Project JOINTS Exemplar Hospital Application
Olean General Hospital- Olean, NY
Number of licensed beds: 186
Non-teaching
Rural
Exemplar Hospital Contact Name: Gail Bagozzoli, RN, IP Nurse
Email: gbagazzoli@ogh.org
We give permission to IHI to make public all the information on this Project JOINTS Exemplar Hospital application. yes
Enhanced Surgical Site Infections Prevention Bundle element (identify one per sheet): Bathing or showering with
chlorhexidine gluconate (CHG) soap for at least three days before surgery
a. Before we joined the project we discussed with one orthopedic surgeon the idea of providing CHG to all
his total and hemi-arthroplasties. We implemented this standard on May 1, 2011.
b. Protocol was set up as follows:
i. Pre admission nurse to see patient at least 14 days prior to surgery
1. Review pre op instructions on CHG wipes (see attachment), if patient is allergic to CHG,
use betadine sponges.
2. Give 2 packets of CHG wipes to patient (total of 4 wipes).
3. Culture nares for MRSA
4. Take culture to outpatient Lab, lab to Enter nares culture in Affinity for Dr.
5. Record patient visit on monthly log, forward log to IP monthly
In a few sentences, describe qualitatively in what ways your hospital has been successful in implementing this
element of the Enhanced Surgical Bundle. This orthopedic surgeon embraced the idea of CHG use and MRSA
screening. We now have 2 more orthopedic surgeons in the project. To date there has been Our orthopedic surgeons
embraced this standard and had their OR assistants take part in this change. Complete educational tools were shared
with office staff. We are now in the process of developing an order set.
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? The hospital gives the CHG wipes to each patient at no cost. We find patients are
more compliant with the wipes. Patient education AND Pre op care prior to orthopedic surgery instructions were
developed, handout reviewS bathing instructions and MRSA testing.
What were the changes in existing processes your organization had to make in order for this to become part of the
routine? Patients needed to be scheduled at least 14 days prior to surgery rather than 7 days to visit with pre op nurse.
Nasal cultures were added to the pre-op admission nurse routine checklist for total joints. Physicians received positive
culture at least 7 days before surgery to treat with mupirocin.
How did you roll out this practice? We provide information and CHG wipes all hip and knee patients in pre-admission
testing . At the Total Joint class we go into great detail on how to prevent infection, the CHG material is reviewed in the
class.
Did you test it with one patient, a few, or all to start? We started testing with one surgeon on May 1, by July 8 the
second orthopedic surgeon requested to participate. Our new orthopedic surgeon came on board in September and was
excited about participating. All patients are instructed to use the wipes three days prior to day of surgery. We are in
the process of developing a quality monitor to follow up with patient on compliance.
What lessons have you learned as you've implemented this practice? What tips do you have to share? Bring everyone
involved to the table to review the process. After 90 days re evaluation the pros and cons, and look at ways to make the
process leaner. Physician office staff must be involved. Start monitoring compliance right away. We started a quality
monitor with patients in December. Get the surgical unit involved as well.
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.