An initiative from the Institute for Healthcare Improvement dramatically decreased surgical site infections in total joint replacement patients. Project JOINTS (Joining Organizations IN Tackling SSIs) is a federally funded initiative that builds on well-established evidence to build a "bundle" for care of these patients. The bundle consists of:

• Antibiotics at the time of surgery
• Use of clippers instead of razor blades
• Surveillance Staphylococcus aureus cultures, with 5 days of nasal gel antibiotic therapy if +
• Checklist of showering procedures with chlorhexidine soap for the 3 days before surgery
• Alcohol based antiseptic skin prep in the OR.