Pre-Operation Total Joint Preparation Class
What You Can Do To Prepare For Surgery
Staphylococcus aureus or “Staph” is a germ that lives on the skin and in the nose of some healthy people. Your skin protects you from those germs. When you have surgery, we will be cutting your skin. Sometimes germs can get into those cuts and cause infection.
PVHMC will swab your nose at your Pre Op appointment, 14 days before surgery, to see if you have Staph. The test will take 3-5 days to get the results. The results will be communicated to your Surgeon. A positive test means that Staph is present (this is referred to as being “colonized”) but does not mean you have an infection or illness.
Showering before Surgery
To decrease the amount of germs on your skin, PVHMC is providing you with a medicated soap called Chlorhexidine Gluconate 4% and instructions to cleanse the skin for FIVE consecutive nights before surgery. You will receive this packet when you complete your pre op admission appointment at the hospital. Start the showering process 5 nights before your surgery. (Example: If your surgery date is April 16th then start the showering on April 11th.) The showering is done whether or not the nasal screen is positive or negative for Staph.
CHG 4% Showering
PVHMC Pre Op Skin Preparation Packet contains 2 bottles of the medicated soap called Chlorhexidine Gluconate (CHG) 4%, a measuring cup, 5 cloth mittens and showering instructions. The instructions will provide you with specific information about showering for FIVE nights in a row before your surgery. Read the showering instructions completely before showering. Follow the instructions for all 5 showers.
Positive Test for Staph
If your test is positive, your surgeon’s office will call you and ask you for the information to your preferred pharmacy. They will call in a prescription for Mupirocin ointment which you will need to pick up from your pharmacy. The medicine will come in one large tube or many small packets. You can call your Clinical Coordinator for any questions concerning the showering and ointment application.
Mupirocin Ointment Application (only if positive for Staph)
Apply a pea size amount of the ointment to a cotton swab. Place the cotton swab inside your nose, applying the ointment to the inside of the nose. Remove cotton swab and discard. Apply a pea size amount of the ointment to another cotton swab. Place the cotton swab inside the other side of your nose, applying the ointment to the inside of the nose. Remove cotton swab and discard. Gently press your nose together and release, together and release for about one minute to get the medicine all over the inside of your nose. Do this once in the morning and once at night for FIVE days before surgery (the same FIVE days you are showering with CHG soap.) Complete the checklist on the showering instruction sheet for the Mupirocin application.
Day of Surgery
Bring with you the completed checklist (on the showering instruction sheet) and give to the holding room RN (this is the nurse getting you ready for surgery). When you arrive to the holding room you will be given CHG cloths to wipe with from “the neck down except the genitals” before you get dressed in your hospital gown. Before surgery you will receive antibiotics that are appropriate for you according to the nasal swab results.
MRSA (Methicillin-Resistant Staphylococcus Aureus)
If you have a type of Staph called MRSA you will be placed on “Contact Isolation”. This means your doctors and nurses will wear gloves and gowns when taking care of you. We do this to make sure we do not spread MRSA to another patient we are caring for. Your family and visitors will also need to wear gowns and gloves when they visit you in the hospital. When leaving your room, they will need to remove the gowns and gloves and clean their hands with alcohol rub found in the room or the isolation cart outside the room.
For any questions, call your Clinical Coordinator at PVHMC or call Pre Admission Testing at PVHMC at (909) 865-9546.
References: vll 2/2016; EBBP: AAOS, Orthopaedic Infection Prevention and Control: An Emerging New Paradigm. 2010. EBBP: IHI. How-to Guide: Prevent Surgical Site Infection for Hip and Knee Arthroplasty. 2012. EBBP: AORN, Evidence for Using Chlorhexidine Gluconate Preoperative Cleansing to Reduce the Risk of Surgical Site Infection. Nov 2010.
Get Excellent Orthopedic Care in Pomona
Post-Surgery, In-Hospital Goals:
- Day of Discharge is Post Op Day (POD) #2 for both Hip and Knee Replacement Patients. (Day of Surgery is considered POD #0).
- Physical Therapy (PT) Evaluation and Treatment on the Day of Surgery occurs in the afternoon or evening after surgery, once the patient is on the floor. Our goal is for patients to stand at bedside, take steps, or walk on the day of surgery.
- PT twice a day until discharged home.
- Occupational Therapy (OT) once a day until discharged home for Hip Replacements and until tasks are mastered for Knee Replacements. OT addresses Activities of Daily Living such as using the restroom, getting dressed, etc.
- Case Management begins on POD #1 to ensure a timely discharge.
- Patients are discharged home with their coach on POD #2. Durable Medical Equipment and Home Health RN or PT services, or Outpatient PT, may be ordered by the surgeon based on patient’s needs prior to discharge.
BASICSS after Joint Replacement: HIP or KNEE:
- The BASICSS is the pneumonic we use to help educate patients on the important factors in self-care after surgery.
Post-Discharge Follow-Up Phone Call:
- Patient who are discharged home from the hospital receive a follow up phone call from the Total Joint Program checking on:
- Patients progress now that they are home.
- Verify patients received their Durable Medical Equipment and / or Home Health Services.
- Educate as needed.
Our Total Joint Program includes a comprehensive, multidisciplinary team approach to standardize care and to provide optimal outcomes for our patients. We believe in providing “Expert Care with a Personal Touch.”
Most insurance plans cover joint replacement surgery, but you should check with your health plan to determine the extent of your coverage.
Need a Doctor?
Call PVHMC’s Physician Referral Line at 909.865.9782 or visit our website to find a doctor.
For more information about our Total Joint Replacement Program, please call 909.630.7815 or click on the PDF below for a copy of our brochure.