To the Editor: Surgical Infection Nomenclature

Abstract

In 1992, the Centers for Disease Control and Prevention (CDC) created a useful system for categorizing nosocomial infections that affect only surgical patients. The foundation of this anatomic classification is the concept of surgical site infections—infections of the tissues, organs, or anatomic spaces potentially contaminated with organisms during operations. The CDC defined four types of infection within a new nosocomial infection category called ‘‘Surgical Site Infection’’: superficial incisional, deep incisional, organ, and space infections. Superficial incisional infections are limited to the subcutaneous fat stratum. Deep incisional infections are those that invade muscle or fascia (or both). Surgeons often misunderstand the CDC nomenclature system. The risk of not using that system properly in journal Articles is that future interpretation is difficult, if not impossible, for researchers. The crux of the problem is that the noun ‘‘site’’ has more than one meaning. The common meaning is ‘‘location’’ but the word ‘‘site’’ in official CDC parlance both prior to and after 1992 means ‘‘nosocomial infection category.’’ Moreover, the word ‘‘site’’ does not mean ‘‘incision’’ or ‘‘wound.’’ A common error is to use ‘‘surgical site infection’’ to mean ‘‘incisional infection’’ or ‘‘wound infection.’’ A little thought shows that this flawed usage ironically defeats the purpose of the 1992 nomenclature system, which was set up to facilitate detection and study of surgical infections in addition to wound (i.e., incision) infections. Another irksome error is use of the terms ‘‘superficial surgical site infection’’ and ‘‘deep surgical site infection.’’ There are simply no such entities. The only use of ‘‘superficial’’ and ‘‘deep’’ in CDC nomenclature is in the context of defining the two types of incisional infection. Woodfield and coworkers unfortunately made nomenclature errors throughout the narrative of a recent and important article. They used the terms ‘‘superficial surgical site infection’’ and ‘‘deep surgical site infection.’’ With due respect, this is simply incorrect. I assume that they were talking about incisional infections throughout, but they do not define their terminology. Whenever the term ‘‘surgical site infection’’ appears in writing, the inference is that the CDC nomenclature is being used. Authors must specify exactly which of the four types of infection is being referenced. Editors must insist on crisp, accurate usage so academic work products are accurate and lucid. What is published in the World Journal of Surgery is out there ‘‘forever.’’