Surgical wound infection as a performance indicator: agreement of common definitions of wound infection in 4773 patients

Abstract

Objective: To assess the level of agreement between common definitions of wound infection that might be used as performance indicators.

Design: Prospective observational study.

Setting: London teaching hospital group receiving emergency cases as well as tertiary referrals.

Participants: 4773 surgical patients staying in hospital at least two nights.

Main outcome measures: Numbers of wound infections based on purulent discharge alone, on the Centers for Disease Control (CDC) definition of wound infection, on the nosocomial infection national surveillance scheme (NINSS) version of the CDC definition, and on the ASEPSIS scoring method.

Results: 5804 surgical wounds were assessed during 5028 separate hospital admissions. The mean percentage of wounds classified as infected differed substantially with different definitions: 19.2% with the CDC definition (95% confidence interval 18.1% to 20.4%), 14.6% (13.6% to 15.6%) with the NINSS version, 12.3% (11.4% to 13.2%) with pus alone, and 6.8% (6.1% to 7.5%) with an ASEPSIS score > 20. The agreement between definitions with respect to individual wounds was poor. Wounds with pus were automatically defined as infected with the CDC, NINSS, and pus alone definitions, but only 39% (283/714) of these had ASEPSIS scores > 20.

Conclusions: Small changes made to the CDC definition or even in its interpretation, as with the NINSS version, caused major variation in estimated percentage of wound infection. Substantial numbers of wounds were differently classified across the grades of infection. A single definition used consistently can show changes in percentage wound infection over time at a single centre, but differences in interpretation prevent comparison between different centres.

Figures

Fig 1

Comparison of diagnoses of surgical site infection in 5804 wounds reported with Centers for Disease Control (CDC) 1992 definition and with ASEPSIS scoring method, for wounds with and without pus

Fig 2

Comparison of diagnoses of surgical site infection in 5804 wounds reported with the Centers for Disease Control (CDC) 1992 definition and with the nosocomial infection national surveillance scheme (NINSS) version of the CDC definition