Surgical Site Infection (SSI Patient Label Date of Admission: Diagnosis: Department Surgeon: ‘Name of Surgery: Date of Surgery - OT Location/No: Date of Detection: Duration of Surgery: Hours Minutes Start Time: End Time: Has Antibiotic prophylaxis been given within 60 min prior to the surgery ‘Surgical Site Infection is infection in the surgical site that occurs within 30 days of the surgical procedure or within one year if there is an implant or foreign body such as prosthetic heart valve or joint prosthesis. 1 Superficial Incisional Infection is defined as a surgical site infection that occurs within 30 days of surgery and involves only the skin or subcutaneous tissue of the incision, a) Superficial Incisional Primary (SIP) — a superficial incisional SSI that is idemtfied in the primary incision in a patient that has had an operation with one or more incisions (e.g., C-section incision or chest incision for CBGB) ) Superficial _Incisional Secondary (SIS) — a superficial incisional SSI that is identified in the secondary incision in a patient that has had an operation with more than one incision (e.g., donor site [leg] incision for CBGB) I Deep Incisional Infection is defined as a surgical site infection involving the deep tissues (ice. fascial and muscle layers) that occurs within 30 days of surgery if no implant is in place, or within a year if an implant is in place and the infection appears to be related to the surgical procedure. a) Deep Incisional Primary (DIP) ~ a deep incisional SSI that is identified in a primary incision in a patient that has had an operation with one or more incisions (e.g,, C-section incision or chest incision for CBGB) b) Deep Incisional Secondary (DIS) ~ a deep incisional SSI that is identified in the secondary incision in a patient that has had an operation with more than one incision (e.g,, donor site [leg] incision for CBGB) Ill Organ/space infection is defined as a surgical site infection involving any part of the anatomy (ice. organ/space), other than the incision, opened or manipulated during the surgical procedure, that ‘occurs within 30 days of surgery if no implant is in place, or within one year if an implant is in place and the infection appears to be related to the surgical procedure.Specific Event: 1 Superficial Incisional Primary (SIP) 1 Superficial Incisional Secondary (SIS) 10 Organ/Space (specify site) 10 Deep Incisional Primary (DIP) 13 Deep Incisional Secondary (DIS) Specify Criteria Used (check all that apply): Signs & Symptoms: 1 Purulent drainage or material «Pain or tendemess 10 Localized swelling 1 Redness 0 Heat b Fever 15 Wound spontaneously dehisces 1 Abscess 10 Hypothermia © Cough 5 Dysuria © Any other comments Laboratory: © Blood Culture Positive / Negative 10 Pus/Discharge Culture Positive / Negative Detected: During admission c Post-discharge Surveillance Readmission Post Discharge follow-up for stitch removal, etc: Secondary Bloodstream Infection: Yes __No Outcome: Expired / Prolonged Stay / Discharged Date of Discharge Pathogens Iden If Yes, specity: ied: Yes No ‘Name and Signature of ICN ‘Name and Signature of Consultant