Project JOINTS Exemplar Hospital Information:
Alcohol-containing antiseptic agent for preoperative skin preparation
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: 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?
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, we have always used an alcohol based prep solution. We are currently using a
single dose applicator prep stick with 2 % chlorhexidine and 70% isopropyl alcohol.

How did you roll out this practice? Did you test it with one patient, a few, or all to start?
Fortunately, it was not something we had to roll out as we have always used alcohol based prep solutions for
our patients in the Bone and Joint Center.

What lessons have you learned as you've implemented this practice? What tips do you have to share?
The most important concept to implement with alcohol based prep solutions is safety. Making absolute certain
you have no pooling of the solution and waiting for the prep to dry completely before draping.
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% (1,029 cases) of our patients with total hip and knee replacements receive an alcohol based prep solution.
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