Improve Wound Misclassification with Focused Education

Surgical wound classification is regularly highlighted and discussed during M&M conferences

Surgical wound classification is followed closely due to its associated risk of surgical site infections

Wound classification is often used as a surrogate to assess quality of care

Evidence shows wounds continue to be misclassified on a regular basis

Butler and Rockstroh created a cheat sheet for wound classification of 114 common pediatric surgical procedures under their corresponding wound class

The educational intervention involved all pediatric surgeons and OR nurses attending a class with educational slide presentations and case discussions

Laminated posters of OR and wound classification algorithms and a reference list of pediatric procedures sorted by wound class were placed in each operating room

The study compared 200 cases before and 200 cases after the intervention, using the operative report to determine the most accurate wound classification based on CDC guidelines

The two study groups had equal number of class one wounds

Class two wounds were greater in the pre-intervention group

Classes three and four wounds were greater in the post-intervention group

The number of cases that had to be corrected decreased from 35% to 9%

The number of cases upgraded decreased from 24.5% to 9%

Appendectomies are one of the most commonly misclassified cases

For appendectomies, the number of wound classes corrected decreased from 48.4% to 11.1%

For appendectomies, the number of cases that needed to be upgraded decreased from 45% to 11%

Education on how to classify wounds can increase accuracy, thereby improving ability to assess the risk of surgical site infections

The wound classification of common pediatric surgical procedures created by Butler and colleagues may provide intraoperative guidance at other institutions