239 - Wound Class and Education: The Heart of the Matter

Description: When a surgical site infection (SSI) is identified, the intraoperative record is investigated. In this process, multiple cases have been found to have an incorrect surgical site wound classification selected —typically the wound class selected is "cleaner" than it actually is. The surgical site wound classification is important in hospital metrics and determining the expected rates of SSIs. Having identified inaccuracies in surgical site wound classification, there is a need for performance improvement. Chart audits were performed from October through December of 2024 focusing on more difficult to classify surgeries such as those in ear, nose and throat (ENT), Colorectal, General, Bariatric, and Gynecologic specialties. Surgical site wound classification accuracies and inaccuracies were recorded to determine knowledge gaps in current practice. For these 3 months, the mean percentage of incorrect surgical site wound classification was 31%. These flaws demonstrate the need for operating room staff education regarding surgical site wound class selection. Literature describes that accuracy in wound classification is essential to determining the expected rates of SSI amongst each wound class (Herman & Bordoni, 2023). Also, wound class helps interprofessional teams determine guidelines and bundles to implement in the care for the patient involved. AORN provides a pocket guide to help OR teams determine accurate wound
classifications. Based on this and information given from the CDC and Methodist's own classification in EPIC. Data was collected via survey to gauge staff knowledge level and comfort level in regard to determining wound classification. The results showed that the mean percentage of surgical wound site examples (total of 6 cases) incorrectly classified by participating OR nurses (N=30) was 39%. 80% of the nurses agreed that "I am confident in determining wound classification." Only 50% of nurses agreed that "The surgeons always select the appropriate wound classification." 87% of nurses agreed that "A guide for determining wound classification wound be helpful to have in each OR." 69% of nurses agreed that "I can easily discuss differing opinions of wound classification with the surgeons."

We performed a survey to determine the preferred way staff would like to be educated on this topic. Ideally, we would like a multimodal approach to this staff education and training in which we would create an educational presentation to provide a unit-wide staff in-service to present the gap in surgical site wound classification and increase knowledge and awareness regarding the importance of accurate surgical site wound classification selection and distributing a badge buddy for wound classification. Unit staff was provided with a post-educational survey to determine competency, as well as chart audits. Our failure rate went from 31% to only 13% in our chart audits. We found that the nurses also display far more confidence in their ability to describe and select the appropriate wound class.