RE-AIM Framework for Evaluating Perioperative Nozin®: A Topical Nasal Antiseptic

Purpose: This project sought to evaluate the process of implementation and the usefulness of Nozin® in reducing surgical site infections using the RE-AIM framework. Evaluation of an intervention often takes place during implementation to give insight into research as a foundation to clinical practice. Background: The RE-AIM framework was selected because of its' design in assessing the health impact of interventions through five core evaluation elements: Reach, Efficacy/Effectiveness, Adoption, Implementation and Maintenance. Using the RE-AIM framework, a systematic evaluation was conducted after the first nine months of implementing an added preventative measure to decrease surgical site infections, using a perioperative topical nasal decontaminant called Nozin® as a Standard of Care. Methods: Pediatric orthopedic surgically implanted patients who were ≥ 4 years old and receiving care at a small pediatric orthopedic hospital met the criteria for peri-operative application of Nozin®. We systematically used RE-AIM to evaluate the Reach, Effectiveness, Adoption, Implementation and Maintenance of the intervention, with a retrospective review of the medical records pre- and post-Nozin® implementation and data obtained from key staff participants using REDCap survey responses. Results: A retrospective review of the medical records comparing 9-months pre- and post-Nozin® implementation found comparable clean surgical cases of 634 and 647 respectively, with a 67% decrease in surgical site infection (SSI) frequency from 6 to 2 and SSI rate decrease from 0.95% to 0.29%. A calculated p-value using the 2x2 Fisher Exact test was not significant given the small number of SSI events. The survey respondents overwhelmingly agreed (91%) that pediatric patients usually tolerated Nozin® and that Nozin® was a simple process to administer. Conclusions: The RE-AIM framework was useful in systematically evaluating the implementation of a peri-operative topical nasal decontaminant as a Standard of Care. Health care program planners and quality improvement stake holders should utilize the RE-AIM framework to systematically evaluate and understand the implications of interventions and the resulting decision making that follows. Nozin® was determined to be a useful agent at this healthcare setting in reducing SSIs and was found to be well tolerated, easy to apply, highly effective and with a low cost.