Surgical Wound Classification Review

1. Dr. Dene W. Daugherty
Department of Surgery

2. Goal
- To increase positive surgical outcomes for
patients by decreasing perioperative
complications from misidentified risk factors
for infection and sepsis

3. Importance
 Predictor of postsurgical site infection
 Risk adjusted data will impact healthcare statistics and grades
 Drives quality improvement initiatives

4. Risk of Post-Operative Infection
• Class I (Clean): 2%
• Class II (Clean Contaminated): 5-15%
• Class III (Contaminated): >15%
• Class IV (Dirty): >30%

5. Wound Classification
Predicts risk of postoperative
infection based on assessment of
bacterial load at time of surgery
Assists surgeon determine his/her
approach to postop care

6. Class I: Clean
 Respiratory, gastrointestinal, genital and urinary tracts not entered
 No break in aseptic technique
 No inflammation

7. Class I: Examples
Breast surgery
C-section with non-ruptured membranes
Exploratory lap with no bowel resection
Eye Surgery (unless inflamed, infected, or
with foreign body)
Hernia repair
Total joint arthroplasty

8. Class II: Clean-Contaminated
Respiratory, gastrointestinal, genital, or urinary
tract is entered under controlled conditions
No major break in aseptic technique
No acute inflammation
No spillage

9. Class II: Examples
Cholecystectomy (chronic inflammation)
Gastrointestinal procedures
Gynecological procedures
Urological procedures

10. Class III: Contaminated
Acute, nonpurulent inflammation encountered
Open, fresh, accidental wounds
Operations with major breaks in sterile technique
Visible spillage from intestinal tract
Necrotic tissue without evidence of purulent
drainage

11. Class III: Examples
Appendectomy (no rupture, no pus)
Bowel resection for infarcted and/or
necrotic bowel
Cholecystectomy with acute inflammation
or bile spillage
Compromised integrity of sterile field

12. Class IV: Dirty
Presence of frank pus or abscess
Perforated viscera
Fecal contamination
Traumatic wounds with retained devitalized tissue
Wet gangrene

13. Class IV: Examples
Amputation in the presence of infection
Laparotomy for intra-abdominal abscess
Incision & Drainage for infection / abscess
Ruptured appendicitis
Ruptured bowel with or without fecal
contamination
Ruptured gastric ulcer

14. When to document class
 At the end of the surgical procedure; during surgical team debriefing
 This ensures any events that occurred during the surgery that may
influence wound class are considered