Project JOINTS Exemplar Hospital Application
Olean General Hospital – Olean, New York
Number of licensed beds: 186
Teaching – Resident program
Rural
Exemplar Hospital Contact Name: Gail Bagazzoli, BSN, RN, Infection Prevention and Control Nurse
Email:
Phone: 716.375.6159
We give permission to IHI to make public all the information on this Project JOINTS Exemplar Hospital application.
Enhanced Surgical Site Infections Prevention Bundle element (identify one per sheet): Staphylococcus aureus (SA) screening (MRSA) and (MSSA) and use of intranasal mupirocin.
In a few sentences, describe in what ways your hospital has been successful in implementing this element of the Enhanced Surgical Bundle. Please answer the following questions:
What key changes did your organization make to incorporate or support SA screening and use of intranasal mupirocin and CHG bathing or showering to decolonize SA carriers? What were the changes in existing processes your organization had to make in order for this to become part of the routine?
1. Olean General Hospital had in place MRSA screening on high risk patients, after review of this project we felt that if the hip and knee arthroplasties could be seen at least 14 days prior to surgery we would be able to screen and educate the patient on the importance of MRSA screening and CHG use. Orthopedic surgeons now schedule elective cases 14 days prior to surgery, the elective surgery patients meet with our pre admission nurse who reviews CHG use and completes a MRSA screen (nose swab of both nares). To date there have been 77 patients in the project with 6 positive screens to date. We have NOT had any surgical site infections noted on any of the 77 patients. 100% of our total joint patients (elective cases) are screened prior to going into surgery. The results are sent to the orthopedic surgeon’s office, if the screen is positive, the patient is prescribed mupirocin. (See attached educational instruction sheet).
2. Attendum 12/4/2012-We have added the testing of MSSA to our protocol beginning in July 2012. Screening for colonization by Staphylococcus aureus (both Methicillin-sensitive and –resistant) is accomplished by swabbing the patient’s nares with swabs which are then submitted to the Laboratory for testing. Those patients requiring screening for colonization by Methicillin-sensitive Staphylococcus aureus (MSSA) will be submitted to the Laboratory on three, rather than two swabs. There will be no other indication that the patient requires this additional screening. Two of the three swabs will be used to inoculate a MRSA Chromagar and the third to inoculate a Staph. aureus Chromagar. Results are sent directly to the surgeon’s office and treatment started per protocol.
3. Please note that we were seeing multiple cases of cellulitis of the knee prior to this project. These have decreased. We report our infections and the organism at the quarterly Infection Control meeting and have noted the excellence results using the CHG and MRSA screening. We are in the process of developing an order set for both hip and knee surgery which will include the CHG wash and MRSA screening (draft order set attached). The order sets have been reviewed by the orthopedic surgeons.
4. Olean General Hospital’s has put in place a quality monitor and is being used by OR staff during the day of surgery. They ask the patient if they followed the cleansing procedure. Sample attached
How did you roll out this practice? Did you test it with one patient, a few, or all to start?
We have rolled it out to one surgeon first then 2 other surgeons came on board in 2 months.
What lessons have you learned as you've implemented this practice? What tips do you have to share?
1. Develop a quality monitor from the very beginning to track patient compliance.
2. Involve the post op nursing staff; they need to know that the patient does not need to go into isolation if they have been treated with mupirocin.
3. Have pre admission nurse involved from the very beginning because he/she will drive the use of CHG and perform the screen.
4. Review the NHSN surgical site infection surveillance definition with the surgeons and advanced practitioners so everyone is on the same page.
Indicate which statement best summarizes your organization’s level of implementation of this Enhanced Surgical Bundle element:
[ x] This practice is used for at least 95% of hip/knee arthroplasty cases.
[ ] We have a well-tested protocol and use it for some hip/knee arthroplasty cases.