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: Bathing or showering with chlorhexidine gluconate (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?
On July 1, 2012, the Greater Baltimore Medical Center (GBMC) began providing all elective hip and knee
replacement surgical patients three days of 2% CHG cloths in our Joint Center Program Preoperative Education
Classes. GBMC has absorbed all costs of the cloths. The patients receive three applications of the cloths to
perform at home while the Preoperative team performs a 4th bath on the day of surgery in the preoperative
holding area. Practice before July 1, 2012 only provided the patient with the bath the day of surgery.

How did you roll out this practice? Did you test it with one patient, a few, or all to start?
GBMC’s Joint Center Coordinator was able to secure the resources to provide the wipes through her budget
for FY13. She began distribution of wipes to all patients in the Joint Center Preoperative Education Classes in
July 2012. Those patients that are unable to attend class have their wipes mailed to their home with
instructions.

What lessons have you learned as you've implemented this practice? What tips do you have to share?
Get the wipes in the mail early for the patients who do not attend class. Some delivered by snail mail did not
arrive in time. Consideration is being given to require all patients to attend class prior to their surgery. We
currently allow those that are back for their second replacement (had right now want left) or are back for a
revision not to attend class as we figure they know what to expect. However, now with all the patient
education given on the screening and the wipes, they may be missing the importance by just receiving the
mailing and coming in for a drive-by swab. We are currently deciding if they all need to attend another class.
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.
GBMC’s Compliance with 3 days (really 4) of CHG 2% cloths preoperatively
July 2012
45:47 = 95%
August 2012
32:35 = 92%
September 2012
8:8 (to date) = 100%
As of September 20th, 2012, we have also created a field to help pull this data electronically from the Electronic Medical
Record. Below is a screen shot.
***HIP & KNEE JOINT MRSA/MSSA SCREENING GO-LIVE***
We are scheduled to activate the MRSA/MSSA screening for Hip & Knee joint patients in Meditech
on Thursday, September 20 at 0800 This will require that nurses will need to document against this portion of
the Pre-Op assessment for hip & knee joint patients only.
_____________________________________________________________________________
What can I expect to be different with this new change?
The following queries have been added to the Pre-Op assessment:
Process Defined:
I. Patients will be instructed in the Joint Class on when to start the 3 Day CHG bath
o All patients will be given written instructions of how to perform.
o When patients arrive to Pre-Op on the day of surgery, you will assess if they have completed the CHG
bath.
II. Patients will receive a nasal swab in the Joint Class.
o
o
o
o
All patients will be given a prescription for Mupirocin at the time of the Joint Class.
If positive for MRSA and/or MSSA, the patient will fill the prescription.
If negative the patient will not fill the prescription.
When patients arrive to you on the day of surgery, they should be aware of this result which you will
document on the assessment, as well as if the Mupirocin was completed
III. Non-compliance with either, the 3 day CHG bath or Mupirocin administration, will NOT interrupt the patients
surgical procedure.