It’s Hip to Get the Antibiotic In

Jewish Hospital Downtown and St. Mary’s Health Care
Louisville, Kentucky, USA

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


To reduce the incidence of infections in total joint replacement through a multidisciplinary team approach.


  • 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)

  • Revised postoperative order sets to include prophylactic antibiotic protocol
  • 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
  • Appropriate hair removal utilizing clipper method
  • Implementation of stamp to notify nursing unit and pharmacy of preoperative antibiotic timing, surgical end time, and timing for discontinuation of antibiotics



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


[Storyboard presentation at IHI's 2006 National Forum]

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