What is the significance of the asepsis wound score in wound management?

ASEPSIS Wound Score: A Validated Tool for Wound Infection Assessment

The ASEPSIS wound score is a validated, objective scoring method used to assess surgical site infections by evaluating wound appearance and clinical consequences, making it more reliable than subjective assessment methods for monitoring wound healing and infection. 1

Components of the ASEPSIS Scoring System

ASEPSIS is an acronym that stands for:

• Additional treatment required 1, 2
• Serous discharge from the wound 1, 2
• Erythema around the wound 1, 2
• Purulent exudate from the wound 1, 2
• Separation of deep tissues 1, 2
• Isolation of bacteria from the wound 1, 2
• Stay as inpatient prolonged over fourteen days 1, 2

Clinical Significance and Applications

Objective Assessment

• The ASEPSIS score makes assessment of wound sepsis more objective and reproducible by assigning numerical points to both wound appearance in the first week and clinical consequences of infection 1
• Points are allocated for specific characteristics, creating a standardized approach to wound evaluation 2

Predictive Value

• An ASEPSIS score over 20 points has been shown to be more sensitive and as specific as the presence of pus for indicating changes in management resulting from infection 1
• Any wound score over 10 points is associated with a significant delay in hospital discharge (median 3 days) 1

Classification of Wound Healing

Based on the ASEPSIS score, wound healing can be classified as:

• Satisfactory healing (lower scores) 1
• Disturbance of healing (intermediate scores) 1
• Minor, moderate, or severe wound infection (higher scores) 1

Validation and Reliability

• The ASEPSIS scoring system was originally developed for post-cardiac surgery wounds 3, 4
• It has demonstrated good reliability in assessing sternal wounds 4
• For non-sternal surgical sites, reliability may decline as the severity of infection worsens 4
• The system has been validated in large research trials and used to compare antibiotic prophylaxis regimens 2

Comparison with Other Infection Assessment Methods

• ASEPSIS has been compared with other definitions of wound infection in over 1,000 surgical patients 1
• It has been found to be particularly useful in research settings and clinical trials of antibiotic prophylaxis 2
• Unlike some other scoring systems, ASEPSIS incorporates both the appearance of the wound and the clinical consequences of infection 1

Limitations and Considerations

• While validated for sternal wounds, caution should be used when applying ASEPSIS to non-sternal surgical sites 4
• The scoring system requires careful training and consistent application to maintain reliability 4
• A systematic review found that ASEPSIS was the only established referenced scoring system to assess for surgical site infection, highlighting the limited options available 4

Clinical Application

• ASEPSIS is particularly valuable in wound surveillance programs and clinical trials 1
• It can help identify risk factors for wound infection through multiple regression analysis 1
• The system has been used to demonstrate that Staphylococcus epidermidis can cause clinically significant wound infections comparable to those caused by Staphylococcus aureus 3

Using the ASEPSIS wound score provides clinicians with a standardized, objective method to assess wound healing and infection, enabling more consistent evaluation and appropriate intervention decisions based on quantifiable criteria rather than subjective assessment.