Classification of Surgical Wounds | Medicalalgorithms.com

Surgical wounds can be separated into 4 classes according to the American College of Surgeons' wound classification schema.

Classes of Surgical Wounds:

(1) clean

(2) clean-contaminated

(3) contaminated

(4) dirty or infected

Finding	Clean	Clean-Contaminated	Contaminated	Dirty or Infected
trauma associated?	nontraumatic or blunt trauma		fresh traumatic	trauma with problems (*)
sterile technique	no break	minor break	major break	operative field not sterile
incision into infected tissue	no		acute nonpurulent inflammation	pus present
surgery	elective
oropharynx	not entered	entered
respiratory tract	not entered	entered with no significant spillage	entered with significant spillage
GI tract	not entered	entered with no significant spillage	entered with significant spillage
biliary tract	not entered	not infected	infected
appendix	not entered	routine	spillage	ruptured
GU tract	not entered	not infected	infected
vagina	not entered	entered
perforated viscus pre-op	N	N	N	Y
collection of pus pre-operative	absent	absent	absent	present
closure	primary
drainage	none, or closed drainage	mechanical drainage

(*) Trauma with problems: retained devitalized tissue, foreign body, fecal contamination, dirty source, delayed treatment

This information can be rearranged:

Dirty or Infected - one ore more of the following:

(1) trauma with foreign body, fecal contamination, dirty source, delayed treatment, retained devitalized tissue

(2) pus present

(3) viscus perforated preoperatively or ruptured appendix

(4) operative field not sterile

Contaminated - one or more of the following:

(1) penetrating trauma not classified as dirty

(2) major break in sterile technique

(3) acute nonpurulent inflammation present

(4) infected anatomic area without pus: biliary or GU tract

(5) anatomic area entered with significant spillage: respiratory tract, GI tract, appendix

Clean-Contaminated:

(1) minor break in sterile technique

(2) anatomic area entered without significant spillage or infection: respiratory tract, GI tract, biliary tract, GU tract, vagina

(3) routine appendectomy

(4) mechanical drainage

Clean: everything else

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