Selecting Nasal Antiseptic Swabs for Nasal Decolonization
By Amanda Sivek, PhD, a-IPC; and Mairead Smith
Healthcare-associated infections( HAIs) are a well-recognized, ongoing challenge for healthcare facilities in the United States, where it’ s estimated that about 1 in 31 patients and 1 in 43 nursing home residents contracts an HAI( Current HAI Progress Report: 2023 National and State Healthcare-Associated Infections Progress Report, 2024). These numbers are trending downwards, with a 16 percent decrease in reported methicillin-resistant staphylococcus aureus( MRSA) bacteremia between 2022 and 2023, and a 3 percent reduction in surgical site infections( SSIs)( Current HAI Progress Report: 2023 National and State Healthcare-Associated Infections Progress Report, 2024).
Nasal decolonization is one of many tools available to healthcare facilities to help combat HAIs. Intranasal mupirocin, for example, is commonly administered to patients known to be colonized with S. aureus – a practice known as targeted decolonization. However, due to costs and challenges associated with testing patients to identify those who are colonized, some facilities are moving more toward universal decolonization – a practice in which all patients in a certain category or care area( e. g., all patients undergoing surgery) receive decolonization, regardless of whether they have been tested for S. aureus( Universal and Targeted Decolonization Strategies, 2025). In fact, Centers for Disease Control and Prevention( CDC) guidance recommends reducing carriage of S. aureus among all patients admitted to ICUs, patients undergoing high risk surgeries( such as cardiothoracic or orthopedic surgeries), and as a supplemental strategy, patients with central venous catheters( CVCs) or midline catheters outside of the ICU( Strategies to Prevent Hospital-onset Staphylococcus aureus Bloodstream Infections in Acute Care Facilities, 2024).
CDC suggests that“ Based on the results of a single trial, intranasal mupirocin may be preferred [ for nasal decolonization in ICU patients ]; however, intranasal iodophor could be considered as an alternative to intranasal mupirocin.”( Strategies to Prevent Hospital-onset Staphylococcus aureus Bloodstream Infections in Acute Care Facilities, 2024) Facilities are looking for alternatives, likely because mupirocin requires a prescription and, as an antibiotic, it raises concerns about antibiotic resistance( Products Used for S. aureus Nasal Decolonization, 2025). In contrast, nasal antiseptic swabs present an inexpensive, over-the-counter option for these facilities. ECRI estimates that collectively, member facilities spent about $ 17.7 million on nasal antiseptic swabs between November 2024 and November 2025, with about 75 percent of that spent on povidone-iodine-based models.
Active Ingredients
Nasal antiseptic swabs can be broadly categorized by their antiseptic agents – common products incorporate either 62 % ethyl alcohol or 5 % or 10 % povidone-iodine( sometimes also called iodophor, as in the CDC guidance) antiseptic agents.
Products generally come pre-packaged and pre-saturated for single-patient use. However, some products include a bottle of antiseptic agent and dry swabs, to be moistened at the time of use; these products are primarily intended for patients to use in the home environment, such as after discharge. Single-patient packaging is strongly preferred for most purposes within a healthcare facility.
Typical Application Procedures
For alcohol-based swabs, the application process typically consists of rotating the swab within one nostril for approximately 30 seconds, followed by swabbing the other nostril( with the same swab) in the same manner. In contrast, povidone-iodine-based swabs commonly require a total of four swabs: two swabs per nostril, each rotated for 15 to 30 seconds.
Some manufacturers provide guidance to healthcare facilities regarding when to administer nasal decolonization. For example, they may recommend one or two applications pre-operatively, or daily decolonization for patients in the ICU. Other manufacturers defer to facility protocol or to CDC guidance.
Human Factors
Regardless of the recommendations, adherence to administration protocols is ultimately determined by patients, residents, and frontline staff who use these swabs. For clinicians, the swab should be easy to use – the packaging should be easy to open, the swab should be easy to remove from its packaging, and it should be easy to apply the swab to the nares of patients and residents. For patients and residents, the swab should be pleasant to use, not causing pain or discomfort during application. Swabs should have neutral or favorable odors, as well as not sting, burn, or drip antiseptic from patient or resident nares after application. Considerations for Selection When choosing among the available nasal antiseptic swabs products, key considerations include: 1. What is the active ingredient? 2. What is the evidence for the effectiveness of this product, and for other products with the same active ingredient? 3. How does this product fit into guidelines by CDC, AORN, AHRQ,
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