Project JOINTS Exemplar Hospital Information:
Staphylococcus aureus (SA) screening and use of intranasal mupirocin and
CHG bathing or showering to decolonize SA carriers
Application
Magee-Womens Hospital of UPMC—Pittsburgh, Pennsylvania
Number of licensed beds: 360
Teaching
Urban
Exemplar Hospital Contact Name: Anthony M. DiGioia, III, MD, Orthopaedic Surgeon, Renaissance Orthopaedics,
Medical Director of The Bone and Joint Center at Magee-Womens Hospital and The PFCC Innovation Center of UPMC
Email: tony@pfcusa.org
Phone: 412-641-8654
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?
Since 2006 the Bone and Joint Center (BJC) at Magee-Womens Hospital has applied the Patient and Family
Centered Care Methodology and Practice (PFCC M/P) to redesign the Total Joint Replacement (TJR) Care
Experience. This approach to care delivery enables patients, families and care givers to co-design the ideal
care experience that delivers value by improving patient satisfaction, patient safety, and clinical outcomes
while decreasing waste and cost (www.pfcc.org).
In the Bone and Joint Center all patients are required to attend pre-operative testing and education three
weeks prior to surgery. The SA screening and intranasal Mupirocin bundle element was added to the existing
pre-operative testing regimen.

How did you roll out this practice? Did you test it with one patient, a few, or all to start?
The care givers met and reviewed the bundle element, ordered the necessary supplies, developed an
educational sheet for patients and families, and established an implementation date for all patients.

What lessons have you learned as you've implemented this practice? What tips do you have to share?
The lessons learned are mainly in the areas of patient education and compliance with positive result protocol:
o Most patients and families knowledge of MRSA/MSSA is limited to what they have learned through
media coverage.
o Positive result protocol can be overwhelming to patients increasing anxiety prior to surgery. Printed
material and verbal instruction are still not enough.
Tip to share:
o Proactively answer common question regarding positive results,
o Enhance printed and verbal educational material with coaching sessions via follow-up phone calls
with Nurse Practitioner.
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:
100% of patients undergoing hip and knee replacement surgery that attended preoperative testing through The Bone
and Joint Center have had preoperative nasal swabs to screen for MSSA/MRSA.
For 2013, we have started to collect data regarding the patients who require five days of intranasal mupirocin and
compliance rate.
Infection Rates Following Surgery
4.0%
3.0%
1.5%
2.0%
1.0%
1.0% 1.2%
1.4%
1.5%
Bone and Joint Center
Pennsylvania Avg
0.7%
National Avg
0.0%
Total Knee
Total Hip
Data for 2012