The degree of contamination at the time of an operation concludes how medical professionals determine the type of surgical wound for classification on medical charts. As determined by the American College of Surgeons, there are four classes of wound types: clean, clean-contaminated, contaminated and dirty-infected. Surgical wound classification utilizes the degree of contamination in order to predict the risk of postoperative infections and provide accurate clinical, economic and educational outcomes for research studies and national reporting on health care quality.
Class I: Clean
Class I clean wounds are nontraumatic wounds with no presenting inflammation. These wounds do not involve the respiratory, gastrointestinal and genitourinary tracts. Examples of a Class I clean wound include vascular and endocrine procedures, eye surgery and simple orthopedic procedures, surgical procedures involving the skin and exploratory laparotomies.
Class II: Clean-Contaminated
Any wound open for drainage or reopened to remove wires, pins or for other surgical reasons is considered a Class II contaminated-clean wound. Class II wounds comprise generally clean wounds with a higher potential for infection. Gastrointestinal, respiratory or genitourinary tract surgeries without significant spillage carry the Class II wound label, as well as thoracic procedures, ear surgeries, nose/oropharynx procedures and gynecologic procedures.
Class III: Contaminated
A foreign body, such as a bullet, knife blade, or tree branch, passing through a wound indicates a Class III contaminated wound. Class III wounds accommodate a range of causes, including surgeries where a major break in operative technique occurs, serious spillage from the gastrointestinal tract, admittance into the genitourinary or biliary tracts, surgeries where infected urine or bile is present, and incisions involving serious inflammations.
Class IV: Dirty-Infected
Class IV dirty-infected wounds include traumatic wounds from a dirty source or that receive delayed treatment; dirty or infected operative wounds; a wound that is exposed to fecal matter or pus; and wounds in which a foreign body, such as a bullet or knife blade, is embedded. These wounds often involve wound debridement to rid it of infected tissue and may feature abscesses and infection.
