Surgical audit: variations in wound infection rates according to definition.

A prospective study of 702 postoperative surgical patients was undertaken to determine whether clinicians showed consistency in their interpretation of signs of infection in wounds. In the 62 cases where symptoms suggestive of such infection were noted, clinical signs were recorded, as were the clinicians' subjective impressions. The application of different criteria would have resulted in a substantial variation in the apparent rates of infection, which raises questions about the need for an agreed definition of the term 'wound infection'. The lack of a specific definition has implications for surgical audit.

Wound infection: the surgeon's responsibility.

Surgical audit has two main purposes: the pursuit of efficiency through the review of clinical workload and the pursuit of quality by reviewing clinical outcomes. In-house quality control is an important aspect of surgical practice. This prospective study aimed to determine the incidence of infection, describe the time distribution of presentation and identify contributory factors. There were 1 242 consecutive patients in the survey (1 086 inpatients and 156 day cases), of whom 83 became infected (79 in-patients and four day cases) - an overall infection rate of 6.7%. Over 55% presented during the first week and 89% within the first two weeks. Of 23 specific aetiological variables studied, four - age, preoperative stay, shaving and the surgeon - were shown to have a statistically significant association with the development of wound infection. A strong association between the surgeon and the development of wound infection was demonstrated. In addition to obvious strong resource implications, it supports the need for routine audit supervision and training of junior staff and peer review for senior clinicians.