Jewish Hospital Downtown and St. Mary’s Health Care
Louisville, Kentucky, USA
Team
Lynn Simon, MD, MBA, CHE, Senior Vice President, Chief Medical Officer
Aneeta Bhatia, MD, Medical Center Anesthesia
Michael Sabes, RPh, Pharmacy
Traci Adkins, PharmD, CGP, Pharmacy
Kim Hite, RN, BSN, CRRN, Assistant Vice President, Hand and Microsurgery, Orthopedics and Sports Medicine
Paula Heinz, RN, BSN, CPHQ, Manager, Quality Care and Outcomes Management
Ronnie Pennington, RN, BSN, CIC, Infection Control Program Manager
Sherron Alexander, RN, MSN, Nurse Educator, Jewish Hospital Rhonda Endler, RN, BSN, Total Joint Coordinator
Susan Rich, PTA, Orthopedic Coordinator, Frazier Rehab Institute Christina Thompson, RN, BSN, CNOR, Director, Surgery
Dorie Shelburne, RN, BSN, Manager, Perianesthesia JHOR
Angie Freeman, RN, BSN, BS, CNA, Nurse Manager, 7 Heart and Lung
Carrie Dodson, RN, BSN, CNA, BC, CAPA, Manager, Emergency Department Medical Center South
Dorothy Rodgers, RN, BSN, CNA, BC, Manager, 3 East Orthopedic Unit
Aim
To reduce the incidence of infections in total joint replacement through a multidisciplinary team approach.
Measures
Instruction preoperatively for Hibiclens bath/shower as recommended by the Centers for Disease Control and Prevention (CDC)
Timing of antibiotic
Incision time
Antibiotic within one hour of incision
Surgical end time
Antibiotic discontinued 24 hours after surgery end time
History of preoperative antibiotic treatment and/or history of preoperative infection
Blood glucose monitoring and control
Incorporate use of CHG skin prep in the operating room (OR)
Changes
Education for orthopedic surgeons and anesthesia teams to Prophylactic Antibiotic Protocols
Education for orthopedic office managers and registered nurses to use of Hibiclens bath/shower as recommended by CDC
Implementation of Hibiclens bath/shower in pre-procedure testing department
Blood glucose monitoring for ALL total joint replacement patients
Preoperative staff flexed hours to ensure appropriate delivery and timing of antibiotics for 7:30 AM start surgical cases
Kefzol pushed IV by anesthesia to ensure therapeutic timeframe of 30 minutes before incision time
Implementation of stamp to notify nursing unit and pharmacy of preoperative antibiotic timing, surgical end time, and timing for discontinuation of antibiotics
Results
Summary of Results / Lessons Learned / Next Steps
This multidisciplinary team quickly implemented changes to reduce surgical site infection. Success was maintained with ongoing data review and evolved into a group that continues to identify opportunities for reduction in all surgical site infection.
Lessons Learned
Involve stakeholders and add/delete team members as appropriate
Educate all areas affected by changes
Gain buy-in from surgeons and anesthesia, and provide literature for review to support processes
Re-evaluate and analyze processes as changes are implemented
Celebrate successes with team members
Measure the important things and share results with team members
Contact Information
Kimberly C. Hite
Assistant Vice President, Hand and Microsurgery, Orthopedics and Sports Medicine
Jewish Hospital and St. Mary’s Health Care
kim.hite@jhsmh.org
[Storyboard presentation at IHI's 2006 National Forum]
