Contemporary wound infection surveillance issues.

Contemporary wound infection surveillance is inexact. Tracking down suspicious incisions with maximal accuracy to isolate the subset of healing failures attributable to established tissue invasion by infecting pathogens has a solitary purpose: to learn how to improve one aspect of surgical practice. Wound infection is always the result of complex, probabilistic interplay of numerous concealed variables. A wound infection rate, whether determined for a hospital, a specialty, a risk class, an operation type, or a surgeon, only approximates a degree of failure to achieve one kind of surgical perfection. Interpretation of any rate will be flawed if issues of accuracy and meaning are suppressed. Gathering and revealing circumstances of individual infections may heuristically affect surgical teams. Interpretation of surveillance wound infection rates, infection rate comparisons to standards as a means of performance measurement, and particularly the meaning of rate changes over time in a hospital are matters of more than academic importance. Given current health care reform and a widespread fascination with industrial process-improvement philosophy, wound infection surveillance programs may be natural test platforms for probing surgical relevance of several quality-improvement methodologies. It is not a trivial fact that wound infection shares important prototypical features with most contemporary surgical care process flaws: rare, random, multifactorial in cause, costly, and impossible to uniformly preclude or predict.