Infection Prevention

Nasal decolonization should be part of a multifaceted approach to stop the transmission of the new coronavirus in surgical settings and to protect staff and patients from infection.

Elective surgeries will be performed again, and when they are you'll be faced with the reality of having to treat every patient as a carrier of COVID-19 due to the virus's prevalence within the community, it's high asymptomatic rate — 40% to 50% of infected patients don't show symptoms — and testing effectiveness that's somewhat limited because the viral load is initially higher in the nasal or oral pharynx before moving to the lower respiratory tract after seven days of infection. We're also dealing with an elevated transmission pressure in health care due to the virus's widespread community-associated spread. For these reasons, it's best to treat the nares of every patient undergoing surgery.

Treating the nares should be part of efforts to limit transmission risks.

My colleagues and I have been studying the epidemiology of disease transmission in the perioperative space for 14 years by exploring various modes, vectors, methods and reservoirs of origin in how pathogenic infectious microorganisms move. The modeling we've done on disease transmission has been largely about the behavior of clinicians — it relates to compliance with basic preventative measures.

Environmental contamination is an important mode of transmission for COVID-19. This means residual contamination of environmental surfaces can lead to infection. Contaminated surfaces are touched by hands, followed by touching of the eyes and nasal or oral pharynx. COVID-19 is an enveloped virus that is highly susceptible to isopropyl alcohol, chlorhexidine, and low concentrations of povidone iodine; the virus is inactivated with brief exposure to these agents. Timely use of these agents, based on our knowledge of the epidemiology of transmission of other infectious organisms like S. aureus, creates an evidence-based defense strategy against COVID-19. Improvements in hygiene practices, such as patient decolonization, will help combat the spread of COVID-19. When exposure to COVID-19 occurs, it puts your providers and subsequent patients at increased risk of infection because of the transmissibility of the virus. You must consider not just the patient undergoing surgery, but patients who will receive care in the same ORs.

Nasal decolonization is currently applied to a subset of patients — primarily those undergoing joint replacements — but the evidence for surgical site infection prevention suggests its use should be more widespread.

COVID-19 should serve as a wake-up call. We need to pay attention to limiting transmission by universally applying evidence-based measures, including nasal decolonization. It's through that approach that we'll control the spread of bacteria and viruses, reduce infections and dramatically improve patient outcomes. OSM