Project JOINTS Exemplar Hospital Application

Rochester General Hospital (RGH) – Rochester, NY

Number of licensed beds: 535

Teaching

Urban

Exemplar Hospital Contact Name : Michelle Vignari RN, CIC; Infection Preventionist

Email:

Phone: 585-922-5620

[X ]: 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):

Use of an alcohol-containing antiseptic agent for preoperative skin preparation

What key changes did your organization make to incorporate or support use of an alcohol-containing antiseptic agent for preoperative skin preparation? What were the changes in existing processes your organization had to make in order for this to become part of the routine?

1.  At the time we joined Project Joints Rochester General Hospital had already been using an alcohol based skin prep since 2009. Our choice was chlora-prep.

2.  With RGH averaging >750 hip/knee joints a year, the changes were vast in that our surgical preps varied from surgeon to surgeon. It started with evidence based literature reviews, buy in from the key stakeholders, budget analysis, education, roll-out and assessment of success.

How did you roll out this practice? Did you test it with one patient, a few, or all to start?

1.  Roll out was a comprehensive multidisciniplary process:

a.  All surgeons, midlevels and peri-operative staff were educated on the planned change

b.  Official educational sessions and compentancies were done with all OR staff and surgeons by OR educators and vendor for Chlora-prep. Chlora-prep was implemented for ALL orthopedic surgeries, not just joint arthroplasties. Continuity within the service made the change easier.

c.  All OR custom packs were changes to include chlora-prep

d.  Roll out date was not chosen until all educated and process in place

e.  After roll out date, monthly re-evaluation was done until process hardwired.

f.  Any individual surgeon concerns/issues were dealt with on a one to one basis. Compliance was monitored by Clinical Leaders and reported off to Chief of Surgery.

What lessons have you learned as you've implemented this practice? What tips do you have to share?

2.  Process needs to be well planned and education is vital. Change is hard but a well defined, evidence based approach can make it happen seamlessly.

[ X] This practice is used for at least 95% of hip/knee arthroplasty cases.