Project JOINTS Exemplar Hospital Information:
Staphylococcus aureus (SA) screening and use of intranasal mupirocin and
CHG bathing or showering to decolonize SA carriers
Hospital Name: Ministry Saint Michael’s Hospital, Stevens Point, WI
Exemplar Hospital Contact Name: Joanne Madigan, joanne.madigan@ministryhealth.org
Number of licensed beds: 181 Teaching or Non-Teaching? Non-teaching Setting: Rural
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?
Once we had begun participation in the Project JOINTS initiative, we involved the key orthopedic surgeons,
both in the educational webinars and in the development of the MRSA and MSSA screening protocols. Collaboration
with our hospital lab was obtained, along with business office/billing input since we had determined that patients would
not be billed for this testing – if they did not have insurance coverage, we were going to absorb the cost.
 How did you roll out this practice? Did you test it with one patient, a few, or all to start?
There were several components to the implementation of this process:
1) Engagement and education for Ortho surgeons and their office staff in preparation for their role in education of the
patient and the actual nasal swabbing
2) Discussions with Lab and Business office to plan process for all hip, knee and shoulder total joint replacement
patients, specifically regarding cost of cultures and cost of mupirocin for those patients with financial need
3) Development of patient education materials about MRSA, MSSA and the potential role of these organisms in their
surgical outcome
4) We chose a go-live date and all patients from the hospital affiliated practice group scheduled beyond that date were
cultured. Electronic documentation fields had to be updated in order to track patient compliance with mupirocin use.

What lessons have you learned as you've implemented this practice? What tips do you have to share?
Patients in our service area are becoming very knowledgeable about surgical site infections and the things
hospitals and providers ought to be doing to minimize infections to ensure best patient outcomes. Patients are
coming to the providers and asking what we are doing in this aspect of care – our providers have been very
pleased to be able to inform patients about our SSI Prevention program and provide them with educational
materials and supplies. A recent Joint Commission surveyor was informed by a patient that he was so pleased
about how seriously we took his post-operative outcomes that he had to do special skin prep and was cultured
to be sure he did not have the implicated bacterial organisms in his system before surgery - we learned that our
patients are listening and are more educated.
There is an independent group of Ortho providers in the community who initially were not interested in
participating with us in implementing all three of the bundle elements – as patients began to ask them, and as
area facilities began participation in the Project JOINTS initiative, they recognized the value of choosing to
participate. By keeping a very positive and approachable attitude toward this practice group, we were able to
bring them into the prevention project so that now all patients having joint replacements in our facility are
receiving the same level of care.
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]
Data for time period September 2012 (implementation of process) – November 2012
51 patients – 100% screened
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]
Data for time period September 2012 (process implementation) – November 2012
6/8 = 75% (two patients with partial compliance, did not complete full 5 days)
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
NOTE: Please attach available data in any format you currently have in the email included with this application.
Surgical Site Infection Prevention Program
Sept-Nov 2012
Mupirocin
Volumes
Cultured
MRSA +
MSSA +
Ordered
MMG
51
51
1
7
8
%
Compliance
100%
Patients
completing
5 day RX
2 d CHG
Shower
6
51
75%
100%
Eve.
Prior
CHG
DOS
CHG
on Adm
51
51
100%
Note: Independent practice group began CHG bathing protocol and nasal swabbing with mupirocin treatment for
MSSA/MRSA positive cultures in December 2012. Next reporting cycle will include data from each of the two provider
groups.
100%