• R.K.A. Bhalaji Kalasalingam University
  • S. Bathrinath Kalasalingam University
  • S.G. Ponnambalam Universiti Malaysia Pahang
  • S. Saravanasankar Kalasalingam University



risk factors; SSI; orthopedic hospital; fuzzy set theory.


This study portrays a ranked structure on different risk factors including patient, surgery and hospital related risk factors and allied unfavorable outcomes concerning an orthopedic hospital. The paper suggests a methodical surgical site infection (SSI) risk assessment method for assessing level of risk factors using three vital quantifying elements; outcome, time and likelihood of exposure. To transform the linguistic data into numeric risk scores, an enhanced decision making technique using fuzzy set theory has been endeavored in this paper. The notion of ‘centre of area’ technique for widespread TFNs has been discovered to measure the ‘extent of risk’ with regard to crisp scores. Lastly, a reasonable structure for classifying risk factors into various risk levels has been built based on differentiated ranges of assessed crisp risk scores. Then, an activity necessity plan has been proposed, which could give direction to the officials for effectively controlling risk factors in the circumstance of orthopedic hospital.


Korol, E., Johnston, K., Waser, N., Sifakis, F., Jafri, H. S., Lo, M., & Kyaw, M. H. (2013). A systematic review of risk factors associated with surgical site infections among surgical patients. PloS one, 8(12), e83743.

de Boer, A. S., Mintjes-de Groot, A. J., Severijnen, A. J., van den Berg, J. M. J., & van Pelt, W. (1999). Risk assessment for surgical-site infections in orthopedic patients. Infection Control & Hospital Epidemiology, 20(6), 402-407.

Ribeiro, J. C., Santos, C. B. D., Bellusse, G. C., Rezende, V. D. F., & Galvão, C. M. (2013). Occurrence and risk factors for surgical site infection in orthopedic surgery. Acta Paulista de Enfermagem, 26(4), 353-359.

Ercole, F. F., Franco, L. M. C., Macieira, T. G. R., Wenceslau, L. C. C., Resende, H. I. N. D., & Chianca, T. C. M. (2011). Risk of surgical site infection in patients undergoing orthopedic surgery. Revista latino-americana de enfermagem, 19(6), 1362-1368.

Triantafyllopoulos, G., Stundner, O., Memtsoudis, S., & Poultsides, L. A. (2015). Patient, surgery, and hospital related risk factors for surgical site infections following total hip arthroplasty. The Scientific World Journal, 2015.

British Standards Institution. (2008). BS OHSAS 18002: 2008 Occupational Health and Safety Management Systems: Guidelines for the Implementation of OHSAS 18001: 2007. British Standards Institution.

De Boer, A. S., Geubbels, E. L. P. E., Wille, J., & Mintjes-de Groot, A. J. (2001). Risk assessment for surgical site infections following total hip and total knee prostheses. Journal of Chemotherapy, 13(sup4), 42-47.

Babkin, Y., Raveh, D., Lifschitz, M., Itzchaki, M., Wiener-Well, Y., Kopuit, P., ... & Yinnon, A. M. (2007). Incidence and risk factors for surgical infection after total knee replacement. Scandinavian journal of infectious diseases, 39(10), 890-895.

Fang, A., Hu, S. S., Endres, N., & Bradford, D. S. (2005). Risk factors for infection after spinal surgery. Spine, 30(12), 1460-1465.

Jämsen, E., Huhtala, H., Puolakka, T., & Moilanen, T. (2009). Risk factors for infection after knee arthroplasty: a register-based analysis of 43,149 cases. JBJS, 91(1), 38-47.

Minnema, B., Vearncombe, M., Augustin, A., Gollish, J., & Simor, A. E. (2004). Risk factors for surgical-site infection following primary total knee arthroplasty. Infection Control & Hospital Epidemiology, 25(6), 477-480.

Olsen, M. A., Nepple, J. J., Riew, K. D., Lenke, L. G., Bridwell, K. H., Mayfield, J., & Fraser, V. J. (2008). Risk factors for surgical site infection following orthopaedic spinal operations. JBJS, 90(1), 62-69.

Khan, M. S., Rehman, S., Ali, M. A., Sultan, B., & Sultan, S. (2008). Infection in orthopedic implant surgery, its risk factors and outcome. J Ayub Med Coll Abbottabad, 20(1), 23-5.

Kalmeijer, M. D., van Nieuwland-Bollen, E., Bogaers-Hofman, D., de Baere, G. A., & Kluytmans, J. A. (2000). Nasal carriage of Staphylococcus aureus: Is a major risk factor for surgical-site infections in orthopedic surgery. Infection Control & Hospital Epidemiology, 21(5), 319-323.

Sánchez, J. Á., Mira, J. M., de la Paz López, F., & Troncoso, J. C. (2007). The centre of area method as a basic mechanism for representation and navigation. Robotics and Autonomous Systems, 55(12), 860-869.

Chu, T. C., & Varma, R. (2012). Evaluating suppliers via a multiple levels multiple criteria decision making method under fuzzy environment. Computers & Industrial Engineering, 62(2), 653-660.

Zadeh, L. A. (1965). Fuzzy sets. Information and control, 8(3), 338-353.

Klir, G. J., & Folger, T. A. (1988). Fuzzy sets, uncertainty, and information.

Atanassov, K. T. (1986). Intuitionistic fuzzy sets. Fuzzy sets and Systems, 20(1), 87-96.

Xia, H. C., Li, D. F., Zhou, J. Y., & Wang, J. M. (2006). Fuzzy LINMAP method for multiattribute decision making under fuzzy environments. Journal of Computer and System Sciences, 72(4), 741-759.

Chen, S. M., & Chen, J. H. (2009). Fuzzy risk analysis based on ranking generalized fuzzy numbers with different heights and different spreads. Expert systems with applications, 36(3), 6833-6842.

Samantra, C., Datta, S., & Mahapatra, S. S. (2017). Analysis of occupational health hazards and associated risks in fuzzy environment: a case research in an Indian underground coal mine. International journal of injury control and safety promotion, 24(3), 311-327.

Hsu, H. M., & Chen, C. T. (1996). Aggregation of fuzzy opinions under group decision making. Fuzzy sets and systems, 79(3), 279-285. 24. Australia, S. W. How to Manage Work Health and Safety Risks: Code of Practice. Safe Work Australia publications. 2011.




How to Cite

Bhalaji, R., Bathrinath, S., Ponnambalam, S., & Saravanasankar, S. (2019). ANALYSIS OF RISK FACTORS FOR SURGICAL SITE INFECTION: A CASE RESEARCH IN AN ORTHOPEDIC HOSPITAL (HEALTHCARE INDUSTRY). Journal of Modern Manufacturing Systems and Technology, 3, 98–113.