Proactive Risk Assessment of Surgical Site Infection in Ambulatory Surgery Centers

Final Contract Report

The Agency for Healthcare Research and Quality commissioned in August 2010 a study with two primary objectives: using proactive risk assessment, to identify the realm of risk factors associated with surgical site infections resulting from procedures performed at ambulatory surgery centers; and to design an intervention to reduce the likelihood of such infections due the most common risk factors identified by the proactive risk assessment.

Prepared for the Agency for Healthcare Research and Quality under contract HHSA 290-06-00019i-12.

Select to download print version ( PDF file PDF version - 752.24 KB). 

Prepared by Laura A. Steighner, Ph.D., (Project Director), American Institutes of Health, Washington, DC; and Anthony D. Slonim, M.D., Dr.P.H. (Principal Investigator).


Executive Summary
Chapter 1. Introduction
Chapter 2. ST-PRA Development
   Overview of Sociotechnical Probabilistic Risk Assessment
   Data Sources
   Development of the Fault Tree Model
Chapter 3. Risk-Informed Interventions
   Importance Measures
   Event(s) Targeted for Intervention
   Proposed Intervention
   Intervention Implementation
Chapter 4. Conclusions and Next Steps
   Study Strengths and Limitations
   Next Steps
   Examining How to Make ST-PRA More Accessible
Appendix A. Literature Review
Appendix B. Database Analysis
Appendix C. Site Visit Protocol
Appendix D. Site Visit Process Comparison
Appendix E. Study Parameters
Appendix F. ST-PRA Fault Tree Model With Probability Estimates ( PDF file PDF version - 230.97 KB )
Appendix G. References for Fault Tree Model Probability Estimates

Disclaimer: This document is in the public domain and may be used or reprinted for nonprofit purposes without permission, except those copyrighted materials that are clearly noted in the document. Further reproduction of those copyrighted materials is prohibited without the specific permission of the copyright holders. Use of this document, in whole or part, for profit-making purposes requires written approval from the Agency for Healthcare Research and Quality.

The opinions presented here are those of the authors and do not necessarily reflect the position of the U.S. Department of Health and Human Services or the Agency for Healthcare Research and Quality.


We gratefully acknowledge the four local ambulatory surgery centers who took time out of their busy schedules to give our team a tour of their facilities and to answer a few questions about the "day in the life of a surgical patient." In addition, we would like to acknowledge Alex Alonso, PhD, for his guidance and support throughout the project, as well as Janan Musa for her quality assurance review of the final report.

Page last reviewed April 2018
Page originally created April 2013
Internet Citation: Proactive Risk Assessment of Surgical Site Infection in Ambulatory Surgery Centers. Content last reviewed April 2018. Agency for Healthcare Research and Quality, Rockville, MD.
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