Surgical wound infection as a performance indicator: agreement of common definitions of wound infection in 4773 patients

A. P. Wilson, C. Gibbons, B. C. Reeves, B. Hodgson, M. Liu, D. Plummer, Zygmunt H Krukowski, Julie Bruce, J. Wilson, A. Pearson

Research output: Contribution to journalArticle

132 Citations (Scopus)

Abstract

Objective To assess the level of agreement between common definitions of wound infection that might be used as performance indicators.

Design Prospective observational study.

Setting London teaching hospital group receiving emergency cases as well as tertiary referrals.

Participants 4773 surgical patients staying in hospital at least two nights.

Main outcome measures Numbers of wound infections based on purulent discharge alone, on the Centers for Disease Control (CDC) definition of wound infection, on the nosocomial infection national surveillance scheme (NINSS) version of the CDC definition, and on the ASEPSIS scoring method.

Results 5804 surgical wounds were assessed during 5028 separate hospital admissions. The mean percentage of wounds classified as infected differed substantially with different definitions: 19.2% with the CDC definition (95% confidence interval 18.1% to 20.4%), 14.6% (13.6% to 15.6%) with the NINSS version, 12.3% (11.4% to 13.2%) with pus alone, and 6.8% (6.1% to 7.5%) with an ASEPSIS score >20. The agreement between definitions with respect to individual wounds was poor. Wounds with pus were automatically defined as infected with the CDC, NINSS, and pus alone definitions, but only 39% (283/714) of these had ASEPSIS scores >20.

Conclusions Small changes made to the CDC definition or even in its interpretation, as with the NINSS version, caused major variation in estimated percentage of wound infection. Substantial numbers of wounds were differently classified across the grades of infection. A single definition used consistently can show changes in percentage wound infection over time at a single centre, but differences in interpretation prevent comparison between different centres.

Original languageEnglish
Pages (from-to)720-723
Number of pages3
JournalBritish Medical Journal
Volume329
Issue number7468
DOIs
Publication statusPublished - Sep 2004

Keywords

  • SCORING METHOD
  • VALIDATION
  • ASEPSIS

Cite this

Wilson, A. P., Gibbons, C., Reeves, B. C., Hodgson, B., Liu, M., Plummer, D., ... Pearson, A. (2004). Surgical wound infection as a performance indicator: agreement of common definitions of wound infection in 4773 patients. British Medical Journal, 329(7468), 720-723. https://doi.org/10.1136/bmj.38232.646227.DE

Surgical wound infection as a performance indicator: agreement of common definitions of wound infection in 4773 patients. / Wilson, A. P.; Gibbons, C.; Reeves, B. C.; Hodgson, B.; Liu, M.; Plummer, D.; Krukowski, Zygmunt H; Bruce, Julie; Wilson, J.; Pearson, A.

In: British Medical Journal, Vol. 329, No. 7468, 09.2004, p. 720-723.

Research output: Contribution to journalArticle

Wilson, AP, Gibbons, C, Reeves, BC, Hodgson, B, Liu, M, Plummer, D, Krukowski, ZH, Bruce, J, Wilson, J & Pearson, A 2004, 'Surgical wound infection as a performance indicator: agreement of common definitions of wound infection in 4773 patients', British Medical Journal, vol. 329, no. 7468, pp. 720-723. https://doi.org/10.1136/bmj.38232.646227.DE
Wilson, A. P. ; Gibbons, C. ; Reeves, B. C. ; Hodgson, B. ; Liu, M. ; Plummer, D. ; Krukowski, Zygmunt H ; Bruce, Julie ; Wilson, J. ; Pearson, A. / Surgical wound infection as a performance indicator: agreement of common definitions of wound infection in 4773 patients. In: British Medical Journal. 2004 ; Vol. 329, No. 7468. pp. 720-723.
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abstract = "Objective To assess the level of agreement between common definitions of wound infection that might be used as performance indicators.Design Prospective observational study.Setting London teaching hospital group receiving emergency cases as well as tertiary referrals.Participants 4773 surgical patients staying in hospital at least two nights.Main outcome measures Numbers of wound infections based on purulent discharge alone, on the Centers for Disease Control (CDC) definition of wound infection, on the nosocomial infection national surveillance scheme (NINSS) version of the CDC definition, and on the ASEPSIS scoring method.Results 5804 surgical wounds were assessed during 5028 separate hospital admissions. The mean percentage of wounds classified as infected differed substantially with different definitions: 19.2{\%} with the CDC definition (95{\%} confidence interval 18.1{\%} to 20.4{\%}), 14.6{\%} (13.6{\%} to 15.6{\%}) with the NINSS version, 12.3{\%} (11.4{\%} to 13.2{\%}) with pus alone, and 6.8{\%} (6.1{\%} to 7.5{\%}) with an ASEPSIS score >20. The agreement between definitions with respect to individual wounds was poor. Wounds with pus were automatically defined as infected with the CDC, NINSS, and pus alone definitions, but only 39{\%} (283/714) of these had ASEPSIS scores >20.Conclusions Small changes made to the CDC definition or even in its interpretation, as with the NINSS version, caused major variation in estimated percentage of wound infection. Substantial numbers of wounds were differently classified across the grades of infection. A single definition used consistently can show changes in percentage wound infection over time at a single centre, but differences in interpretation prevent comparison between different centres.",
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AU - Wilson, A. P.

