Project JOINTS Exemplar Hospital Information:
Staphylococcus aureus (SA) screening and use of intranasal mupirocin and
CHG bathing or showering to decolonize SA carriers
Official Hospital Name: The Greater Baltimore Medical Center (GBMC), Baltimore, Maryland
Exemplar Hospital Contact Name: Stephanie Mayoryk, RN BSN CIC (Infection Prevention) and/or Shannon Isaac, RN
BSN (Joint Center Coordinator) smayoryk@gbmc.org; sisaac@gbmc.org
Number of licensed beds: 367 Teaching or Non-Teaching? Teaching
Setting (Urban or Rural): Urban
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?
Prior to Project Joints, GBMC did not screen for MRSA/MSSA prior to total hip/knee replacement procedures.
Joint Class did exist and the planning group elected to use this venue to obtain the screens. The microbiology lab
was instrumental in providing both the MRSA and MSSA (standard, culture methodology). Managed Information
Systems also assisted in creating reports that allowed the results to be communicated timely to all interested
parties (Infection Prevention, Joint Center and the Preop areas). The Joint Center telephones results to the
patients if positive and faxes a script for mupirocin to their pharmacy. The preoperative nursing team validates
that the patient has completed the 5 days of mupirocin BID and documents the compliance in the medical record.

How did you roll out this practice? Did you test it with one patient, a few, or all to start?
The Joint Center tested this practice in the first Joint Class in September. The process for obtaining the swab and
communicating results when smoothly in the first cohort. The testing continued in subsequent Joint Classes,
which occur every two weeks.

What lessons have you learned as you've implemented this practice? What tips do you have to share?
Scheduling with the surgeon’s offices have remained the biggest challenge. In order to have the swabs obtained,
results communicated, and mupirocin for 5 days, the patients must be scheduled far enough in advance. We
have had a few late “add-on’s” that have been missed or unable to be screened and will be tackling the specific
offices/surgeons to address.
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
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
100%
Screening
Screened
Positive
80%
60%
40%
25% 24% 26%
13%
20%
0%
Cases from September 2012-December 2012:
123/124 were screened: 99.2%

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
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
28 patients of 28 positive for MSSA/MRSA (100%) were treated with mupirocin 5 days BID preoperatively
Mupirocin
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
100% 100% 100%100%