Table 1.

Proposed Application of SEIPS 2.0 Model to the Implementation of a Complex SSI Prevention Bundle

SEIPS Work System Element	Preoperative		Intraoperative		Postoperative
Task persons	Task	Person(s)	Task	Person(s)	Task	Person(s)
	Risk factor modification counseling	Surgeon Surgical PA Surgical NP	Appropriate hair removal	Surgical nurse	Supplemental oxygen	Anesthesiologist Anesthetist Surgical nurse
	Bioburden reduction prescriptions and instructions		Skin prep with chlorexidine-alcohol solution	Surgical nurse	Dressing change with or without removal at 48 h	Surgeon Surgical nurse
	Risk factor modification • Smoking cessation • Glucose control • Adequate nutrition	Patient Clinicians from primary and specialty care Patient	Appropriate antibiotic prophylaxis	Surgeon Anesthesiologist Pharmacist	Surgical wound care	Surgeon Surgical nurse Patient Caregiver
	Mechanical bowel prep + oral antibiotics		Maintain sterile field	All clinicians working within the sterile field	Surgical follow-up	Surgeon Surgical PA Surgical NP Patient Caregiver
	Chlorhexidine bathing		Maintain normal body temperature	Surgical nurse Anesthesiologist Anesthetist	Infection surveillance	Infection Preventionist
	Support patient tasks	Caregivers and families	Glucose control	Anesthesiologist Anesthetist	Support patient tasks	Caregivers and Families
	Communicate with clinicians		Use of wound protectors	Surgeon	Communicate with clinicians
	Appropriate surgical attire	All clinicians entering the OR	Separate instrument tray for surgical closure	Surgical tech Surgical nurse Circulating tech Surgeon
	Surgical hand scrub	Surgeon Anesthesiologist Anesthetist Surgical nurse Scrub tech Circulating tech Trainees	Glove change before wound closure Antibiotic-impregnated sutures	Surgeon Surgical nurse Surgical tech Surgeon
Tools and technologies	Preoperative		Intraoperative		Postoperative
	Pharmaceutical products and supplies		Surgical instruments and wound protectors		Wound-care products and supplies
			Computerized order sets for required tasks
Environment Internal (physical) External	Ambulatory surgical clinics Patient homes Skilled nursing facilities		Operating room Pre- and postanesthesia acute-care units Hospital surgical and medical acute-care units		Surgical instrument reprocessing sites Ambulatory surgical clinics Patient homes Skilled nursing facilities Rehabilitation centers
	Healthcare regulatory agencies that track patient safety outcomes, including HAIs such as SSIs
Organization	Culture of patient safety and infection prevention
	Leadership support and dedication of appropriate resources for all tasks

Note. SSI, surgical site infection; SEIPS, Systems Engineering Initiative for Patient Safety; PA, physician assistant; NP, nurse practitioner; HAI, healthcare-associated infection. Highlighted cells show collaborative work between patients/caregivers and clinicians.