Hospital: Watertown Regional Medical Center, Watertown, Wisconsin

Exemplar Hospital Contact Name: Linda Gehring, RN, Infection Preventionist,

Beds: 90 Setting: Rural

· What key changes did your organization make to incorporate or support bathing or showering with CHG soap for at least three days before surgery? What were the changes in existing processes your organization had to make in order for this to become part of the routine? The project joint team took a look at the current 1 bath process for surgical patients and what we had to do to make the change. The medical staff did not have a problem with the changes we proposed. We revised the current educational tool to make instruction clear for patients. The use of CHG cloths was explored and the decision was made to utilize these only for patients who were unable to bathe or shower effectively. The orthopedic navigators and clinic staff then hand out the CHG.

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

We did not do a test. After getting the orthopedic physicians approval, a target start date was chosen and the process implemented. Hospital staff was informed of the procedure change.

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

As with all process change, make sure everyone is kept informed and that all options explored

Measurement

Measurement provides information on whether the changes made to implement the Enhanced Surgical Bundle are resulting in improvement. In any improvement initiative, the ultimate goal is to improve an outcome measure (e.g., reduce SSIs); hospitals and surgical practices will accomplish this by first improving the processes that are key drivers.

Please provide for us any information you can regarding compliance with process measures, in this case:

Percentage of patients undergoing elective hip or knee replacement surgery who have bathed or showered with chlorhexidine soap or wipes during the three days prior to surgery. 100%

Numerator Definition: Number of patients undergoing hip or knee replacement surgery who have bathed or showered with chlorhexidine soap or wipes for at least the three days prior to surgery

Denominator Definition: Number of patients undergoing elective hip or knee replacement surgery