CDC definitions of nosocomial surgical site infections, 1992: A modification of CDC definitions of surgical wound infections

In 1988, the Centers for Disease Control (CDC) published definitions of nosocomial infections.1 However, because of journalistic style and space constraints, these definitions lacked some of the detail provided to National Nosocomial Infections Surveillance (NNIS) System hospitals in the NNIS Manual (unpublished). After the NNIS System hospitals had had considerable experience with the definitions and in response to a request for review by The Surgical Wound Infection Task Force,2 a group composed of members of The Society for Hospital Epidemiology of America, the Association for Practitioners in Infection Control, the Surgical Infection Society, and the CDC, we slightly modified the definition of surgical infection and changed the name to surgical site infection (SSI). The changes were made for two reasons. First, in the 1988 definitions, it was not clear that for deep surgical infections, specifying the anatomic location of the deep infection was necessary. For example, NNIS System hospitals would report osteomyelitis as the specific site of a deep surgical infection if it followed an orthopedic operative procedure. Hospitals unfamiliar with this two-level designation might not have gleaned this information from the 1988 definitions. In this revision, we have included a Table listing specific sites. Second, we have removed the term wound, because in surgical terminology, wound connotes only the incision from skin to deep soft tissues. We introduce the term organ/space to define any part of the anatomy (e.g., organs or spaces), other than the incision, opened or manipulated during the operative procedure. The distinction between this component of the surgical site and the incision is important in the pathogenesis of SSI following certain operative procedures. The following revised definitions should be used f r surveillance of SSI by hospitals wishing to compare their SSI data with NNIS System SSI data. This article includes some additional considerations when comparing hospital data to NNIS System data.