monday, 23 October 2017 1:59 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Nasal Decolonisation
Hi Matthias
I was loathe to use trade names on this site. However, I will to respond. There is a growing body of US evidence around a product called Nozin. More details are at nozinpro.com
When I was at APIC in June 2017 there was a lot of interest in the product in healthcare and other settings.
Thanks for your view on the existing literature Matthias, I always enjoy your responses.
Yours sincerely
Cath
Cathryn Murphy RN B. Photog MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
QLD, Australia
E: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W:http://www.infectioncontrolplus.com.au
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Matthias Maiwald (SingHealth – PATH)
Sent: Monday, 23 October 2017 12:50
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Nasal Decolonisation
Hi Cath, hi Michael,
I am curious about the remark below concerning ethanol for nasal decolonisation. The last time I looked (which is a while ago), the results achieved were not convincing.
From a physiological and/or conceptual point of view, while alcohol is a fantastic antiseptic/disinfectant for superficial skin, it is usually deemed unsuitable for mucous membranes (which the inside of the nose consists of), due to its more aggressive nature than aqueous antiseptics.
Best regards, Matthias.
—
Matthias Maiwald, MD, FRCPA
Senior Consultant in Microbiology
Adj. Assoc. Prof., Natl. Univ. Singapore
Department of Pathology and Laboratory Medicine
KK Women’s and Children’s Hospital
100 Bukit Timah Road
Singapore 229899
Tel. +65 6394 8725 (Office)
Tel. +65 6394 1389 (Laboratory)
Fax +65 6394 1387
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Michael Wishart
Sent: Monday, 23 October, 2017 5:57 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Nasal Decolonisation
Hi Cath
Just a comment: the povidone iodine nasal cream commonly used pre-op in the US is not yet available in Australia, as far as I am aware. I wish it was, as getting traditional pre-admission nasal decolonisation (5 days of mupuricin or the like) done in a private hospital is not easy!
Cheers
Michael
Michael Wishart
Infection Control Coordinator
A 627 Rode Road, Chermside QLD 4032
P (07) 3326 3068 | F (07) 3607 2226 | E michael.wishart@svha.org.au | W http://www.hsnph.org.au
[cid:image001.png@01D01926.61F1C2B0]
P Please consider the environment before printing this email
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Cathryn Murphy
Sent: Monday, 23 October 2017 7:26 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Nasal Decolonisation
Dear All
I am interested in learning more about the adoption and use of nasal decolonisation in Australia and New Zealand. In the US this appears to be being used sometimes in place of Contact Precautions. There is a download from IC Today to that effect plus some recent papers. Happy to share if anyone wants it, please email me. So would any of you be able to comment on these questions and if and how you use nasal decolonisation in your organisations please. Thanks in advance.
a) other than ethanol and povidone iodine (e.g.: 3M and others) what else is used for nasal decolonisation right before surgery?
b) which are the most commonly used products?
c) what are the surgery profiles where these are used? (e.g.: ortho, open heart, hernia repair etc)
d) what is the adoption rate for using something like this? Is it universal or a % of surgeons opt to do it?
Yours sincerely
Cath
Cathryn Murphy RN B. Photog MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
QLD, Australia
E: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W:http://www.infectioncontrolplus.com.au
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