Wound infection classification

The Study of the Efficacy of Nosocomial Infection Control (SENIC) identified four independent risk factors for postoperative wound infections operations on the abdomen, operations lasting more than 2 hours, contaminated or dirty wound classification, and at least three medical diagnoses. Patients with at least two SENIC risk factors who undergo clean surgical procedures have an increased risk of developing surgical wound infections and should receive antimicrobial prophylaxis. 

Death and surgical complications seem relatively unambiguous outcomes. However, some indicators of morbidity, such as wound infection, anastomotic leak and postpartum haemorrhage are difficult to define with precision (Lilford etal, 2004). Even death can pose difficulties of classification, in the sense that a death in hospital can simply mean the arrival of a terminally ill person who died shortly after admission. A death in those circumstances says nothing at all about the quality or safety of care in that hospital. 

Pneumonia is inflammation of the lung with consolidation. The cause of the inflammation is infection, which can result from a wide range of organisms. There are five classifications of pneumonia community-acquired, aspiration, hospital-acquired, ventilator-associated, and health care-associated. Patients who develop pneumonia in the outpatient setting and have not been in any health care facilities, which include wound care and hemodialysis clinics, have community-acquired pneumonia (CAP). Aspiration is of either oropharyngeal or gastrointestinal contents. Hospital-acquired pneumonia (HAP) is defined as pneumonia that occurs 48 hours or more after admission.1,2 Ventilator-associated pneumonia (VAP) requires endotracheal intubation for at least 48 to 72 hours before the onset of... 

TABLE 82-1. National Red Cross Wound Classification, Risk of Surgical Site Infection (SSI), and Antibiotic Indication6 24... 

The traditional classification system developed by the National Research Council (NRC) stratifying surgical procedures by infection risk is reproduced in Table 48-1. The NRC wound classification for a specific procedure is determined intraoperatively and is the primary determinant of whether antibiotic prophylaxis is warranted. 

TABLE 121—3. Surgical Site Infection Incidence (%) Stratified by National Research Council Wound Classification and SEN 1C Risk Factors ... 

The incidence of surgical site infections traditionally has been stratified by the National Nosocomial Infection Surveillance (NNIS) system. Participating hospitals are categorized by size and medical school affiliation. Surgical site wounds are classified by the degree of microbial contamination at the operative site. The classification scheme is as follows [1,3] ... 

Armstrong DG, Lavery LA, Harkless LB. Validation of a diabetic foot wound classification system contribution of depth infection and vascular disease to the risk of amputation. Diabetes Care 1998 21 855-859. 

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