title: A socio-technical, probabilistic risk assessment model for surgical site infections in ambulatory surgery centers.
abstract: BACKGROUND
  To understand how structural and process elements may affect the risk for surgical site infections (SSIs) in the ambulatory surgery center (ASC) environment, the researchers employed a tool known as socio-technical probabilistic risk assessment (ST-PRA). ST-PRA is particularly helpful for estimating risks in outcomes that are very rare, such as the risk of SSI in ASCs.
  
  
  OBJECTIVE
  Study objectives were to (1) identify the risk factors associated with SSIs resulting from procedures performed at ASCs and (2) design an intervention to mitigate the likelihood of SSIs for the most common risk factors that were identified by the ST-PRA for a particular surgical procedure.
  
  
  METHODS
  ST-PRA was used to study the SSI risk in the ASC setting. Both quantitative and qualitative data sources were utilized, and sensitivity analysis was performed to ensure the robustness of the results.
  
  
  RESULTS
  The event entitled "fail to protect the patient effectively" accounted for 51.9% of SSIs in the ambulatory care setting. Critical components of this event included several failure risk points related to skin preparation, antibiotic administration, staff training, proper response to glove punctures during surgery, and adherence to surgical preparation rules related to the wearing of jewelry, watches, and artificial nails. Assuming a 75% reduction in noncompliance on any combination of 2 of these 5 components, the risk for an SSI decreased from 0.0044 to between 0.0027 and 0.0035.
  
  
  CONCLUSIONS
  An intervention that targeted the 5 major components of the major risk point was proposed, and its implications were discussed.
authors.affiliation: Grado Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, Virginia.
authors.forename: Ebru K
authors.initials: EK
authors.lastname: Bish
authors.forename: Hadi
authors.initials: H
authors.lastname: El-Amine
authors.forename: Laura A
authors.initials: LA
authors.lastname: Steighner
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Slonim
mesh_terms: D000556:Ambulatory Surgical Procedures / Q000009:adverse effects* / Q000592:standards / Q000706:statistics & numerical data; D019983:Guideline Adherence; D006801:Humans; D015233:Models, Statistical; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control