Surgical site infections (SSIs) are the most common and costly of hospital-acquired infections. They are associated with increased length of stay, emergency department visits and readmissions. Because most SSIs are preventable with evidence-based measures that have been published in guidelines, they have become a quality metric and a target for improvement efforts worldwide. Surveillance of SSIs with feedback for appropriate data for surgeons is an important component in the strategy of lowering infection risks.
The most widely used definition for SSIs has been provided by the CDC. According to this definition, SSIs are classified by depth and tissue spaces involved in: Superficial Incisional SSI, Deep Incisional SSI and Organ/Space SSI.
Definition criteria are specific for each one and they include: purulent drainage from incision, positive cultures, patient symptoms and diagnostic technique.
Superficial incisional SSIs are only followed for a 30-day period for all procedure types and secondary incisional SSIs are only followed for a 30-day period regardless of the surveillance period for the primary site. The chart indicates 30 and 90-day surveillance indication for specific procedures.
All SSI should be reported in a form that includes patient demographic information and event details that pertain to the SSI event.
There are specific instructions when reporting SSI, including:
– Excluded Organisms: Well-known community associated organisms (organisms belonging to the following genera: Blastomyces, Histoplasma, Coccidioides, Paracoccidioides, Cryptococcus and Pneumocystis) and/or organisms associated with latent infections (for example, herpes, shingles, syphilis, or tuberculosis) are excluded from meeting SSI criteria.
– PATOS: an infection present at the time of surgery (PATOS) only applies to the depth of SSI that is being attributed to the procedure (ie. Intraabdominal abscess after ruptured appendix).
– Multiple tissue levels affected: report must reflect the deepest tissue level of SSI.
– Multiple primary incision sites: only a single SSI should be reported, representing the deepest tissue level where SSI criteria is met