Case Risk Stratification
Clinical Objective
Classify each case into a standardised infection risk tier before the patient enters the OR. The tier determines the level of intraoperative and perioperative infection prevention applied — from standard precautions through to full enhanced protocol with mandatory lavage and post-operative monitoring.
Why This Matters
Patient and procedural risk factors for surgical site infection are identifiable before incision. Early stratification enables proportional planning — including antimicrobial prophylaxis, intraoperative lavage, postoperative monitoring, and client communication. Cases that go unclassified default to standard precautions, which may be insufficient for the actual risk present.
Critical Control Points
Tier assigned at case planning stage — not the morning of surgery
Assigned tier documented in the surgical record
Tier confirmed aloud at the pre-case briefing
Tier reviewed and updated if new clinical information emerges at prep or clip
Risk Factor Checklist
Complete during case planning. Each factor present increases infection risk and contributes to the tier assignment.
Tier Assignment
| Tier | Criteria | Action |
|---|---|---|
| Standard | 0 factors present | Standard infection prevention protocol |
| Elevated | 1–2 factors present | Heightened prophylaxis timing, sterile field discipline, wound lavage. Enhanced post-op monitoring. |
| High | 3+ factors, OR any single high-weight factor (revision surgery, prior infection, active immunosuppression, resistant organism history) | Full infection prevention protocol. Antiseptic lavage indicated. Post-op monitoring plan required. Consider pre-op client communication. |
Step-by-Step Protocol
- 1
Review patient history and planned procedure during case scheduling or day-prior review.
- 2
Complete the risk factor checklist — every case, every time. Stratification must be routine, not reserved for suspected high-risk cases.
- 3
Count the factors present and apply the tier assignment criteria.
- 4
Record the assigned tier in the surgical plan.
- 5
Communicate the tier to the full surgical team at pre-case briefing so that each team member understands the level of infection prevention required.
- 6
If new clinical findings emerge at clip or prep, reassess and reassign the tier before proceeding.
Key Pitfalls
Applying a risk tier only when infection risk is already suspected — stratification must be routine for every case, not a reactive step.
Not reassigning the tier when new findings emerge at patient prep.
Failing to communicate the assigned tier to the entire team before the case begins.
The checklist is not the goal. The goal is a surgical team that walks into the OR knowing this case requires more — and has already prepared for it.