Criteria surgical site infection (SSI)

Superficial incisional SSI must meet the following criteria:

Date of event for infection occurs within 30 days after any NHSN operative procedure (where day 1 = the procedure date)

AND

involves only skin and subcutaneous tissue of the incision

AND

patient has at least one of the following:

  1. purulent drainage from the superficial incision.
  2. organisms identified from an aseptically-obtained specimen from the superficial incision or subcutaneous tissue by a culture ornon-culture based microbiologic testing method which isperformed for purposes of clinical diagnosis or treatment (forexample, not Active Surveillance Culture/Testing (ASC/AST).
  3. superficial incision that is deliberately opened by a surgeon, attending physician** or other designee and culture or non-culturebased testing is not performed.

AND

patient has at least one of the following signs or symptoms: pain or tenderness; localized swelling; erythema; or heat.

  1. diagnosis of a superficial incisional SSI by the surgeon orattending physician** or other designee.

 

** The term attending physician for the purposes of application of the NHSN SSI criteria may be interpreted to mean the surgeon(s), infectious disease, other physician on the case, emergency physician or physician’s designee (nurse practitioner or physician’s assistant).

 

Comments

There are two specific types of superficial incisional SSIs:

  1. Superficial Incisional Primary (SIP) – a superficial incisional SSIthat is identified in the primary incision in a patient that has had anoperation with one or more incisions (for example, C-sectionincision or chest incision for CBGB)
  2. Superficial Incisional Secondary (SIS) – a superficial incisionalSSI that is identified in the secondary incision in a patient that hashad an operation with more than one incision (for example, donorsite incision for CBGB)

 

The following do not qualify as criteria for meeting the NHSN definition of superficial SSI:

  • Diagnosis/treatment of cellulitis (redness/warmth/swelling), by itself,does not meet criterion “d” for superficial incisional SSI. Conversely,an incision that is draining or that has organisms identified by cultureor non-culture based testing is not considered a cellulitis.
  • A stitch abscess alone (minimal inflammation and discharge confinedto the points of suture penetration).
  • A localized stab wound or pin site infection- Such an infection mightbe considered either a skin (SKIN) or soft tissue

Note: A laparoscopic trocar site for an NHSN operative procedure isnot considered a stab wound.

  • Circumcision is not an NHSN operative procedure. An infectedcircumcision site in newborns is classified as CIRC and is not an SSI
  • An infected burn wound is classified as BURN and is not an SSI.

 

Deep incisional SSI must meet the following criteria:

The date of event for infection occurs within 30 or 90 days after the NHSN operative procedure (where day 1 = the procedure date) according to the list in Table 2

AND

involves deep soft tissues of the incision (for example, fascial and muscle layers)

AND

patient has at least one of the following:

  1. purulent drainage from the deep incision.
  2. a deep incision that spontaneously dehisces, or is deliberately opened or aspirated by a surgeon, attending physician** or other designee

AND

organism is identified by a culture or non-culture based microbiologic testing method which is performed for purposes of clinical diagnosis or treatment (for example, not Active Surveillance Culture/Testing (ASC/AST) or culture or non-culture based microbiologic testing method is not performed

AND

patient has at least one of the following signs or symptoms: fever (>38°C); localized pain or tenderness. A culture or non-culture based test that has a negative finding does not meet this criterion.

  1. an abscess or other evidence of infection involving the deepincision that is detected on gross anatomical or histopathologicexam, or imaging test.

 

** The term attending physician for the purposes of application of the NHSN SSI criteria may be interpreted to mean the surgeon(s), infectious disease, other physician on the case, emergency physician or physician’s designee (nurse practitioner or physician’s assistant).

 

Comments

There are two specific types of deep incisional SSIs:

  1. Deep Incisional Primary (DIP) – a deep incisional SSI that isidentified in a primary incision in a patient that has had anoperation with one or more incisions (for example, C-sectionincision or chest incision for CBGB)
  2. Deep Incisional Secondary (DIS) – a deep incisional SSI that isidentified in the secondary incision in a patient that has had anoperation with more than one incision (for example, donor siteincision for CBGB)

 

Organ/Space SSI must meet the following criteria:

Date of event for infection occurs within 30 or 90 days after the NHSN operative procedure (where day 1 = the procedure date) according to the list in Table 2

AND

infection involves any part of the body deeper than the fascial/muscle layers, that is opened or manipulated during the operative procedure

AND

patient has at least one of the following:

  1. purulent drainage from a drain that is placed into the organ/space(for example, closed suction drainage system, open drain, T-tubedrain, CT guided drainage)
  2. organisms are identified from fluid or tissue in the organ/space bya culture or non-culture based microbiologic testing method whichis performed for purposes of clinical diagnosis or treatment (forexample, not Active Surveillance Culture/Testing (ASC/AST).
  3. an abscess or other evidence of infection involving theorgan/space that is detected on gross anatomical or histopathologicexam, or imaging test evidence suggestive of infection.

AND

meets at least one criterion for a specific organ/space infection site listed in Table 3. These criteria are found in the Surveillance Definitions for Specific Types of Infections chapter.

 

T2

 

T3