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Project JOINTS: Joining Organizations IN Tackling SSIs

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Project JOINTS: Joining Organizations IN Tackling SSIs Instruct patients to bathe or shower with chlorhexidine gluconate (CHG) soap for at least 3 days before surgery – PowerPoint PPT presentation

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Title: Project JOINTS: Joining Organizations IN Tackling SSIs


1
Project JOINTS Joining Organizations IN
Tackling SSIs
  • Instruct patients to bathe or shower with
    chlorhexidine gluconate (CHG) soap for at least 3
    days before surgery

2
What is Project JOINTS?
  • A new initiative funded by the federal government
    to give participants support from IHI in the form
    of in-person and virtual coaching on how to test,
    implement and spread the three new evidence-based
    practices to prevent surgical site infection for
    hip and knee arthroplasty as well as the two
    applicable Surgical Care Improvement Project
    (SCIP) practices.

3
Support Contributions
  • American Academy of Orthopaedic surgeons
    (AAOS/Academy)
  • The JOINTS project is a remarkable endeavor and
    the Academy looks forward to working with you to
    accomplish the goal of eliminating preventable
    SSIs.
  • AORN
  • Hospitals already engaged in the new
    interventions

4
Project JOINTS Website
http//www.ihi.org/ProjectJOINTS/
5
  • Evidence suggests three new practices to prevent
    surgical site infections in patients undergoing
    hip and knee arthroplasty.

6
Interventions to Prevent SSIs for Hip and Knee
Arthroplasty
  • New Practices
  • Use of an alcohol-containing antiseptic agent for
    pre-op skin prep
  • Instruct patients to bathe or shower with
    chlorhexidine gluconate (CHG) soap for at least
    three days before surgery
  • Screen patients for Staphylococcus aureus (SA)
    and decolonize SA carriers with five days of
    intranasal mupirocin and bathing or showering
    with CHG soap for at least three days before
    surgery

7
What evidence supports patient bathing or shower
with CHG soap for at least 3 days prior to
surgery?
  • Studies show that repeated use of CHG soap
    enhances the ability of CHG to reduce bacterial
    counts on the skin
  • not only during the immediate period after the
    shower but for a number of hours afterward
  • Study results suggest that patients may benefit
    from bathing or showering with CHG soap for at
    least 3 days before surgery in order to achieve
    the most benefit.
  • It is unknown whether using CHG soap for longer
    periods (e.g., five days) has additional benefit.

8
Implementing pre-operative bathing or showering
with CHG soap for at least 3 days prior to
surgery
  • Strategies to Accelerate Change

9
Preoperative bathing or showering with CHG soap
for at least 3 days prior to surgery
  • Provide patients with chlorhexidine soap or
    instruct them where they can purchase and have
    them use the soap in bathing or showering for at
    least three days before surgery.
  • Key considerations to ensure reliable CHG bathing
    or showering 3 days prior to surgery
  • Assess where most preoperative assessments
    currently take place in your setting, because
    that is the optimal time to discuss use of
    chlorhexidine soap with patients.
  • Assess current preoperative communication between
    the hospital OR department and the orthropaedic
    surgeons offices to ensure patients receive
    consistent instructions on CHG bathing or
    showering.

10
Preoperative bathing or showering with CHG soap
for at least 3 days prior to surgery
  • Additional considerations to ensure reliable CHG
    preoperative bathing 3 days prior to surgery
  • Decide whether its feasible to give
    chlorhexidine soap to all patients during the
    preoperative assessment visit. If not, provide
    information to the patients/families about where
    they can purchase and the approximate cost.
  • Provide patients/families instructions on how to
    do preoperative bathing.
  • Develop a simple form for patients to track days
    of CHG bathing or showering completion.

11
Preoperative bathing or showering with CHG soap
for at least 3 days prior to surgery
  • Additional key considerations in developing a
    reliable process for CHG bathing/showering 3 days
    prior to surgery
  • Develop a process flow diagram, specific to your
    hospital setting
  • define all necessary components of the process
    for patient bathing/showering for at least three
    days prior to surgery
  • build into the pre-op assessment/visit a process
    for providing CHG or instructing patients on
    where to obtain and instructions for use.
  • NOTE An example process flow diagram for Pre-Op
    CHG bathing or showering is available in the
    How-to Guide.

12
Assessing Progress Over Time Recommended
Process Measure
  • Percentage of patients undergoing hip or knee
    replacement surgery who have bathed or showered
    with chlorhexidine soap at least three days prior
    to surgery.

13
FAQs CHG bathing or showering
  • Are there disadvantages to recommending 5 days of
    CHG soap?The disadvantages are mainly practical,
    and include
  • patients would need a larger, more expensive
    bottle of CHG soap or the even more expensive
    5-day supply of CHG wipes
  • compliance with an additional two days of CHG
    showering/bathing could be even more challenging
    for patients.
  • Should the whole body be bathed with the CHG soap
    or just the surgical site? The CHG bath/shower
    prior to surgery should include the whole body
    from the neck down to avoid soap getting into
    the eyes, ears, nose, or mouth. Patients should
    also be reminded not to wash genital areas with
    CHG solution.

14
FAQs CHG bathing or showering
  • Can chlorhexidine-impregnated wipes be used
    instead of chlorhexidine soap?
  • If used correctly, the wipes may be better than
    chlorhexidine soap because the chlorhexidine
    doesn't get washed away in the shower or bath.
    One possible problem with the wipes is that many
    patients prefer showering to using the cloths
    which may reduce compliance.
  • before using cloths, consider asking individual
    patients if they're willing to use the cloths
    instead of showering.
  • Are there concerns about skin reactions to
    chlorhexidine bathing? Based on studies that
    have used chlorhexidine cloths for daily bathing
    of hospitalized patients (mainly in ICUs), skin
    reactions are very rare.

15
FAQs CHG bathing or showering
  • Can lotion be used following CHG bathing or
    showering?Lotions or moisturizers should not be
    used following CHG showering/bathing.
  • Can CHG soap be purchased in a regular
    pharmacy?CHG soap can be found at most
    pharmacies and drug stores. Be sure to check your
    local area to confirm availability.

16
For More Information
  • The How-To Guide contains more information on all
    three interventions

http//www.ihi.org/knowledge/Pages/Tools/HowtoGuid
ePreventSSIforHipKneeArthroplasty.aspx
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