Comparison of wound scoring methods for use in audit

Area of Science:

• Healthcare research
• Infection control

Background:

• Accurate surgical wound infection prevalence data is scarce due to inadequate outpatient follow-up.
• Existing surveillance methods for surgical wound infections present challenges in consistent data collection.

Purpose of the Study:

• To compare the sensitivity of two standard definitions (Centers for Disease Control and National Prevalence Survey) with two scoring methods (ASEPSIS and Southampton) for assessing surgical wound infection.
• To evaluate the impact of a feedback-based surveillance program on surgical wound infection rates.

Main Methods:

• Two cross-sectional surveys of surgical wounds were conducted in 1993 and 1995.
• Standard definitions (CDC, NPS) and scoring methods (ASEPSIS, Southampton) were compared.
• Data included wound examination, patient follow-up, and infection/healing status.

Main Results:

• ASEPSIS identified infection in 13% and healing disturbance in 16.5% of wounds, with no significant difference between the two survey years.
• Scoring methods (ASEPSIS, Southampton) were more sensitive than standard definitions (CDC, NPS).
• A significant proportion (44-47%) of wounds classified as infected by standard definitions were categorized as healing disturbance by ASEPSIS. A surveillance program with feedback did not significantly alter infection rates two years later.

Conclusions:

• Both standard definitions and scoring methods for surgical wound infection are labor-intensive, potentially requiring a full-time investigator for regular implementation.
• The sensitivity of wound assessment methods varies, impacting the accurate identification of surgical site infections.
• Feedback to surgeons did not significantly reduce infection rates in this study.