Carroll Hospital Center, Westminster, Maryland

Number of Licensed Beds: 190

Non-teaching

Rural

Exemplar Hospital Contact Name: Charlotte Petela RN, BSN

Email:

Phone: 410-871-6840

Enhanced Surgical Site Infections Prevention Bundle element: Bathing or showering with chlorhexidinegluconate (CHG) soap for at least three days before surgery

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 bathing or showering with CHG soap for at least three days before surgery? What were the changes in existing processes your organization had to make in order for this to become part of the routine?

Carroll Hospital Center offered a non-mandatory Preop class prior to February 2009. As of February 2009 the class was made mandatory with the buy in from our surgeons. At this class we talk about the initiative to decrease post operative infections and the patients truly are appreciative of all our efforts. We complete a nasal swab for MRSA at the class. (In July 2012 we started swabbing for MSSA as well) In addition, the patients are given 5 CHG sponges to shower with each day for the 4 days prior to and day of surgery, and an instruction sheet with the date that they are to start using the sponges. We have results of the PCR’s Wednesday morning and if a patient is positive for MRSA (or MSSA) we give the patient a 5 day supply of mupiricin and an instruction sheet to follow.

On admission the preop nurses question the patients and all have stated they have used the sponges appropriately. June 2012 we initiated using a checklist for our patients to utilize each time they complete the shower. They are instructed to bring this sheet back with them day of surgery so we can track compliance. The checklist is on blue paper and the patients are told to bring the blue paper back with them day of surgery.

In addition, if a patient has already been to the class and has had a joint replacement already but is returning for their second joint, I meet with them individually give them their sponges and do the nasal swab.

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

When we mandated the class I met with each of the MD office staff to inform them of their role in scheduling these patients for class. At this point, when they post the case, they schedule the class.

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

I keep in close contact with the surgeons offices and if there are any “add on” cases I meet with the patient individually.

Measurement

Measurement provides information on whether the changes made to implement the Enhanced Surgical Bundle are resulting in improvement. In any improvement initiative, the ultimate goal is to improve an outcome measure (e.g., reduce SSIs); hospitals and surgical practices will accomplish this by first improving the processes that are key drivers.

Please provide for us any information you can regarding compliance with process measures, in this case:

Percentage of patients undergoing elective hip or knee replacement surgery who have bathed or showered with chlorhexidine soap or wipes during the three days prior to surgery.

Numerator Definition: Number of patients undergoing hip or knee replacement surgery who have bathed or showered with chlorhexidine soap or wipes for at least the three days prior to surgery

Denominator Definition: Number of patients undergoing elective hip or knee replacement surgery

NOTE: Please attach available data in any format you currently have in the email included with this application.

We have had 100% compliance with patient showering 4 days prior to and day of surgery with CHG sponges. In October we implemented a form for the patients to complete for “homework” and to return to us the day of surgery. This indicates that they have indeed utilized the shower sponges appropriately. I am attaching the form with this email.