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ISSUE: Opportunities for improvement exist for the prevention of surgical site infections (SSIs) in patients undergoing total hip (THA) and total knee arthroplasty (TKA) in the National Health Service (NHS) of the United Kingdom (UK). PROJECT: In 2000, Hospital for Special Surgery (HSS), a 160-bed specialty center for musculoskeletal diseases located in New York City (NYC), partnered with four NHS trusts in Southwest London that were in the process of constructing an elective orthopedic facility, known as SWLEOC. Infection control was one of the outcome measurements selected for implementation as part of this best practice knowledge transfer project. Physical rehabilitation, preoperative patient education, and leadership were also selected. Infection control was integrated into this project at all levels, including facility design and construction, protocol development, and staff education. Numerous site visits, consultations, and education sessions were conducted in the United States at HSS and in London at SWLEOC during a 12-month period. RESULTS: The new orthopedic center opened in January 2004, as a 50-bed elective orthopedic center performing predominantly hip and knee surgery. As per data reported by the center, 1128 patients underwent surgery from April through November 2004. The center has reported an infection rate of 0.33%. All patients are followed 4 weeks post discharge as part of the National Surgical Site Surveillance (UK). All patients are swabbed for MRSA at pre-assessment. No cases of hospital-acquired MRSA have occurred to date. LESSONS LEARNED: Knowledge and understanding of the receiving facility''s culture and system are necessary for a successful transfer of knowledge to occur. It was essential for the NYC team to become familiar with UK/NHS patient care practices, occupational health standards, and environmental and construction protocols. Infection control data collection and reporting systems in the United Kingdom are evolving; retrieval of post-discharge information is critical for accurate outcome measurement. Infection control impacts all aspects of the orthopedic center, from operational flow to patient outcomes; therefore it was an essential component of this project. [Copyright &y& Elsevier]

ISSUE: Reinforcing the linkages between infection control and occupational health strengthens both programs and enhances patient and employee safety. PROJECT: This is a 160-bed center specializing in the care of patients with musculoskeletal diseases. The hospital employs approximately 2000 professional and ancillary staff. In 2000, the occupational health services (OHS) nurse manager left to assume a different position within the facility. After much discussion, a decision was made to link the infection control and occupational health services under one leader. The person selected had previous experience in both occupational health and infection control. It was agreed by the vice president for nursing that the manager for the newly combined departments would not provide clinical services for occupational health, but would serve in an administrative capacity only. RESULTS: The linking of the two departments has been a remarkable success. Nursing staff in both areas has been cross trained in activities such as surveillance, education, immunizations, reportable communicable diseases, and bloodborne pathogen exposure response. The office staffs have been cross trained for computer support. Employees from both departments welcomed the opportunity for additional education and professional development. Each department has maintained its own distinct personality and responsibility but supports the other, leading to greater productivity for both. Hospital employees are sharing information about occupational health issues such as problems with sharps devices with the IC/OHS team who are visible and approachable within the hospital. These problems can then be observed and acted upon in real time. Important events such as tuberculosis skin testing, influenza vaccination programs, and annual education day have become successful team events. The number of influenza vaccines administered has increased by more than 100% in 4 years; Tuberculosis skin testing has increased by 58%, and annual health assessment compliance has increased by 40%. LESSONS LEARNED: This program can reap tremendous benefits for patients and staff if both departments and the manager are committed to success, and the linkage is fully supported by administration. Resources spent to educate and develop the staff have been repaid by patient and employee satisfaction statements and increased compliance with immunization and competency efforts. [Copyright &y& Elsevier]