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Guideline for Prevention of Surgical Site Infection, 1999

Table 1

Criteria For Defining A Surgical Site Infection (SSI)*
Superficial Incisional SSI

Infection occurs within 30 days after the operation
and
infection involves only skin or subcutaneous tissue of the incision
and at least one of the following:

  1. Purulent drainage, with or without laboratory confirmation, from the superficial incision.
  2. Organisms isolated from an aseptically obtained culture of fluid or tissue from the superficial incision.
  3. At least one of the following signs or symptoms of infection: pain or tenderness, localized swelling, redness, or heat and superficial incision
    is deliberately opened by surgeon, unless incision is culture-negative.
  4. Diagnosis of superficial incisional SSI by the surgeon or attending physician.


Do not report the following conditions as SSI:

  1. Stitch abscess (minimal inflammation and discharge confined to the points of suture penetration).
  2. Infection of an episiotomy or newborn circumcision site.
  3. Infected burn wound.
  4. Incisional SSI that extends into the fascial and muscle layers (see deep incisional SSI).


Note: Specific criteria are used for identifying infected episiotomy and circumcision sites and burn wounds.[433]

Deep Incisional SSI

Infection occurs within 30 days after the operation if no implant† is left in place or within 1 year if implant is in place and the infection appears to be related to the operation
and
infection involves deep soft tissues (e.g., fascial and muscle layers) of the incision
and at least one of the following:

  1. Purulent drainage from the deep incision but not from the organ/space component of the surgical site.
  2. 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: fever (>38°C), localized pain, or tenderness, unless site is culture-negative.
  3. An abscess or other evidence of infection involving the deep incision is found on direct examination, during reoperation, or by histopatholog
    ic or radiologic examination.
  4. Diagnosis of a deep incisional SSI by a surgeon or attending physician.


Notes:

  1. Report infection that involves both superficial and deep incision sites as deep incisional SSI.
  2. Report an organ/space SSI that drains through the incision as a deep incisional SSI.
Organ/Space SSI

Infection occurs within 30 days after the operation if no implant† is left in place or within 1 year if implant is in place and the infection appears to be related to the operation
and
infection involves any part of the anatomy (e.g., organs or spaces), other than the incision, which was opened or manipulated during an operation
and at least one of the following:

  1. Purulent drainage from a drain that is placed through a stab wound‡ into the organ/space.
  2. Organisms isolated from an aseptically obtained culture of fluid or tissue in the organ/space.
  3. 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.
  4. Diagnosis of an organ/space SSI by a surgeon or attending physician.

* Horan TC et al.[22]
† National Nosocomial Infection Surveillance definition: a nonhuman-derived implantable foreign body (e.g., prosthetic heart valve, nonhuman vascular graft, mechanical heart, or hip prosthesis) that is permanently placed in a patient during surgery.
‡ If the area around a stab wound becomes infected, it is not an SSI. It is considered a skin or soft tissue infection, depending on its depth.

 

 
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