Project JOINTS Exemplar Hospital Application
Greater Baltimore Medical Center (GBMC) – Baltimore, Maryland
Number of licensed beds – 270
Teaching
Urban
Exemplar Hospital Contact Name: Stephanie Mayoryk RN BSN CIC
Email: smayoryk@gbmc.org
Phone: 443-849-3628
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: Use of an alcohol-containing antiseptic agent for
preoperative skin preparation
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 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?
Chlorhexidine + alcohol (Chloraprep) is the surgical skin prep of choice at GBMC. Education was performed
with the assistance of the manufacturer within in the Operation Room on the application process of
CHG+alcohol and the benefits of the residual effect of the antiseptic. Use of betadine paint was discouraged
and the compliance with appropriate skin antiseptic agent choice has been monitored quarterly.

How did you roll out this practice? Did you test it with one patient, a few, or all to start?
GBMC implemented Chlorhexidine gluconate + alcohol across our general operating room several years ago.
Compliance is tracked quarterly in the procedures that are under surveillance for surgical site infections.

What lessons have you learned as you've implemented this practice? What tips do you have to share?
It was noted in reviewing the compliance data for hip and knee replacements that two surgeons in particular
where still utilizing betadine paint. The Joint Committee’s Physician Champion spoke to the two surgeons and
shared the most recent evidence-based data to encourage the Chlorhexidine + alcohol agent. Physician
champion (surgeon support) is key to address questions / concerns of colleagues.
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 or knee replacement surgery with skin antisepsis at the surgical site using an
alcohol-containing preoperative skin antisepsis agent.
Numerator Definition: Number of patients undergoing hip or knee replacement surgery with skin antisepsis at the
surgical site using an alcohol-containing preoperative skin antisepsis agent (e.g., Chlorhexidine gluconate plus alcohol or
iodophor plus alcohol)
Denominator Definition: Number of patients undergoing elective hip or knee replacement surgery
GBMC % Compliance with CHG +
Alcohol as Intraoperative Skin Prep
Q1FY12 (July-September 2011)
Hips
Knees
48:52 = 92.3%
85:90 = 94.4%
Q2FY12 (October-December 2011)
39:42 = 89%
102:107 = 95.3%
Q3FY12 (January-March 2012)
46:47 = 97.9%
116:116 = 100%
Q4FY12 (April-June 2012)
37:37 = 100%
114:114 = 100%