Surgical Wound Classication Decision Tree

Is Is there there a a wound? wound?

NO NO

No No Wound Wound Classication Classication

YES YES
Is Isthe thewound wound clean or clean(ie, (ie,not notinfected infectedor orinflamed) inflamed); or the result of a non-penetrating, blunt trauma? did the incision follow non-penetrating, blunt trauma? Was the procedure free from entry into the respiratory, alimentary, Was the procedure free from entry into respiratory, alimentary, or or genitourinary tract? genitourinary tract? Was Wasthe thewound woundprimarily primarilyclosed closedor ordrained drainedwith withclosed closeddrainage drainage (eg, bulb drain)? (eg, chest tubes)?

YES YES

Class Class II Clean Clean

NO NO
Was Wasthe therespiratory, respiratory,alimentary, alimentary,or orgenitourinary genitourinarytract tractentered enteredunder under controlled controlledconditions conditionswithout without evidence or evidenceof ofinfection infectionor orcontamination contamination; or major break in technique (eg, spillage from gastrointestinal tract)? major break in technique (eg, spillage fromthe gastrointestinal tract)?

YES YES

Class Class II II Clean Clean Contaminated Contaminated

NO NO
Is Isthe thewound wound fresh, fresh,open, open,or oraccidental; accidental;or or is gastrointestinal tract; or isthere theregross gross(ie, (ie,visible) visible)spillage spillagefrom fromthe GI tract; or is isthere therenon-purulent non-purulentinflammation inflammationpresent? present? Was technique (eg, unsterile instruments Wasthere therea amajor majorbreak breakin insterile technique (eg, unsterile instruments used) used) during the procedure? during the procedure?

YES YES

Class Class III III Contaminated Contaminated

NO NO
Is Isthis thisan anold oldwound wound(ie, (ie,greater greaterthan than4 4to to6 6hours) hours)with with retained devitalized tissue (eg, gangrene, retained devitalized tissue (eg, gangrene,necrosis), necrosis);or or existing existingclinical clinicalinfection infection(eg, (eg,purulence), purulence);or or perforated perforatedviscera? viscera?
REFERENCES
1. Mangram AJ, Horan TC, Pearson ML; Hospital Infection Control Practices Advisory Committee. Guidelines for prevention of surgical site infection, 1999. Am J Infect Control. 1999;27(2):97-132. 2. Garner, JS. CDC guideline for prevention of surgical wound infections, 1985. Supercedes guideline for prevention of surgical wound infections published in 1982. (Originally published in 1985). Revised. Infect Control. 1986;7(3):193-200. http://wonder.cdc.gov/wonder/prevguid/p0000420/p0000420.asp. Accessed July 31, 2011. 3. Altemeier WA. Surgical infections: incisional wounds. In: Bennett JV, Brachman PS, eds. Hospital Infections. Boston, MA: Little, Brown and Co; 1979:287-306. 4. Howard JM, Barker WF, Culbertson WR, et al. Postoperative wound infections: the influence of ultraviolet irradiation of the operating room and various other factors. Ann Surg. 1964;160(Suppl2):1-192. NOTE: These are the original source documents for development of the CDC surgical wound classication system.

YES YES

Class Class IV IV Dirty, Infected Dirty, Infected

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