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Background
Surgical wound classification is an important factor for surgical site infection (SSI)
surveillance and reporting. Intended to be a surgeon's decision, use of electronic
medical records (EMRs) may instead enter a default value. During SSI review, Infection
Preventionists (IPs) will change a wound class if the entered value does not match
the operative note's description but may not adjust the EMR-generated denominator.
We assessed SSI rates when adjusting both numerator and denominator based on IP review.
Methods
We performed a retrospective review of all National Health Safety Network (NHSN) SSIs
at our institution between 1/1/2019–10/31/2021. A meaningful change was one made by
an IP that would change a wound class from I or II to III or IV. We calculated rate
using class I and II procedures only. We used percent meaningful of all changes to
estimate IP-derived denominators. We compared rates generated by different numerators
and denominators (EMR and IP) using Fisher's exact test.
Results
We identified 176 SSIs during the study period. Of the 82 changes made by IPs, 37
(45%) were meaningful. The proportion of meaningful changes ranged from 0-60% across
all months. Out of 34 months, 21 (62%) showed a higher rate when using EMR class vs.
IP class with the largest difference of 2.33 vs. 0.47 (p = 0.22). When comparing the
alternative rate to IP class rate across all months, the rate was 1.14 vs. 0.91 (p=0.17).
For both comparisons, September 2019 showed the largest monthly rate difference.
Conclusions
This study found that using EMR wound class for numerator and denominator increases
the SSI rate, although not significantly different from IP class rate, even when adjusting
the denominator for meaningful changes. Rates using IP class numerator and EMR class
denominators are likely accurate.
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Copyright
© 2022 Published by Elsevier Inc.
