Risk is a Myriad Event SSI Fishbone Diagram

1. Pre-operative Factors Peri-operative Team Factors Organizational and Management Factors Patient Factors Surgeon Factors Technique Work Environmental Factors Care Delivery problems (CDPs) Risk is a Myriad Event SSI Fishbone Diagram Lack of traffic control – too many in room Lack of hand hygiene Financial constraints Contaminated environment Improper surgical hand antisepsis Patient body colonization Inadequate surgical prophylaxis Poor leadership Improper surgical attire Poor communication among team Increase hospitalization days Lack of pre-op shower Unsterile instruments Surgical irrigation Non-coated sutures Use of Staples or steri-strips SSI MRSA or MSSA nasal colonization Lack of discontinuation of antibiotics at 24 hrs Obese Poor staff levels Use of Drains Diabetic Workload and shift patterns Poor surgical technique Smoker Contamination of incision post-op Use of staples Infection at another site Contaminated environment Lack of re-dosing of antibiotic Design, availability and maintenance of equipment Environment and physical plant problems (air handling system) Inadequate staffing for post-op care Immunosuppressive agents Lack of foley catheter removal within 48 hrs Lack of hand hygiene

2. Pre-operative Factors Peri-operative Team Factors Organizational and Management Factors Patient Factors Surgeon Factors Technique Work Environmental Factors Care Delivery problems (CDPs) SSI Fishbone Diagram SSI