Comment from Mayo, Jenny

See attached file(s) for additional details. I am an experienced Infection Preventionist and user of the NHSN patient safety manual. I would like to respectfully request a modification to "Vaginal Cuff Infection" surveillance definition in Chapter 17, page 24. Chapter 17 definitions are applied to organ space level infections. The vaginal cuff is a surgical closure at the top of the vagina, and that outermost incision is a layer of non-keratinized stratified columnar squamous epithelial cells, similar to skin closure which is keratinized stratified squamous epithelium cells. The criteria for VCUF are Vaginal cuff infections must meet at least one of the following criteria: 1. Purulent drainage from the vaginal cuff on gross anatomic exam. 2. Abscess or other evidence of infection at the vaginal cuff on gross anatomic exam. 3. Organism(s) identified from fluid or tissue obtained from the vaginal cuff by a culture or non-culture based microbiologic testing method which is performed for purposes of clinical diagnosis or treatment, for example, not Active Surveillance Culture/Testing (ASC/AST). " I propose that purulent drainage or abscess visualized during vaginal exam can only be verified to the level of superficial infection. I propose a clarification that to meet organ space, there would need to be confirmation by imaging of an abscess deeper than the level of vaginal epithelium, or communication of the purulence through the levels of the epithelium and reaching the pelvic space. I would request that we clarify purulence visualized only at the level of the epithelium be classified as a superficial SSI, which is consistent with the NHSN classification of level of infection for all other sites. Thank you for your consideration of this issue.