Postoperative surveillance, registration and classification of wound infection in cardiac surgery—experiences from Great Britain

Wound infection in cardiac surgery is a continuing problem despite improvements in surgical technique. The risk factors for, and appearance of, the infected wound differ from operations in other specialties. A robust definition is required for successful surveillance but many are open to different interpretations. At UCLH, comparison between UK and US definitions shows marked differences in patients defined as infected. Surveillance with feedback is effective if conducted over several years, but a high proportion of infected wounds are only identified during post-discharge follow-up. Deteriorating performance of an individual surgeon can be detected and interventions focused on improving faults identified during data collection. Often highlighting the problem is sufficient to reverse the trend, but the process of audit and control is becoming more important as accountability and performance is demanded by primary care providers and patients.