AU - Gibbons, C.

AU - Reeves, B. C.

AU - Hodgson, B.

AU - Liu, M.

AU - Plummer, D.

AU - Krukowski, Zygmunt H

AU - Bruce, Julie

AU - Wilson, J.

AU - Pearson, A.

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N2 - Objective To assess the level of agreement between common definitions of wound infection that might be used as performance indicators.Design Prospective observational study.Setting London teaching hospital group receiving emergency cases as well as tertiary referrals.Participants 4773 surgical patients staying in hospital at least two nights.Main outcome measures Numbers of wound infections based on purulent discharge alone, on the Centers for Disease Control (CDC) definition of wound infection, on the nosocomial infection national surveillance scheme (NINSS) version of the CDC definition, and on the ASEPSIS scoring method.Results 5804 surgical wounds were assessed during 5028 separate hospital admissions. The mean percentage of wounds classified as infected differed substantially with different definitions: 19.2% with the CDC definition (95% confidence interval 18.1% to 20.4%), 14.6% (13.6% to 15.6%) with the NINSS version, 12.3% (11.4% to 13.2%) with pus alone, and 6.8% (6.1% to 7.5%) with an ASEPSIS score >20. The agreement between definitions with respect to individual wounds was poor. Wounds with pus were automatically defined as infected with the CDC, NINSS, and pus alone definitions, but only 39% (283/714) of these had ASEPSIS scores >20.Conclusions Small changes made to the CDC definition or even in its interpretation, as with the NINSS version, caused major variation in estimated percentage of wound infection. Substantial numbers of wounds were differently classified across the grades of infection. A single definition used consistently can show changes in percentage wound infection over time at a single centre, but differences in interpretation prevent comparison between different centres.

AB - Objective To assess the level of agreement between common definitions of wound infection that might be used as performance indicators.Design Prospective observational study.Setting London teaching hospital group receiving emergency cases as well as tertiary referrals.Participants 4773 surgical patients staying in hospital at least two nights.Main outcome measures Numbers of wound infections based on purulent discharge alone, on the Centers for Disease Control (CDC) definition of wound infection, on the nosocomial infection national surveillance scheme (NINSS) version of the CDC definition, and on the ASEPSIS scoring method.Results 5804 surgical wounds were assessed during 5028 separate hospital admissions. The mean percentage of wounds classified as infected differed substantially with different definitions: 19.2% with the CDC definition (95% confidence interval 18.1% to 20.4%), 14.6% (13.6% to 15.6%) with the NINSS version, 12.3% (11.4% to 13.2%) with pus alone, and 6.8% (6.1% to 7.5%) with an ASEPSIS score >20. The agreement between definitions with respect to individual wounds was poor. Wounds with pus were automatically defined as infected with the CDC, NINSS, and pus alone definitions, but only 39% (283/714) of these had ASEPSIS scores >20.Conclusions Small changes made to the CDC definition or even in its interpretation, as with the NINSS version, caused major variation in estimated percentage of wound infection. Substantial numbers of wounds were differently classified across the grades of infection. A single definition used consistently can show changes in percentage wound infection over time at a single centre, but differences in interpretation prevent comparison between different centres.

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KW - VALIDATION

KW - ASEPSIS

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SN - 0959-8146

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