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Table 1 Five bundle components of Project JOINTS and the corresponding measures of evidence-based practices (in italics)a

From: Does a quality improvement campaign accelerate take-up of new evidence? A ten-state cluster-randomized controlled trial of the IHI’s Project JOINTS

Bundle component/measures Evidence/rationale for inclusion
New evidence-based infection control practices
 1. Nasal screening and decolonization Screen patients for SA carriage and decolonize SA carriers with 5 days of intranasal mupirocin [15, 16] because SA nasal colonization has been shown to be associated with an increased risk for SSI
   1.a. Pre-operative nasal screening for Staphylococcus aureus (SA) carriage
   1.b. Intranasal mupirocin prescribed for methicillin-resistant S. aureus (MRSA) carriers
   1.c. Intranasal mupirocin prescribed for methicillin-resistant S. aureus (MRSA) carriers
2. Chlorhexidine bathing 3 or more times pre-operatively Instruct patients to bathe or shower with chlorhexidine gluconate (CHG) for at least 3 days before surgery [1719] to reduce bacterial colonization of the skin prior to surgery (regardless of SA carriage)
3. Alcohol-containing antiseptic used to prepare skin in operating room Use an alcohol-containing antiseptic agent for pre-operative skin preparation [20, 21] because the use of alcohol in addition to a long-acting antiseptic agent provides superior protection against SSIs
Previously promoted infection control practices from the Surgical Care Improvement Program (SCIP)
 4. Peri-operative intravenous antibiotics SCIP practice 1
   4.a. Timely receipt of prophylactic intravenous antibiotics  
   4.b. Peri-operative intravenous vancomycin for MRSA carriers  
5. Appropriate hair removal technique (not razor) SCIP practice 2
  1. aFor each infection control practices, respondents answered the following question: “Thinking about the patients undergoing hip and knee surgery whose care you are involved in, to the best of your knowledge, estimate how frequently each of the following processes occurs for those patients who do not have any contra-indications.” Response options were percentages from 0 to 100% in 10% increments and “do not know”