A U G U S T 2 0 1 8 • O U T PA T I E N T S U R G E R Y. N E T • 4 9
from the care continuum came together to form the Surgical Unit
Safety Program (SUSP), which performed a tracer methodology to
assess every patient touch and developed a standardized SSI preven-
tion bundle and a checklist tool called the Travel Tag, which moves
with the patient from the surgeon's office through to discharge. Every
staff member who cares for patients adds a checkmark to the docu-
ment to show she's done her part to prevent SSIs.
Since implementing the program in 2015, rates of infection at
Einstein steadily declined before bottoming out at zero last year. If
Einstein's efforts are any indication, there's likely plenty more you can
do to prevent infections in joint replacement patients.
1. Pre-operative nasal screening. Some evidence suggests that
testing for the presence of bacteria (particularly the Staphylococcus
species) in the nasal passages 2 to 6 weeks before surgery may help
prevent joint infection. Patients who have staph in their nasal pas-
sages receive an intranasal antibacterial ointment before surgery.
"Direct correlation studies have found that bacterial isolates that
come from the nares match those found in periprosthetic joint infec-
tions, so shedding from the nose can affect the surgical site," says
Antonia Chen, MD, MBA, a joint replacement specialist at Brigham
and Women's Hospital in Boston, Mass. "Screening and treating
patients reduces S. aureus colonization, which therefore lowers the
risk of SSI."
Treat patients who test positive for Methicillin-sensitive
Staphylococcus aureus (MSSA) or Methicillin-resistant
Staphylococcus aureus (MRSA) with intranasal mupirocin and
instruct them to take a chlorhexidine body wash for 5 days before sur-
gery. Ms. Yerkes's team also swabs each patient's nasal cavities in pre-
