VALIDATION OF SURGICAL WOUND CLASSIFICATION IN THE OPERATING-ROOM

OBJECTIVE: To determine the accuracy with which circulating nurses (CN s) classify surgical procedures by risk of contamination in the operat ing room. DESIGN: Classification of surgical procedures by CNs was com pared with the classification of surgical procedures by a physician ob server. SETTING: University-affiliated, tertiary care hospital. METHOD S: Circulating nurses used the traditional wound classification system of clean, clean-contaminated, contaminated, and dirty-infected to cla ssify surgical wounds in the operating room. A physician remained in t he operating room throughout each of 100 surgical procedures and simul taneously classified surgical wounds without the knowledge of the CNs. RESULTS: Classification of surgical wounds by CNs was compared with c lassification by the physician observer for 50 cases in general surger y and 50 cases in trauma surgery. Compared with the physician observer , the overall accuracy of classification by CNs was 88% (95% confidenc e interval [CI] of 81.6% to 94.4%; Kappa statistic, 0.83). Classificat ion of surgical wounds was more difficult in trauma surgery (accuracy of 82%) than in general surgery (accuracy of 94%). Accuracy increased for both services when surgical wounds were classified into just two c ategories (clean or clean-contaminated versus contaminated or dirty-in fected). CONCLUSIONS. Surgical wounds can be classified in the operati ng room with a high degree of accuracy by CNs. Classification was more difficult in trauma than in general surgery, but classification in tr auma surgery improved with feedback to and additional education of CNs . The accuracy of classification by CNs was even higher when classific ations were divided into just two categories.