Criteria for defining a surgical site infection

Superficial incisional SSI

Infection occurs within 30 days after any NHSN operative procedure (where day 1 = the procedure date)

AND

Infection involves only skin or subcutaneous tissue of the incision

AND at least ONE of the following:

Purulent drainage, with or without laboratory confirmation, from the superficial incision.

Organism(s) are identified from an aseptically obtained specimen from the superficial incision or subcutaneous tissue by a culture or non-culture-based microbiologic testing method, which is performed for purposes of clinical diagnosis or treatment.

At least one of the following signs or symptoms of infection: pain or tenderness, localized swelling, redness, or heat AND superficial incision is deliberately opened by a surgeon, physician, or physician designee, UNLESS incision is culture-negative.

Diagnosis of superficial incisional SSI by the surgeon, physician, or physician designee.

Do NOT report the following conditions as SSI:

Stitch abscess (minimal inflammation and discharge confined to the points of suture penetration).

Infection of an episiotomy or newborn circumcision site.

Infected burn wound.

Incisional SSI that extends into the fascial and muscle layers (see deep incisional SSI).

NOTE: Specific criteria are used for identifying infected episiotomy and circumcision sites and burn wounds.

Deep incisional SSI

Infection occurs within 30 days (eg, carotid endarterectomy, liver transplant) or 90 days (eg, breast surgery, herniorrhaphy) after the NHSN operative procedure (where day 1 = the procedure date)

AND

Infection involves deep soft tissues (eg, fascial and muscle layers) of the incision

AND at least ONE of the following:

Purulent drainage from the deep incision but not from the organ/space component of the surgical site.

A deep incision spontaneously dehisces or is deliberately opened by a surgeon, physician, or physician designee when the patient has at least one of the following signs or symptoms: fever (>38°C), localized pain, or tenderness AND organism(s) are identified from the deep soft tissues of the incision by a culture or non-culture-based microbiologic testing method, which is performed for purposes of clinical diagnosis or treatment.

An abscess or other evidence of infection involving the deep incision is found on gross anatomical or histopathologic exam, or imaging test.

NOTES:

Report infection that involves both superficial and deep incision sites as deep incisional SSI.

Report an organ/space SSI that drains through the incision as a deep incisional SSI.

Organ/space SSI

Infection occurs within 30 days (eg, carotid endarterectomy, liver transplant) or 90 days (eg, breast surgery, herniorrhaphy) after the NHSN operative procedure (where day 1 = the procedure date)

AND

Infection involves any part of the anatomy (eg, organs or spaces), other than the incision, which was opened or manipulated during an operation and at least one of the following:

Purulent drainage from a drain that is placed through a stab wound^¶. If the area around a stab wound becomes infected, it is not an SSI. It is considered a skin or soft tissue infection, depending on its depth into the organ/space.

Organism(s) are identified from fluid or tissue in the organ/space by a culture or non-culture based microbiologic testing method which is performed for purposes of clinical diagnosis or treatment.

An abscess or other evidence of infection involving the organ/space that is detected on gross anatomical or histopathologic exam, or imaging test evidence suggestive of infection.

AND

Meets at least one criterion for a specific organ/space infection site.

SSI: surgical site infection; NHSN: National Healthcare Safety Network.

* National Nosocomial Infection Surveillance definition: a nonhuman-derived implantable foreign body (eg, prosthetic heart valve, nonhuman vascular graft, mechanical heart, or hip prosthesis) that is permanently placed in a patient during surgery.

¶ If the area around a stab wound becomes infected, it is not an SSI. It is considered a skin or soft tissue infection, depending on its depth.

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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Criteria for defining a surgical site infection