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Validation of Surgical Wound Classification in the Operating Room

Published online by Cambridge University Press:  21 June 2016

Denise M. Cardo ,
Pamela S. Falk  and
C. Glen Mayhall
Denise M. Cardo
Affiliation:
Division of Infectious Diseases, Department of Medicine, College of Medicine, University of Tennessee, Memphis, and the Hospital Epidemiology Unit, the Regional Medical Center at Memphis, Memphis, Tennessee
Pamela S. Falk
Affiliation:
Division of Infectious Diseases, Department of Medicine, College of Medicine, University of Tennessee, Memphis, and the Hospital Epidemiology Unit, the Regional Medical Center at Memphis, Memphis, Tennessee
C. Glen Mayhall*
Affiliation:
Division of Infectious Diseases, Department of Medicine, College of Medicine, University of Tennessee, Memphis, and the Hospital Epidemiology Unit, the Regional Medical Center at Memphis, Memphis, Tennessee
*
Division of Infectious Diseases, University of Tennessee, Memphis, 956 Court Avenue, Room H308, Memphis, TN 38163
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Abstract

Objective:

To determine the accuracy with which circulating nurses (CNs) classify surgical procedures by risk of contamination in the operating room.

Design:

Classification of surgical procedures by CNs was compared with the classification of surgical procedures by a physician observer.

Setting:

University-affiliated, tertiary care hospital.

Methods:

Circulating nurses used the traditional wound classification system of clean, clean-contaminated, contaminated, and dirty-infected to classify surgical wounds in the operating room. A physician remained in the operating room throughout each of 100 surgical procedures and simultaneously classified surgical wounds without the knowledge of the CNs.

Results:

Classification of surgical wounds by CNs was compared with classification by the physician observer for 50 cases in general surgery and 50 cases in trauma surgery. Compared with the physician observer, the overall accuracy of classification by CNs was 88% (95% confidence interval [CI] of 81.6% to 94.4%; Kappa statistic, 0.83). Classification of surgical wounds was more difficult in trauma surgery (accuracy of 82%) than in general surgery (accuracy of 94%). Accuracy increased for both services when surgical wounds were classified into just two categories (clean or clean-contaminated versus contaminated or dirty-infected).

Conclusions:

Surgical wounds can be classified in the operating room with a high degree of accuracy by CNs. Classification was more difficult in trauma than in general surgery, but classification in trauma surgery improved with feedback to and additional education of CNs. The accuracy of classification by CNs was even higher when classifications were divided into just two categories.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 14 , Issue 5 , May 1993 , pp. 255 - 259
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1993

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Footnotes

Escola Paulista Medicina, Sao Paolo, Brazil

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