Zero Based Budget Proposal

New Product Implementation to

Lower Surgical Site Infections
September 16, 2018
K E L L E Y S CH L O S S H AN
N U R 4 2 4 0 BU S I N E SS O F H E A LT H CA RE I N CO MP L E X
S Y S T E MS
CAT H E RI N E MI K E L A ITE S , D N P, RN - BC, CMS RN
H O N O R CO D E : I P L E D G E …
Objective
 To review decontamination protocols with the Shared Governance
Council to determine the most cost effective solution to decrease
surgical site infections
 Surgical Site Infections are on the rise at Facility A
 Class 1 Surgical Site Infections (excludes joint and cardiac surgeries)
 2017 – 15
 2018 – 32

Year Colon Surgeries Hysterectomies

2017 3 1
2018 8 0
Driving and Restraining Forces
DRIVING FORCES RESTRAINING FORCES

 MRSA and SSI’s are costly to  Implementation of Nozin Nasal

health systems Sanitizer is an additional
 Federal government does not expense
reimburse for SSI’s
 Increase patient satisfaction
Alternative 1
 Require patients and healthcare workers on
surgical unit to use Nozin Nasal Sanitizer.
 Discontinue MRSA screen and treat
protocol.
 Continue current pre-surgical skin
decolonization protocol.
Alternative 1
ADVANTAGES
 Protects patients and health care
staff
 Lower cost
 Enhance patient quality of care
 Increased patient satisfaction scores
 Contact isolation is not required
 Universal decolonization
 Replaces screen & treat
 Avoids antibiotic ointments -
mupirocin
DISADVANTAGES
 Additional facility cost to treat
surgical staff
 Discontinuing MRSA
screening, the perception is that
you could come in contact with
a MRSA positive patient and
not be aware of it.
 MRSA positive patients may
not have appropriate pre-
operative antibiotic selection
Alternative 1
 Nozin Nasal Sanitizer because it is 99.9% effective in killing nasal
bacteria
 Nozin is antiseptic, not an antibiotic, supporting antibiotic stewardship
 Nozin is approved by the Food and Drug Administration
 Can support a healthy workplace
 Can be optional for staff
 Nozin has moisturizing properties
 Can eliminate contact isolation for patients and increase patient
satisfaction
 Cuts down on costs
Alternative 1 Costs
Treatment Protocol Treatment 1
Per Patient
Chlorhexidine wipes $11.00

Hibiclens $10.00

Dawn Mist Soap $0.64

Nozin Nasal Sanitizer $19.99

For Patient
Nozin Nasal $19.99
Sanitizer for
Surgical Staff
Total Cost per Patient $41.63
Alternative 2
 Continue current skin decolonization
protocol
 Antibacterial soap
 Chlorhexidine wipes
 Have all patients use Nozin Nasal Sanitizer
as an additional precaution
Alternative 2
ADVANTAGES DISADVANTAGES
 Universal patient decolonization  Discontinuing preoperative
benefits
MRSA screen and treat
 Replaces screen and treat
protocol  Without doing a MRSA nasal
 No contact isolation required culture, you would not know
appropriate preoperative
 Avoids nasal antibiotic ointments antibiotic selection if the
such as mupirocin
patient tested positive for
 Increase patient satisfaction MRSA
 Reduces cost
 Enhances patient quality of care
Alternative 2 Costs
Treatment Protocol per Patient Treatment 2

Chlorhexidine $11.00

Hibiclens $10.00

Dawn Mist Soap $0.64

Nozin Nasal Sanitizer for patient $19.99

Total Cost per Patient $41.63

Alternative 3
 Continue current treatment protocol on surgical patients
 This includes MRSA screen and treat decolonization
protocol on all of the following surgical cases:
 Orthopedic
 Cardiac
 Colorectal
 Preoperative skin decolonization protocol
 antibacterial soap
 chlorhexidine wipes
Alternative 3
ADVANTAGES
 Patients and staff are aware of
patients who have MRSA or
Staph preoperatively
 Patients who test positive are
treated with mupirocin nasal
ointment
 Correct preoperative antibiotic
selection
DISADVANTAGES
 Targets only orthopedic, cardiac,
and colorectal surgical cases
 Can lead to antibiotic resistance
 Contact isolation
 Lower patient satisfaction scores
 Could increase length of stay
 Usually patient receive less care,
substandard outcomes
 Higher cost for screen and treat
protocol
Alternative 3 Costs
Treatment Protocol per patient Treatment 3
MRSA nasal culture $28.00
Mupirocin Nasal Ointment $16.00
Vancomycin $29.00
Chlorhexidine $11.00
Hibiclens $10.00
Dawn Mist Soap $0.64
Total Cost per Patient $94.64
 References
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Healthcare Bluebook. (2018).

https://www.healthcarebluebook.com/page_ProcedureDetails.aspx?id=154&dataset=med&g=Chlorhexidine

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