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A Socio-Technical, Probabilistic Risk Assessment Model for Surgical Site Infections in Ambulatory Surgery Centers

Published online by Cambridge University Press:  10 May 2016

Ebru K. Bish ,
Hadi El-Amine ,
Laura A. Steighner  and
Anthony D. Slonim
Ebru K. Bish
Affiliation:
Grado Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, Virginia
Hadi El-Amine
Affiliation:
Grado Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, Virginia
Laura A. Steighner
Affiliation:
American Institutes for Research, Washington, DC
Anthony D. Slonim
Affiliation:
Renown Health, Reno, Nevada
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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.

Conclusion.

An intervention that targeted the 5 major components of the major risk point was proposed, and its implications were discussed.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue S3: Preventing Healthcare–Associated Infections: Results and Lessons Learned from AHRQ's HAI Program , October 2014 , pp. S133 - S141
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

References

1. Barie, P. Infection control practices in ambulatory surgical centers. J Am Med Assoc 2010;303:2295–2297.Google Scholar
2. Centers for Disease Control and Prevention. U.S. outpatient surgeries on the rise, http://www.cdc.gov/media/pressrel/2009/r090128.htm. Published January 28, 2009. Accessed November 14, 2013.Google Scholar
3. Ambulatory Surgery Center Association. For patients: what is an ASC? http://www.ascassociation.org/asca/resourcecenter/forpatients/. Accessed April 16, 2014.Google Scholar
4. Hall, M, Lawrence, L. Ambulatory surgery in the United States: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, 1996, 1997.Google Scholar
5. Hedrick, TL, Anastacio, MM, Sawyer, RG. Prevention of surgical site infections. Expert Rev Anti Infect Ther 2006;4:223–233.CrossRefGoogle ScholarPubMed
6. Slonim, A, Bish, E, Xie, R. Red blood cell transfusion safety: probabilistic risk assessment and cost/benefits of risk reduction strategies. Ann Oper Res 2011:1–30.Google Scholar
7. Cohen, M, Smetzer, J, Westphal, J, Comden, S. Risk models to improve safety of dispensing high-alert medications in community pharmacies. J Am Pharm Assoc 2012;52:584–602.Google Scholar
8. Bish, D, Bish, E, Xie, R, Slonim, A. Optimal selection of screening assays for infectious agents in donated blood. HE Trans Healthc Syst Eng 2011;1:67–90.Google Scholar
9. Centers for Disease Control and Prevention. Surgical Site Infection (SSI). http.//www.cdc.gov/HAI/ssi/ssi.html. Accessed February 4, 2014.Google Scholar
10. Agency for Healthcare Research and Quality. California State Ambulatory Surgery Database. 2008. http://www.hcup-us.ahrq.gov/sasdoverview.jsp.Google Scholar
11. Slonim, A, Bish, E, Steighner, L, Zeng, X, Crossno, R. Proactive risk assessment of surgical site infections in ambulatory surgery centers: final report (prepared by the American Institutes of Research under contract no. 290-06-00019i-12). Agency for Healthcare Research and Quality (AHRQ) publications no. 12-0045-ER. Rockville, MD: Agency for Healthcare Research and Quality, 2012.Google Scholar
12. Slonim, A, Bish, E, Steighner, L. Using socio-technical probabilistic risk assessment (ST-PRA) to assess risk and improve patient safety and reliability in healthcare systems. In: Battles, IB, Cleeman, JI, Kahn, KL, Weinberg, DA, eds. Advances in the Prevention and Control of HAIs. Rockville, MD: Agency for Healthcare Research and Quality, 2014.Google Scholar
13. Bish, E, Azabeh-Fard, N, Steighner, L, Hall, K, Slonim, A. Proactive risk assessment of surgical site infections in ambulatory surgery centers, J Patient Saf (forthcoming).Google Scholar
14. Mangram, A, Horan, T, Pearson, M, Silver, LC, Jarvis WR; Hospital Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection, 1999. Am J Infect Control 1999;27:97–134.Google Scholar
15. Barie, P, Eachempati, S. Surgical site infections. Surg Clin North Am 2005;85:1115–1135.Google Scholar