Tag Archives: SSI

Changes to reporting of SSI to CDC

The following information will be added to the current report to CDC/NHSN

  • Patient height, weight, and diabetes status will be reported for all procedures.
  • Operative duration, NHSN will adopt the Association of Anesthesia Clinical Directors definitions of Procedure/Surgery Start Time (PST), and Procedure/Surgery Finish.
  • NHSN is broadening its definition of an operative procedure to include those procedures that were not closed primarily. The closure type will be recorded for all procedures as either primarily closed or non-primarily closed, and this information will be used for risk adjustment purposes. NHSN has closely adapted the American College of Surgeons, NSQIP definition of primary closure.
    • Primary Closure is defined as closure of all tissue levels during the original surgery, regardless of the presence of wires, wicks, drains, or other devices or objects extruding through the incision. This category includes surgeries where the skin is closed by some means, including incisions that are described as being “loosely closed” at the skin level. Thus, if any portion of the incision is closed at the skin level, by any manner, a designation of primary closure should be assigned to the surgery.
    • Non-primary Closure is defined as closure that is other than primary and includes surgeries in which the superficial layers are left completely open during the original surgery and therefore cannot be classified as having primary closure. For surgeries with non-primary closure, the deep tissue layers may be closed by some means (with the superficial layers left open), or the deep and superficial layers may both be left completely open.
  • Hip arthroplasy (HPRO) and Knee arthoroplasty (KPRO): additional detail about procedures; total, hemi, and resurfacing (HPRO only) will be collected.
  • NHSN will adopt the Muscular Skeletal Infection Society’s (MSIS) Definition of Periprosthetic Joint Infection as a new organ/space infection site, SSI-PJI, which will replace SSI-JNT for HPRO and KPRO procedures.

Definition of Periprosthetic Joint Infection (PJI)

Joint or bursa infections must meet at least 1 of the following criteria:

  1. Two positive periprosthetic (tissue or fluid) cultures with identical organisms
  2. A sinus tract communicating with the joint
  3. Having three of the following minor criteria:
    1. Elevated serum C-reactive protein (CRP; >100 mg/L) AND erythrocyte sedimentation rate (ESR; >30 mm/hr).
    2. Elevated synovial fluid white blood cell (WBC; >10,000 cells/μL) count OR ++ (or greater) change on leukocyte esterase test strip of synovial fluid.
    3. Elevated synovial fluid polymorphonuclear neutrophil percentage (PMN% >90%).
    4. Positive histological analysis of periprosthetic tissue (>5 neutrophils (PMNs) per high power field).
    5. A single positive periprosthetic (tissue or fluid) culture.

Surgical wound classification

This past week we reviewed some hospital data and found ongoing confusion with regards to classifying surgical wounds. I put together a quick cheat sheet to help with wound classification.

Under classifying the wound will produce a lower severity of illness making the provider and the institution appear worse for the same outcomes

Remember as more data is being collected for hospital report cards it is imperative to have accurate wound classification. The knee jerk reaction of many providers is to under classify the surgical wound. Outcomes are being compared to these data points. Under classifying the wound will produce a lower severity of illness making the provider and the institution appear worse for the same outcomes.

So lets all get the credit we deserve by making sure we classify wounds correctly.

Classification of surgical wounds

Classification of surgical wounds