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Table 1 Criteria for surgical site infection classification, reproduced from the ACPS Surgical Audit Tool guidelines, based upon the Australian Council on Health Care Standards clinical indicators (version 3.1, 2012)

From: Risk factors for infection following ingrowing toenail surgery: a retrospective cohort study

Superficial incisional Deep incisional
Infection involves only skin and subcutaneous tissue of this incision
AND
Occurs within 30 days after the operative procedure
AND
Exhibits at least one of the following from the superficial incision:
 1. Purulent discharge (NOT stitch abscess).
 2. Organisms isolated from an aseptically collected culture of fluid or tissue. Note: a positive wound swab (in contrast to wound aspirate) without other significant evidence of infection is not adequate for diagnosis of infection.
 3. Displays at the site of incision any of the following signs and symptoms of infection:
  • Pain or tenderness
  • Localised swelling
  • Redness or heat
AND
  the incision is deliberately explored by the Surgeon resulting in a positive wound culture.
  Note: A culture-negative finding does not meet this criterion unless the patient was on antibiotics immediately prior to diagnosis.
4. Diagnosis or antimicrobial treatment of superficial incisional infection by the operating Surgeon or Registrar.
Infection involves deep soft tissues (e.g. fascial and muscle layers) AND/OR organs/spaces opened or manipulated during an operation
AND
Occurs within 30 days after the operative procedure if implant not present OR within 1 year if implant insitu
AND
Exhibits either 1 and/or 2:
 1. Purulent drainage from deep soft tissue or drain that is placed through a stab wound into the organ/space.
 2. Spontaneous dehiscence at the incision site or the wound is deliberately explored by a surgeon with the patient showing evidence of one or more of the following signs or symptoms:
  • Fever 38 °C, localised pain or tenderness with culture positive specimen. A culture-negative finding does not meet this criterion unless the patient was on antibiotics immediately prior to the wound being explored and/or the culture being taken;
  • Organisms isolated from aseptically obtained culture of fluid or tissue obtained from an organ/space;
  • An abscess or other evidence of infection involving a deep/organ space is found on direct examination, during re-operation, or by histopathologic or radiologic examination; or
  • Diagnosis of, or antimicrobial treatment of a deep incisional or organ/space surgical site infection by the operating Surgeon or Registrar.