Project JOINTS Exemplar Hospital Application
Canton Potsdam Hospital – Potsdam, NY
Non-teaching
Rural
Exemplar Hospital Contact Name: Lisa McDonald, RNFA
Email:
Phone: 315-265-3300 ext 4003
[ X]: 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: 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?
We have been using Chloraprep for all of our orthopedic surgical cases since 2008, except open fractures and any other case where the skin integrity is compromised or the area is dirty. If the area is dirty we do a hibiclens scrub followed by Chloraprep. We had to standardize the orthopedic prep, which took about six months. One doc was doing a hibiclens scrub, one was using duraprep and the third was using betadine. We still additionally do a hibiclens scrub and Chloraprep for one of our MD’s as this is the only way he would agree to the change. I don’t personally think it makes a difference unless the area is visibly dirty and it has not made a difference in our infection rates. Lately this one doc is only insistent on the scrub for cases that have implants, so he is happy with Chloraprep only for knee arthroscopies, hand cases, etc.
How did you roll out this practice? Did you test it with one patient, a few, or all to start?
We rolled out this change for all orthopedic patients in 2008 across the board. I can’t really say all three of our doctors were happy about it at first, but it was one of four changes we made at the time to decrease our infection rate. They are all very happy with it now, one even brought me a JBJS article after we were using Chloraprep for six months showing that Chloraprep was a better prep than iodophors.
What lessons have you learned as you've implemented this practice? What tips do you have to share?
I let our doctors decide what color(orange or blue) to order, they chose blue at the time. Teal blue Chloraprep is not good for extremities. It is alarming to nurses, patients and patients’ families to see a “blue” foot or hand post-op. We now use orange only. It is also important to instruct OR staff that this product is different than Duraprep. The sticks look similar, but Chloraprep requires a gentle friction scrub at the incision site for 30 seconds. Duraprep is just painted on with no scrub. Some of our general surgeons have now switched to Chloraprep also. It is very important to have an OR “champion” to intitate this change with the docs, someone they work with daily and trust. It is also very important to involve them and get them on board with the change.
[ X ] This practice is used for at least 95% of hip/knee arthroplasty cases.