Roles & Responsibilities

SSI prevention fails when nobody owns the step. This section defines who is responsible for each critical control point.

Surgeon

The surgeon holds ultimate accountability for the SSI prevention plan, from case selection and planning through closure and discharge instructions.

Responsibilities

  • ·Procedure planning and SSI risk assessment
  • ·Antimicrobial prophylaxis plan
  • ·Implant plan and handling standards
  • ·Surgical field isolation standards
  • ·Intraoperative contamination event decisions
  • ·Closure technique and postoperative instructions

Critical Moments

  • ·Pre-case planning
  • ·Antibiotic selection and timing confirmation
  • ·Implant opening and handling
  • ·Contamination event response
  • ·Closure decision-making
  • ·Discharge instructions

Common Failure Points

  • ·Antibiotic timing not confirmed before incision
  • ·Implant touched before placement without glove change
  • ·Contamination event not recognized or acted on
  • ·Discharge instructions too brief or verbal-only

Protocols This Role Owns

Contamination Pathways Controlled

PatientInstruments & ImplantsSurgical TechniqueIntraoperative AdjunctsPostoperative Care

Anesthetist / Anesthesia Technician

The anesthesia team manages intravenous access and medication delivery, creating a direct pathway for contamination into the bloodstream.

Responsibilities

  • ·IV catheter asepsis
  • ·Infusion line handling
  • ·Medication hygiene
  • ·Antibiotic timing
  • ·Workspace cleanliness

Critical Moments

  • ·Catheter placement
  • ·Drug preparation
  • ·Line access
  • ·Antibiotic timing
  • ·Intraoperative handling

Common Failure Points

  • ·Late antibiotics
  • ·Poor catheter prep
  • ·Contaminated line access
  • ·Dirty workspace
  • ·Shared fluids
Insight
Every line and syringe is a potential contamination pathway.

Protocols This Role Owns

Contamination Pathways Controlled

Intraoperative AdjunctsSurgical Team

Prep Technician / Circulating Nurse

The prep technician executes the patient preparation sequence and helps maintain OR environmental discipline before and during the case.

Responsibilities

  • ·Clipping protocol
  • ·Initial and final skin preparation
  • ·Transfer cleanliness
  • ·OR traffic control
  • ·Instrument availability
  • ·Documentation of sterility indicators

Critical Moments

  • ·Hair clipping
  • ·Antiseptic contact time
  • ·Patient transfer into OR
  • ·Final skin antisepsis
  • ·Door control after sterile setup

Common Failure Points

  • ·Clipping too narrow or in the wrong location
  • ·Contaminated gloves after clipping
  • ·Inadequate drying before draping
  • ·Recontamination during transfer
  • ·OR traffic not controlled

Protocols This Role Owns

Contamination Pathways Controlled

PatientOperating Room EnvironmentSurgical Field IsolationSurgical Team

Scrub Nurse / Scrub Technician

The scrub technician is the steward of the sterile field, responsible for setup integrity, instrument handling, implant handling, and monitoring for breaks in sterility.

Responsibilities

  • ·Sterile setup
  • ·Instrument counts
  • ·Implant handling
  • ·Field break monitoring
  • ·Glove-change prompts
  • ·Instrument passing

Critical Moments

  • ·Sterile table setup
  • ·Implant opening
  • ·Implant transfer
  • ·Glove change before implant handling
  • ·Recognition of field breaks

Common Failure Points

  • ·Field break not recognized
  • ·Implant opened too early
  • ·Implant handled without glove change
  • ·Instrument passed incorrectly
  • ·Sterile setup exposed too early

Protocols This Role Owns

Contamination Pathways Controlled

Surgical TeamSurgical Field IsolationInstruments & ImplantsSurgical Technique

Recovery / Ward Team

The recovery and ward team owns the early postoperative window when the wound is still vulnerable and the patient may contaminate or disrupt the incision.

Responsibilities

  • ·Wound protection
  • ·Patient monitoring
  • ·E-collar compliance
  • ·Dressing care
  • ·Early SSI recognition
  • ·Discharge education support

Critical Moments

  • ·Immediate anesthetic recovery
  • ·First hours after surgery
  • ·Dressing checks
  • ·Patient transfer to ward
  • ·Discharge preparation

Common Failure Points

  • ·E-collar missing or removed too early
  • ·Incision contacts dirty bedding
  • ·Dressing contamination not recognized
  • ·Early swelling or discharge not escalated
  • ·Owner instructions not reinforced

Protocols This Role Owns

Contamination Pathways Controlled

Postoperative CarePatientSurgical Team

Owner / Caregiver

After discharge, the owner becomes the primary observer and the final control point for incision protection, activity restriction, medication compliance, and early reporting.

Responsibilities

  • ·Incision protection
  • ·Activity restriction
  • ·Medication compliance
  • ·Monitoring for signs of infection
  • ·Sending photos or contacting the clinic when concerned

Critical Moments

  • ·First 24–48 hours at home
  • ·E-collar compliance
  • ·Dressing care
  • ·Any licking, chewing, or rubbing
  • ·Missed medications
  • ·Early swelling, redness, discharge, or pain

Common Failure Points

  • ·Removing the e-collar too early
  • ·Allowing excessive activity
  • ·Bathing or wetting the incision
  • ·Delaying contact with the clinic
  • ·Missing subtle early SSI signs

Protocols This Role Owns

Contamination Pathways Controlled

Postoperative Care