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Surgical site infection definitions

Surgical site infection definitions
  Time to event* Extent of tissue involvement Clinical features Criteria for diagnosis
Superficial incisional SSI Within 30 days of NHSN procedureΔ Skin and subcutaneous tissue
  • Peri-incisional pain or tenderness
  • Localized peri-incisional swelling
  • Peri-incisional erythema or heat
At least one clinical feature AND at least one of the following:
  • Purulent drainage from the superficial incision
  • Organisms are identified by culture (or non-culture-based microbiologic testing method) performed for clinical diagnosis or treatment (eg, not surveillance)
  • Incision opened by the surgeon (or other designated clinician) because of concern for superficial SSI
Deep incisional SSI Within 30 or 90 days of NHSN procedureΔ Deep soft tissues of the incision such as the fascia and muscle layers
  • Fever (>38°C)
  • Localized pain or tenderness
  • Purulent drainage from the deep incision
  • Deep incision that spontaneously dehisces or is opened by the surgeon (or other designated clinician) because of concern for deep SSI AND organisms are identified by culture (or non-culture-based microbiologic testing method) performed for clinical diagnosis or treatment (eg, not surveillance). Presence of at least one clinical feature, in absence of microbiologic testing
Organ/space SSI Within 30 or 90 days of NHSN procedureΔ Any part of the body deeper than the fascia/muscle layers that was opened or manipulated during the procedure

Clinical features for specific organ/space can be found at the CDC website§

As an example, for intra-abdominal infection, at least two of the following:
  • Fever (>38°C)
  • Hypotension
  • Nausea, vomiting
  • Abdominal pain or tenderness
  • Elevated transaminases
  • Jaundice
Appropriate clinical features specific to the organ/space AND at least one of the following:
  • Purulent drainage from a drain placed into the organ/space¥
  • Organisms identified from culture of fluid or tissue obtained from a superficial incision
  • Abscess or other evidence of infection involving the organ/space detected on gross anatomical examination or histopathologic examination
  • Radiographic imaging findings suggestive of infection

SSI: surgical site infection; NHSN: National Health Safety Network; CDC: Centers for Disease Control.

* Day 1 is the procedure date.

¶ SSI can occur in a primary incision or a secondary incision among those undergoing an operation with one or more incisions.

Δ Depends on the surveillance period of the specific procedure.

◊ Typically copious drainage from the incision sufficient to warrant inspection of the fascia to ensure its integrity and to rule out incisional hernia or fasciitis. Fluid and tissue cultures should be obtained. The following do NOT meet the criteria for superficial SSI: cellulitis, stitch abscess, stab (eg, drain not laparoscopic port) or pin site infection, infection in non-NHSN procedures (eg, circumcision), burn wound infection.

§ Additional information can be found at: https://www.cdc.gov/nhsn/PDFs/pscManual/17pscNosInfDef_current.pdf.

¥ Percutaneous or surgical drain.

‡ Based on microbiologic testing performed for purposes of clinical diagnosis or treatment (eg, not surveillance).
Adapted from: Centers for Disease Control and Prevention. Procedure-associated Module: Surgical Site Infection (SSI) Event, January 2018. Available at: https://www.cdc.gov/nhsn/PDFs/pscManual/9pscSSIcurrent.pdf (Accessed on January 24, 2018).
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