Healthcare Executive - September/October 2013 - 69

practices give providers an opportunity to engage patients in their
own care in ways that not only
help prevent SSIs but also increase
patient satisfaction. While surgeons may initially worry about
potentially frightening patients
by explicitly addressing the risk of
infection, we have found the opposite to be true. participants in
project JOINTS report that
patients express appreciation for
the frank communication, including being given the necessary
information to help prevent SSIs.
project JOINTS offers free patient
education tools and resources,
available on ihi.org, to help clinicians educate patients on infection
prevention.

As the number of hip and
knee arthroplasty procedures
quadruples and healthcare
organizations face public
reporting on infections,
careful attention to infection
reduction for these procedures
will be critical to reducing
costs, improving health and
enhancing the patient
experience.
putting all the project JOINTS
recommendations into practice
has led many facilities to create or
enhance already-existing “joint
classes” for patients a few weeks
prior to surgery. Joint classes
inform patients about what to

expect on the day of surgery,
during hospitalization and during
the rehabilitation process. preadmission testing is included in
this visit, and many project
JOINTS participants also incorporate patient education on the use
of chlorhexidine and mupirocin.
Even without joint classes, facilities can integrate these procedures
into their pre-admission testing
process.
Doing everything possible to
reduce harm is obviously good for
patients. It is also worth noting
that improved outcomes also offer
providers a way to distinguish
themselves in an increasingly competitive market in which patients
have more access to information
(online, through word of mouth,

etc.). Joint replacement surgeries
are often elective, allowing patients
the f lexibility and time to “shop
around” for providers. A number
of project JOINTS participants
report that patients have told them
they chose their facilities after
hearing about their efforts to prevent SSIs, sometimes rejecting
their geographically closest providers to do so.
Consider the ROI
As healthcare leaders, placing
undue emphasis on cost reduction
risks shifting focus away from our
primary purpose—providing the
best care possible for patients—
and can alienate some of our most
dedicated clinicians. Especially in
the current healthcare environment it’s essential for responsible

Practices to Reduce SSIs After Total Hip and Knee Arthroplasty
Comparative effectiveness research has identified three relatively simple
and affordable practices that substantially reduce surgical site infections
after hip and knee replacement surgery. The Institute for Healthcare
Improvement’s Project JOINTS aims to accelerate the spread of the following three practices in conjunction with two applicable Surgical Care
Improvement Project (SCIP)* practices (appropriate antibiotic use and
appropriate hair removal):
•	 Clinician use of an alcohol-containing antiseptic agent for preoperative
skin preparation
•	 Patient use of chlorhexidine wipes or soap for three days prior
to surgery
•	 Clinician screening and decolonization of Staphylococcus aureus
intranasal mupirocin and chlorhexidine wipes or soap
These practices are described in detail in the How-to Guide: Prevent SSI
for Hip and Knee Arthroplasty, available on IHI’s website at: http://www.
ihi.org/explore/SSIHipKnee/Pages/default.aspx.
*SCIP is the national initiative to reduce surgical complications sponsored
by the Centers for Medicare & Medicaid Services in collaboration with a
number of national partners.

Healthcare Executive
SEpT/OCT 2013

69
Healthcare Executive - September/October 2013

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