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Getting Started: How to Improve

Learn about the Model for Improvement, forming the improvement team, setting aims, establishing measures, and selecting and testing changes. Go to How to Improve.

Surgical Site Infection for Hip and Knee Arthroplasty

Among surgical procedures, arthroplastic (hip and knee) surgeries are key high-cost, high-volume surgeries targeted for surgical site infection prevention. Infections following hip or knee replacement surgery are devastating for the patient and those caring for the patient. Treatment often requires additional surgery and hospitalization; prolonged systemic antibiotic therapy; and impaired mobility during treatment. Patients generally require intensive rehabilitation in a skilled nursing facility or at home, where the burden of care, as well as considerable out-of-pocket expense, falls upon family members.

Key Changes for Improvement

  • Use an alcohol-containing antiseptic agent for preoperative skin preparation
  • Instruct patients to bathe or shower with chlorhexidine gluconate (CHG) soap for at least three days before surgery
  • Screen patients for Staphylococcus aureus (SA) and decolonize SA carriers with five days of intranasal mupirocin and bathing or showering with chlorhexidine gluconate soap for at least three days before surgery
  • Appropriate use of prophylactic antibiotics
  • Appropriate hair removal

The IHI How-to Guide contains detailed information on key changes to prevent surgical site infection for hip and knee arthroplasty and measures to guide improvement.

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