Validation of surgical wound classification in the operating room.
OBJECTIVE
To determine the accuracy with which circulating nurses (CNs) classify surgical procedures by risk of contamination in the operating room.


METHODS
Classification of surgical procedures by CNs was compared with the classification of surgical procedures by a physician observer.


METHODS
University-affiliated, tertiary care hospital.


METHODS
Circulating nurses used the traditional wound classification system of clean, clean-contaminated, contaminated, and dirty-infected to classify surgical wounds in the operating room. A physician remained in the operating room throughout each of 100 surgical procedures and simultaneously classified surgical wounds without the knowledge of the CNs.


RESULTS
Classification of surgical wounds by CNs was compared with classification by the physician observer for 50 cases in general surgery and 50 cases in trauma surgery. Compared with the physician observer, the overall accuracy of classification by CNs was 88% (95% confidence interval [CI] of 81.6% to 94.4%; Kappa statistic, 0.83). Classification of surgical wounds was more difficult in trauma surgery (accuracy of 82%) than in general surgery (accuracy of 94%). Accuracy increased for both services when surgical wounds were classified into just two categories (clean or clean-contaminated versus contaminated or dirty-infected).


CONCLUSIONS
Surgical wounds can be classified in the operating room with a high degree of accuracy by CNs. Classification was more difficult in trauma than in general surgery, but classification in trauma surgery improved with feedback to and additional education of CNs. The accuracy of classification by CNs was even higher when classifications were divided into just two categories.
Cardo
D M
DM
Department of Medicine, College of Medicine, University of Tennessee, Memphis 38163.
Falk
P S
PS
Mayhall
C G
CG
D006745:Hospital Bed Capacity, 300 to 499; D006785:Hospitals, University / Q000592:standards; D006801:Humans; D016357:Infection Control Practitioners / Q000592:standards*; D009719:Nurse Anesthetists; D009871:Operating Room Nursing; D009873:Operating Rooms / Q000592:standards*; D010820:Physicians; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000145:classification*; D013714:Tennessee; D000078329:Workforce; D014947:Wounds and Injuries / Q000601:surgery