Effective and creative surveillance and reporting of surgical wound infections.

Surgical wound infections offer a major challenge to hospital infection control programs. Surgical procedures and host factors are independent variables which markedly influence the risk of infection. Frequently used categories of surgical procedures (clean, contaminated, and infected) are inadequate to identify the special risks and problems of individual procedures. In 1976, in conjunction with the practicing surgeons of a large, referral hospital, the Infections Control Committee instituted surveillance of selected clean surgical procedures and deep-versus-superficial wound infections. Major problems associated with the cleaning of sternal saws and the timing of the administration of prophylactic antibiotics have been detected by these methods. Conventional surveillance undoubtedly would have overlooked these problems. Effective surveillance and control of surgical wound infections requires a willingness to modify surveillance activities to meet the local needs, and a determination to include the operating surgeons in the planning of surveillance activities.