Document Type
DNP Project
Publication Date
2026
Degree Name
Doctor of Nursing Practice
Abstract
Background/Significance
Hospital-onset methicillin-resistant Staphylococcus aureus (MRSA) remains a significant cause of morbidity, mortality, and increased healthcare costs. Alcohol-based nasal decolonization is an evidence-based strategy to reduce MRSA transmission; however, staff compliance with decolonization protocols is often suboptimal, limiting effectiveness in inpatient medical-surgical settings.
Purpose
The purpose of this evidence-based quality improvement (EBQI) project was to evaluate whether implementing a structured, evidence-based nasal decolonization protocol improved staff compliance and reduced missed administrations and patient refusals among eligible medical-surgical inpatients.
Methods
This EBQI project was implemented on five inpatient medical-surgical units at a large academic medical center. Interventions included standardized staff education, patient education materials, visible unit reminders, and audit-and-feedback cycles. Data were collected over three months (November 2025–January 2026) using infection prevention audit reports and medication administration records to measure compliance, not-given rates, and patient refusals. Descriptive statistics were used to evaluate trends.
Results
Across three months, four of five units demonstrated improved or sustained nasal decolonization compliance, with rates exceeding 91% on several units by January 2026. Not-given rates remained ≤2% on higher-performing units. Patient refusal emerged as the primary barrier, particularly on one unit where compliance declined. No adverse events were reported. Project costs totaled $8,389.51. Preventing a single hospital-onset MRSA bloodstream infection, estimated at $30,998.00, offsets implementation costs, demonstrating positive cost avoidance.
Conclusions
A structured implementation strategy incorporating education, audit and feedback, and leadership engagement improved nasal decolonization compliance in most medical-surgical units. Persistent unit-level variability highlights the need for tailored strategies to address patient refusal and workflow barriers. Alcohol-based nasal decolonization is a safe, feasible, and sustainable infection prevention intervention.
Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-Share Alike 4.0 International License.
Recommended Citation
Annunziato Royer, F. (2026). Improving nasal decolonization rates in the inpatient medical-surgical setting [Unpublished DNP project]. Sacred Heart University.
Comments
A DNP project submitted in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice, Sacred Heart University Davis & Henley College of Nursing.