Table 2.

The evolution of CDC wound infection definitions.

First Author citation	Definition
Berard and Gandon (1964)	1Wounds were considered uninfected if they healed per primam without discharge 2Definitely infected if there was a purulent discharge, whether or not organisms could be cultured from the purulent material 3Wounds that were inflamed without discharge and wounds that drained culture-positive serous fluid were considered possibly infected 4 Stitch abscesses were excluded from definite or possible infections: 1 if inflammation and discharge were minimal and confined to points of suture penetration 2 if the incision healed per primam without drainage 3 if healing occurred within 72 h after removal of sutures
Hart et al. (1968)	“As in the NRC Cooperative Study these data do not include stitch abscesses or erythema around sutures, these being considered as reactions about a foreign body in the skin. Included are all operations where pus, even in small amounts, had to be evacuated from the subcutaneous tissue.”
Pollock (1979)	Wound sepsis is the discharge of pus. It is subdivided into primary (when the first discharge is pus) and secondary (when the first discharge is not pus, but the discharging wound becomes colonized by bacteria from endogenous or exogenous sources). Both primary and secondary sepsis can be classified as minor (when constitutional disturbances are absent) and major (which makes the patient ill)
Polk et al. (1983)	Wound infection has been defined as the emergence of pus from a wound, irrespective of the results of subsequent cultures. Indeed, any incision that must be opened for local care probably should be considered infected.
Garner et al. (1988)	SURGICAL WOUND INFECTIONSurgical wound infection includes incisional surgical wound infection and deep surgical wound infection.Incisional surgical wound infection must meet the following criteria: Infection occurs at incision site within 30 days after surgery AND involves skin, subcutaneous tissue, or muscle located above the fascial layer AND any of the following: 1Purulent drainage from incision or drain located above fascial layer 2Organism isolated from the culture of fluid primarily from closed wound 3Surgeon deliberately opens wound, unless wound is culture-negative 4Surgeon’s or attending physician’s diagnosis of infection Deep surgical wound infection must meet the following criterion: Infection occurs at operative site within 30 days after surgery if no implant" is left in place or within one year if implant is in place AND infection appears related to surgery, AND infection involves tissues or spaces at or beneath fascial layer AND any of the following: 1Purulent drainage from drain placed beneath fascial layer 2Wound spontaneously dehisces or is deliberately opened by surgeon when patient has fever (>38″ C) and/or localized pain or tenderness unless wound is culture-negative 3An abscess or other evidence of infection seen on direct examination, during surgery, or by histopathologic examination 4Surgeon’s diagnosis of infection
Consensus paper on the surveillance of surgical wound infections (1992); Garner et al. (1988); Horan et al. (1992); Mangram et al. (1999)	In the 1988 definitions, it was not clear that for deep surgical wound infections, specifying the anatomic location of the deep infection was necessary. For example, NNIS System hospitals would report osteomyelitis as the specific site of a deep surgical wound infection if it followed an orthopedic operative procedure. Hospitals unfamiliar with this two-level designation might not have gleaned this information from the 1988 definitions. In this revision, we have included a Table listing specific sites. Second, we have removed the term "wound," because in surgical terminology, "wound" connotes only the incision from the skin. For infections involving the incision, we (now) use the term "incisional SSI." The previous definitions of incisional surgical wound infection and deep soft tissue surgical wound infection' are replaced by superficial incisional SSI and deep incisional SSI. Infections that involve the organ/space component of the surgical site were previously called deep surgical wound infections at specific sites other than soft tissue. These are now termed organ/space SSI and use the same specific sites as soft tissues. We introduce the term "organ/space" to define any part of the anatomy (e.g., organs or spaces), other than the incision, opened or manipulated during the operative procedure.