title: Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System.
abstract: To perform a valid comparison of rates among surgeons, among hospitals, or across time, surgical wound infection (SWI) rates must account for the variation in patients' underlying severity of illness and other important risk factors. From January 1987 through December 1990, 44 National Nosocomial Infections Surveillance System hospitals reported data collected under the detailed option of the surgical patient surveillance component protocol, which includes definitions of eligible patients, operations, and nosocomial infections. Pooled mean SWI rates (number of infections per 100 operations) within each of the categories of the traditional wound classification system were 2.1, 3.3, 6.4, and 7.1, respectively. A risk index was developed to predict a surgical patient's risk of acquiring an SWI. The risk index score, ranging from 0 to 3, is the number of risk factors present among the following: (1) a patient with an American Society of Anesthesiologists preoperative assessment score of 3, 4, or 5, (2) an operation classified as contaminated or dirty-infected, and (3) an operation lasting over T hours, where T depends upon the operative procedure being performed. The SWI rates for patients with scores of 0, 1, 2, and 3 were 1.5, 2.9, 6.8, and 13.0, respectively. The risk index is a significantly better predictor of SWI risk than the traditional wound classification system and performs well across a broad range of operative procedures.
authors.affiliation: Hospital Infections Program, Centers for Disease Control, Atlanta, Georgia 30333.
authors.forename: D H
authors.initials: DH
authors.lastname: Culver
authors.forename: T C
authors.initials: TC
authors.lastname: Horan
authors.forename: R P
authors.initials: RP
authors.lastname: Gaynes
authors.forename: W J
authors.initials: WJ
authors.lastname: Martone
authors.forename: W R
authors.initials: WR
authors.lastname: Jarvis
authors.forename: T G
authors.initials: TG
authors.lastname: Emori
authors.forename: S N
authors.initials: SN
authors.lastname: Banerjee
authors.forename: J R
authors.initials: JR
authors.lastname: Edwards
authors.forename: J S
authors.initials: JS
authors.lastname: Tolson
authors.forename: T S
authors.initials: TS
authors.lastname: Henderson
mesh_terms: D002487:Centers for Disease Control and Prevention, U.S.; D006801:Humans; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data; D013530:Surgical Wound Infection / Q000145:classification / Q000453:epidemiology*; D014481:United States