Project JOINTS Exemplar Hospital Application

Huntington Hospital – Huntington, NY

Number of licensed beds: 310

Non-teaching

Rural

Exemplar Hospital Contact Name : Corazon Paraso, RN

Email:

Phone: 631-351-7896

[ √ ]: 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): Use of an alcohol-containing antiseptic agent for preoperative skin preparation

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?

Our facility has a very strong and proactive SCIP Task Force (chair by the Chief of Surgery and consists of ID physicians, ID clinicians, surgeons from each subspecialty, anesthesia, OR educator and Leadership, QM, Pharmacy, and representations from cardiac services, orthopedics, surgical unit, ASU and PST) that meets on a monthly basis and reviews our performance data; develop policies and protocols, implement best practices to reduce surgical infections, and monitors compliance to any newly developed processes. The switch to the use of alcohol-containing agent was influenced by the data showing increased surgical site infections. We looked at individual practices, trends, environment, and length of OR time, OR activity and skin preps to name a few. We identified that drying time for skin preps could have been one of the contributing factors since for betadine it takes 10 minutes to achieve complete drying time and that this is not being followed. OR staff with ID clinician evaluated some preps that would allow shorter drying time and still yield superior antisepsis to the skin. We started with all ortho patients the use of sage wipes prior to surgery that is accomplished in the ASU or holding area, then using chloraprep. And for spine cases, duraprep is used. That is followed now in all surgical cases with chloraprep as the only skin prep used.

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

The testing was all or nothing but initial exceptions were given to some surgeons provided that they adhere to the required drying time if they have to keep their choice of skin preps.

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

Some surgeons were still adamant in changing their old practice especially so that no infection was ever identified in all their cases. But for them to maintain their choice of prep such as betadine, they need to adhere to the 10 minutes drying time with strict monitoring to the time adherence (timers were installed). The longer wait for the betadine drying time forced them to switch to the 3 minute drying time of chloraprep.

[√ ] This practice is used for at least 95% of hip/knee arthroplasty cases.