Revolutionizing Infection Prevention: The Case for Universal Nasal Decolonization

Over twenty years ago, an aspiring young microbiologist with a background in biochemistry posed a few simple yet profound questions:

  1. What is the role of the nose in infection acquisition and transmission?
  2. Why do harmless commensal bacteria on the skin become pathogenic and lead to infection?
  3. If hands are decolonized to reduce risk of infection, shouldn’t the skin at the nasal vestibule be decolonized, too, especially considering high frequency of hand-to-nose contact?

Surprised by the lack of comprehensive answers, he embarked on a research journey. With support from several experts, including a long-time professor at the Johns Hopkins Bloomberg School of Public Health, and funding from National Institutes of Health (NIH) grants, he discovered that the skin of the nasal vestibule serves as a significant reservoir for pathogens and is a critical portal for opportunistic microorganisms. Reducing and maintaining low nasal carriage of pathogenic organisms at this site could significantly decrease infection risk, but achieving this proved more challenging than anticipated. That microbiologist is John Willimann, CEO of Nozin, a company revolutionizing the prevention of healthcare associated infections (HAIs).

The right tool for nasal decolonization programs

Despite significant efforts to prevent infections in healthcare, HAIs still cause over 700,000 infections and nearly 100,000 deaths annually in the U.S., costing billions of dollars. The nose is a primary reservoir for many HAI causing pathogens.

“ The nasal vestibule is not just a site of colonization but a main pathogen reservoir and this offers an opportunity to interrupt the infection chain before it starts,” says Willimann.

Traditional agents used for nasal decolonization, such as mupirocin antibiotic or iodophor, have limitations which could constrain universal adoption for all patients. An alcohol-based nasal antiseptic that is nonantibiotic, well-tolerated and pleasant to use would offer the optimum suitability for universal nasal decolonization. This realization led to the development of the Nozin® Nasal Sanitizer® antiseptic, which is designed as a specially formulated, broad-spectrum antimicrobial for topical application to nasal vestibule skin.

Universal nasal decolonization is key to reducing infection rates and lowering costs

While nasal decolonization is a critical component to patient safety and quality of care, Willimann emphasizes that it is just part of a comprehensive approach to infection prevention and control (IPC). By integrating nasal decolonization with existing protocols, healthcare facilities enhance the overall effectiveness of their IPC programs. Willimann suggests that “including universal nasal decolonization provides opportunity to lower pathogen burden in a facility and unlock more potential for positive outcomes.”

Preventing avoidable infections is a straightforward way to reduce healthcare costs. Addressing nasal colonization is a relatively simple approach to help reduce HAIs and associated costs. In the past decade, clinical evidence for universal nasal decolonization has surged. Over 1,000 hospitals have adopted Nozin programs for their nasal decolonization, reporting encouraging results such as reductions in surgical site infections (SSIs) and decreases in central line-associated bloodstream infections (CLABSIs). These positive outcomes are supported by more than 20 independently conducted clinical studies demonstrating the effectiveness of the Nozin interventions. Furthermore, a meta-analysis recently published in the American Journal of Infection Control (AJIC) suggests that the alcohol based antiseptic (Nozin® Nasal Sanitizer®) is superior to both mupirocin and iodophor for nasal decolonization.

Aligning infection prevention with hospital leadership priorities

While universal nasal decolonization of all patients, regardless of their infection risk profile, makes clinical sense to many infection preventionists (IPs), concerns remained regarding its economic viability and operational feasibility. “Most IPs we collaborate with believe that implementing an all-patient program would reduce SSIs, CLABSIs, bacteremia, and other infections,” says Willimann. “However, many were hesitant to proceed until others had demonstrated success.” Since 2016, pioneering Ips at leading U.S. hospitals have implemented universal programs and are now reporting positive outcomes. Many IPs are looking for how best to help leadership approve of such initiatives in their own facilities.

To assist IPs with this challenge, Nozin focused on quantifying the full value of a prevented infection to an organization. It became evident that IPs and leadership were not always speaking the same language. While Ips emphasized infections avoided, leadership focused on metrics such as length of stay (LOS), patient throughput, and revenue generation per bed. Additionally, many facilities lacked the resources to design and implement a successful program.

“We developed Nozin NOVASM programs as a comprehensive suite of services to implement nasal decolonization, starting with analyzing the hospital’s colonization pressure,” says Willimann. “We show how this burden affects infection risk. Then, we translate risk reduction potential into tangible benefits. Working individually with each facility, Nozin advisers help build a compelling business case. By emphasizing the broader impact of infection prevention, they demonstrate how avoiding HAIs can lead to significant treatment cost savings, save nursing hours, and free up beds to accommodate new patients.” While HAI treatment costs may sometimes be viewed as “soft costs,” reductions in LOS are tangible benefits that directly enhance hospital efficiency and capacity. Additionally, lowering infection rates can positively influence penalties and performance scores. “An all-patient program can generate a substantial return on investment (ROI) without capital expenditure or additional labor required,” notes Willimann. Nozin has also established a team of clinically trained implementation specialists, including nurses, to assist in designing, implementing, and ensuring the success of these programs. These teams are available to consult with hospital IP experts on a complimentary basis.

In addition to utilizing the mounting clinical evidence, IPs can incorporate these Nozin NOVASM tools and services to make a compelling case for universal nasal decolonization. This can provide leadership with key insight to make better resource allocation decisions. “We see large facilities and integrated delivery networks (IDNs) implementing these programs with encouraging results,” says Willimann. “Adding to the 20+ independent studies validating program benefits, we expect that current implementations will lead to additional published evidence of the value of Nozin programs.”

In summary, Willimann adds, “Our Protect Every PatientSM service mission is to help hospitals reduce HAIs and lower costs through universal nasal decolonization. Safeguarding patients is not only the right thing to do—it is also a sound business decision.”

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