Nasal decontamination (cleaning the nose with anti-bacterial products) for the prevention of surgical site infection in people carrying S aureus


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Review question

We reviewed the evidence about whether nasal decontamination (cleaning the nose with anti-bacterial products) is effective and safe for preventing surgical site infection (SSI) in people carrying Staphylococcus aureus (S aureus) bacteria.

Background

If bacteria get into a wound site during surgery, this can result in a wound infection commonly called an SSI. SSIs are one of the most common forms of healthcare-associated infections, with around 1 in 20 surgical patients developing an SSI in hospital. This proportion rises when people go home. SSIs can result in delayed wound healing, increased hospital stays, increased use of antibiotics, unnecessary pain and, in extreme cases, death, so their prevention is a key aim for health services. People who are carrying bacteria such as S aureus are especially vulnerable to wound infections. These bacteria can be carried in the nose, and then transferred to a surgical wound. People who are having surgery can have a nasal swab to test for bacteria, and their noses can be cleaned with anti-bacterial products (antibiotics and antiseptics) before the operation. This can help reduce the growth of bacteria. We wanted to find out if this nasal decontamination is effective in reducing SSIs, and whether people had any adverse reactions to this treatment, such as skin irritation.

Study characteristics

In September 2016 we searched for randomised controlled trials (RCTs) involving nasal decontamination for preventing SSI. We included two studies with 291 participants, all adults undergoing cardiac surgery. The anti-bacterial products used for cleaning the nose were mupirocin (antibiotic cream) and Anerdian (disinfectant solution).

Key results

It is unclear whether nasal decontamination makes a difference to the rate of SSI in people carrying S aureus bacteria. S aureus SSI was reported in only one trial and the results do not allow us to be certain about differences in infection rates. Some participants in the Anerdian study reported side effects such as itching around the nose, but these were not serious. Mortality was low where reported (one death was directly related to S aureus infection).

Quality of the evidence

The two studies we found did not have many participants and the results were inconclusive. The Anerdian study report did not provide information about how the trial was conducted and this makes it difficult to be sure if it was at risk of bias. The mupirocin study was of better quality and at low risk of bias; but the small number of participants and limited effects affect the quality of the results. Evidence of the potential benefits and harms of using nasal decontamination for the prevention of SSI is currently of low to very low certainty. Larger, better-reported RCTs are needed to assess the clinical effectiveness of this treatment.

This plain language summary is up to date as of September 2016.