Surgical wound classification

July 24, 2019

Surgical wound classification is an important predictor of postoperative surgical site infections and this will ensure that correct classification is recorded

Surgical wound classification (SWC) is an important predictor of postoperative surgical site infections and this will ensure that correct classification is recorded (e.g., clean contaminated). SWC should be added to any structured operative debrief after a gynecologic surgery.

For more information on infection bundles: Putting surgical site infection bundles into practice

ClassTypeDescription
ICleanAn uninfected operative wound in which no inflammation is encountered and the respiratory, ailmentary, genital, or uninfected urinary tracts are not entered. In addition, clean wounds are primarily closed and, if necessary, drained with closed drainage. Operative incisional wounds that follow nonpenetrating (blunt) trauma should be included in this category if they meet the criteria.
IIClean-contaminatedOperative wounds in which the respiratory, ailmentary, genital, or uninfected urinary tracts are entered under controlled conditions and without unusual contamination. Specifically, operations involveing the biliary tract, appendix, vagina, and oropharynx are included in this category, provided no evidence of infection or major break in technique is encountered.
IIIContaminatedOpen, fresh, accidental wounds. In addition, operations with major breaks in sterile technique (for example, open cardiac massage) or gross spillage from the gastrointestinal tract, and incisions in which acute, nonpurulent inflammation is encountered, including necrotic tissue without evidence of purulent drainage (for example, dry gangrene), are included in this category.
IVDirty-infectedIncludes old traumatic wounds with retained devitalized tissue and those taht involve existing lcinical infection of perforated viscera. This definition suggests that the organisms causing the postoperative infection were present in the operative field before this operation.

Reprinted with permission from Mangram AJ, Horan TC, Pearson ML, et al. Guideline for prevention of surgical site infection, 1999. Infect control Hosp Epidemiol. 1999;20:250-78.