Surgical Site Infections ( SSIs)

Definitions for Surgical Site Infection (SSI)
Superficial Incisional
Definitions:
1. Involves only skin and subcutaneous tissue of the incision
AND
2. The patient has at least one of the following:
a. purulent drainage from the superficial incision
b. organisms isolated from an aseptically obtained culture of fluid or tissue from the superficial incision
c. at least one of the following signs or symptoms of infection:
o pain or tenderness
o localized swelling
o redness or heat
o superficial incision is deliberately opened by surgeon, unless incision is culture-negative
d. diagnosis of superficial incisional SSI by the surgeon or attending physician.
· Do not count stitch abscesses (minimal inflammation and discharge confined to the points of suture penetration), or a localized stab wound infection as a surgical site infection.
· Do not count infection of the circumcision site in newborns, or infection of the episiotomy site as a surgical site infection.
· If the incisional site infection involves or extends into the fascia and muscle layers, report as a deep incisional surgical site infection.
· An infection that involves both the superficial and deep incision sites should be classified as a deep incisional surgical site infection.
Deep Incisional
Definitions:
1. Infection involves deep soft tissues (e.g., fascia and muscle layers) of the incision
AND
2. The patient has at least one of the following:
a. purulent drainage from the deep incision but not from the organ/space component of the surgical site
b. a deep incision spontaneously dehisces or is deliberately opened by a surgeon when the patient has at least one of the following signs or symptoms (unless incision is culture-negative):
o fever (>38°C)
o localized pain or tenderness
c. an abscess or other evidence of infection involving the deep incision is found on direct examination, during reoperation, or by histopathologic or radiologic examination
d. diagnosis of a deep incisional surgical site infection by a surgeon or attending physician
· An infection that involves both superficial and deep incision sites is classified as a deep incisional surgical site infection
Organ/Space
Definitions:
1. An organ/space surgical site infection involves any part of the body, excluding the skin incision, fascia, or muscle layers, that is opened or manipulated during the operative procedure
2. Infection involves any part of the body, excluding the skin incision, fascia, or muscle layers, that is opened or manipulated during the operative procedure
AND
3. The patient has at least one of the following
a. purulent drainage from a drain that is placed through a stab wound into the organ/space
b. organisms isolated from an aseptically obtained culture of fluid or tissue in the organ/space
c. an abscess or other evidence of infection involving the organ/space that is found on direct examination, during reoperation, or by histopathologic or radiologic examination
d. diagnosis of an organ/space surgical site infection by a surgeon or attending physician
· Occasionally an organ/space infection drains through the incision. Such infection generally does not involve reoperation and is considered a complication of the incision. Therefore, it is classified as a deep incisional surgical site infection
· Report endometritis occurring post C-section as an organ/space nosocomial infection unless the amniotic fluid is infected at the time of admission or the patient was admitted 48 hours after rupture of the membranes
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