Simpler, one-swab iodophor regimen reduces MRSA carriage
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A simpler one-swab-per nostril iodophor regimen produced identical reductions in MRSA carriage among nursing home residents as a two-swab regimen, according to study findings published in Infection Control & Hospital Epidemiology.
The regimens used different concentrations of povidone-iodine (iodophor) solution, an antiseptic. The researchers said antiseptics could be a promising alternative to mupirocin resistance.
“The use of antiseptics to remove germs in the nose is important for preventing infection after surgery and in high-risk settings like the ICU. It is also used to reduce infections due to MRSA, which lives in the nose,” Lauren T. Heim, MPH, a clinical research coordinator at the University of California’s Health Policy Research Institute, told Healio.
“Povidone-iodine (iodophor) is one antiseptic product that is increasingly used for this purpose,” Heim said. “However, iodophor application has been reported to be somewhat impractical and time-consuming, requiring two sequential swabs per nostril for 30 seconds each.”
The study comparing iodophor regimens was conducted at one of three Southern California nursing homes that had participated in a 9-month parent study between June 2015 and February 2016 assessing the impact of universal decolonization on the carriage of multidrug-resistant organisms, including MRSA.
In that study, decolonization involved daily chlorhexidine antiseptic bathing and nasal decolonization with 5% nasal iodophor swabs for 5 days for new admissions and Monday through Friday every other week for the entire nursing home.
Staff from one of the nursing homes expressed concern over the nasal iodophor regimen, which consisted of two swabs per nostril applied for 30 seconds per nostril twice a day.
“Nursing staff reported that iodophor was generally applied for several seconds (rather than 30 seconds) per nostril due to time constraints,” Heim and colleagues wrote. “In response to this feedback, the nursing home implemented nasal decolonization using a 10% generic iodophor swab, applying 1 swab per nostril twice daily for at least three revolutions rather than two 5% iodophor swabs per nostril. The twice daily administration schedule was retained.”
They conducted a 5-week prospective cohort study in August and September 2016 “of nasal decolonization with 10% nasal iodophor administered twice daily, on admission and Monday–Friday every other week plus body decolonization with daily CHG bathing or showering.”
The then conducted two point-prevalence samplings 4 weeks apart “involving bilateral nares and axilla or groin swabs collected from 50 randomly selected residents.”
“Demographic and medical characteristics of randomly sampled residents were compared among the baseline, double-swab 5% iodophor intervention, and single-swab 10% iodophor intervention periods,” they wrote.
According to the study, point-prevalence swabs were collected from 300 randomly selected residents during the baseline period and again during the intervention period, whereas 100 swabs were randomly selected during the poststudy quality improvement assessment period. They found that the relative raw reduction in nasal MRSA carriage was 26% in both iodophor treatment periods, from a baseline prevalence of 27% to 20% for both the double-swab 5% iodophor and single-swab 10% iodophor regimens.
Additionally, adjusted models revealed identical 40% reductions in MRSA nasal carriage when comparing the baseline period with the double-swab 5% iodophor group (P = .03) and the single-swab 10% iodophor group (P = .10). The models also revealed identical 60% reductions in MRSA carriage from nares and axilla or groin when comparing the baseline period to either the double-swab 5% (P < .001) or single-swab 10% (P = .007) nasal iodophor groups, whereas no significant difference between the single-swab and the double-swab regimen was detected for MRSA in the nasal carriage (OR = 1.02; 95% CI, 0.58-1.8) or MRSA carriage on any body site (OR = 1.08; 95% CI, 0.62-1.88).
“We found that nasal iodophor can be applied in an effective way that requires much less effort and is less costly,” Heim said, “This highlights the value of testing simplified approaches when current directions are unlikely to be followed. If a process is important but too challenging, we need to find a method that is well received and supported by staff.”
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