SA Decolonization Exemplar Hospital

Project JOINTS Exemplar Hospital Application

Oneida Healthcare- Oneida, NY Number of licensed beds: 101 Non-teaching Rural Exemplar Hospital Contact Name: Mary Manfredo, RN Email: [email protected] Phone: 315-363-6000 Ext. 1138

We give permission to IHI to make public all the information on this Project JOINTS Exemplar Hospital application.

Enhanced Surgical Site Infections Prevention Bundle element (identify one per sheet): Staphylococcus aureus (SA) screening and use of intranasal mupirocin and CHG bathing or showering to decolonize SA carriers

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?

Staph screening is done in PAT (Pre-admission Testing) at the patient’s pre-op visit. The patient’s visit is 10 days pre-op which allows time for the culture to be done, call in a script for Mupirocin and for the patient’s 5 days course of treatment. The PAT nurse does the screen and checks the result 3 days later. She contacts the MD’s office to assure they received the result. If positive for MRSA or MSSA, the office contacts the patient and arranges for the Mupirocin script to be called to their Pharmacy. At that time, the office reinforces use of the Mupirocin for 5 days and the CHG shower.

How did you roll out this practice? Did you test it with one patient, a few, or all to start?

We convened a small team to work out the logistics and set a start date, so when we started, it was with all joint replacement patients

What lessons have you learned as you've implemented this practice? What tips do you have to share?

We learned that if people are willing to be a little flexible, we can make changes and do what’s right for the patient. Our primary orthopedic surgeon was on board before we started Project JOINTS, so the rest was easy!

This practice is used for at least 95% of hip/knee arthroplasty cases. (So far, we have screened 100% of our patients)