Hi All - I was just thinking about SSI scores (as you do). I've always like PHE definition, because once you get your head around it, in practice it focuses on potential pathogen/host response. It also is fairly good (validation needed!) on excluding mechanical dehiscence, which admittedly can be a precursor to infection, but may not always be an SSI. In the past, we have used ASEPSIS (a validated tool for cardiac surgery) but there are a few things that made it more problematic for us instance, teasing out if the antibiotic therapy was for the wound or chest infection (similarly, whether duration of stay was relayed to SSI or other issue), or with smaller incisions, such as EVH, it was pretty easy for a wound to be >=80%' affected (which is influential in ASEPSIS scoring system). For our hospital, we decided to stick with the dichotomous (y/n) PHE definition, because to influence the SSI rates, we could focus on interventions to reduce the risk of infection. If the score is a continuum (which I accept makes sense), is there any work to demonstrate a reduction in scores (not just those =>21 which have the word 'infection' included)? The reason I ask is because (going back to EVH incision), 100% of the incision could have purulent discharge, and using the ASEPSIS score, the score would be 10. This score (10) = 'satisfactory healing'. If we give antibiotics for the purulent discharge (v likely) then score is 20 = 'disturbed healing'. I would hope to see work done to influence scores less than 21 in these sorts of scenarios? Does anyone use ASEPSIS, and if so, does your work include reducing overall scores for cardiac patients? Or is anyone doing any work to validate PHE definition in cardiac surgery?