Project JOINTS Exemplar Hospital Application
Bellin Hospital – Green Bay, Wisconsin
Number of licensed beds: 167
Non-Teaching
Urban
Exemplar Hospital Contact Name:
Email: cabess@bellin.org
Phone: 920-639-4411
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: Staphylococcus aureus (SA) screening and use of
intranasal mupirocin and CHG bathing or showering to decolonize SA carriers
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?
o We started by reviewing the literature and determining the process we felt would benefit our patients
the most. We then flowed out the process. We developed as much education for staff and patients
before implementing the process to ensure support and success. We learned from issues as they arose
and made changes to the flow in response to issues.

How did you roll out this practice? Did you test it with one patient, a few, or all to start?
o We tested the process with 2 surgeons (we wanted to do 1 but another insisted on being in the pilot)
and only the patients who came through our joints class. We had to make many changes to our flow
and process before we could move to include more patients.

What lessons have you learned as you've implemented this practice? What tips do you have to share?
o Start small. Flow the process so all involved understand the entire process and not just their piece. Be
prepared to make changes frequently. Follow up with the users to be sure they are addressing all of the
issues. Celebrate success!
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 hip and knee replacement surgery who have had preoperative nasal swabs
to screen for Staphylococcus aureus carriage [screening measure]
We did not measure this. We did have all patient fill out a checklist of the showering and bactraban. All
patients have brought the checklist back with them when they came for surgery.
Numerator Definition: Number of patients undergoing hip or knee replacement surgery who have had a nasal swab
specimen processed to screen for Staphylococcus aureus carriage prior to surgery
Denominator Definition: Number of patients undergoing elective hip or knee replacement surgery

Percentage of patients undergoing hip and knee replacement surgery with nasal swabs positive for
Staphylococcus aureus who have received five days of intranasal mupirocin prior to surgery [received
mupirocin measure]
Numerator Definition: Number of patients undergoing hip or knee replacement surgery with a nasal swab specimen
result indicating Staphylococcus aureus carriage who have received five days of intranasal mupirocin prior to surgery
Denominator Definition: Number of patients undergoing elective hip or knee replacement surgery with nasal swabs
positive for Staphylococcus aureus