Project JOINTS Exemplar Hospital Application
Sky Ridge Medical Center - Lone Tree, Colorado
Number of licensed beds: 185
Non-teaching
Urban
Exemplar Hospital Contact Name : Annie Meeks – Service Line Director for the Spine and Total Joint Center
Email: ann.meeks@healthonecares.com
Phone: 720-225-1665
[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
1. We have created a patient information sheet that is given to the patient by their surgeon at the time the surgery
is scheduled. This sheet describes how to use both the CHG and the Bactraban nasal ointment. The patient is
asked to use the skin wash five days prior to surgery and then we wash the area with Sage cloths in pre-op. This
information is also provided with specifics and reminders at both the weekly Total Joint Class and the
Preadmission testing visit. We have a very high percentage of patients who attend both the class and preadmission testing.
2. Our hospital supplies each patient a bottle of Hibiclens wash ( Chlorhexidine antimicrobial skin cleanser) when
they come either to the Total Joint Class or Pre-admission testing visit. If they do not come for either we provide
information on how to purchase the product at the drug store when they pick up their nasal ointment Rx.
Patients who come in are also provided at no charge a packet of 5 sterile cloths to use with the Chloraprep.
3. The instruction sheet has a check list for both the wash and nasal ointment. The patients are asked to bring the
check sheet with them on the day of surgery so we can track patient compliance and it is used as a QA initiative.
The sheet also has a place where the nursing staff can document which antibiotic is given one hour prior to
surgery.
4. The Director and Infection Control specialist have gone to each surgeons office and presented the information
provided by IHI and 100% of our surgeons and their staff have agreed to support this initiative.
5. For pre-operative skin preparation in the operating room 100% of our surgeons utilize ChloraPrep ™ with Tint 2%
w/v chlorhexidine gluconate (CHG) and 70% v/v isopropyl alcohol (IPA).
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 were already giving all of our patients three packets (three days worth) of
Chloraprep. The changes we made were to increase it to 5 days based on the decolonization information we
received from the physicians at IHI. We found that it is less expensive to give the patients a bottle rather than
the small packets and according to the information five days might be more beneficial. This is given to the
patient at no charge.
How did you roll out this practice? Did you test it with one patient, a few, or all to start?
We report our infection rates to our total joint surgeons at monthly steering committee meetings and discuss actions
that may be taken to reduce our rates of post operative infection. Approximately 80% of our reported infections are
MRSA or SA so it was easy to make our recommendations and have surgeon support.
What lessons have you learned as you've implemented this practice? What tips do you have to share?
It’s less expensive to give away the CHG wash and the cloths than deal with a joint infection.
[ X] This practice is used for at least 95% of hip/knee arthroplasty cases.