Surgical Wound Classification

POLICY/ PROCEDURE/PROTOCOL Title: Surgical Wound Classification Policy # SS.40 Audience: Adult, Surgical Services, Labor & Delivery, Emergency Department, Special Procedures Also TX.INT.4 Key Word: Wound Classification Date Page: Issued: 2/6/02 1 of 4 Distribution: All holders of the policy and procedure manuals

Prepared by: Surgical Standards of Practice Committee Effective Date: 4/18/11

Approved by: Date: Surgical Standards of Practice Committee 1/18/11 Infection Control 6/07 Kaleida Nurse Policy Council 6/12/07 Kaleida Nurse Executive Council 7/7/07, 3/4/11

Regulation/ Standards- N/A NYS: Federal: Accreditation Standards: Review Date 7/07 Revision Date 7/07 3/11

I. Introduction The Centers for Disease Control and Prevention (CDC) has a wound classification system that is accepted and used in health care facilities throughout the country. The CDC classifies wounds according to the likelihood and degree of wound contamination at the time of surgery.

II. Communication and Responsibility Department of Surgical Services, Labor and Delivery, Emergency Department, Special Procedures

III. Scope of Practice Physicians, Surgical Technicians, Registered Nurses, Physician Assistants, Registered Nurse First Assistants

IV. Policy The circulating nurse will collect and provide meaningful data for the prevention and control of surgical wound infections through documentation of the surgical wound according to the Centers for Disease Control. All Surgical procedures will be classified and recorded as Wound Class I, II, III, IV on the Perioperative Record KH00006, Urology KH00305, KH00301, KH00444, Minor Surgery KH00065 or in the Electronic Medical Record.

**Keypoint: Wound classification may change due to events and findings during the procedure. Title: Surgical Wound Classification Date Page Policy # Issued: 2 of 4 SS.40 2/6/02

V. Procedure A. The Circulating Nurse will document the surgical wound classification on the perioperative record (KH00006) or in the Electronic Medical Record.

The four Classifications of Wounds are described as follows:

1. Class I -- CLEAN WOUNDS a. Elective procedures with the surgical wound made under ideal operating room conditions. b. A minor break in aseptic technique occurred. c. The wound is drained with closed drainage. d. No break in sterile technique has occurred during the surgical procedure. e. A minor break in sterile technique has occurred, such as a hole in the glove. e. The wound is an uninfected operative wound in which no inflammation is encountered f. None of the following cavities are entered: 1) respiratory 2) alimentary 3) genitourinary 4) oropharyngeal

2. Class II -- CLEAN CONTAMINATED WOUNDS a. The wound has a primary closure, the wound is drained b. No inflammation or infection is encountered c. The Alimentary, respiratory, and genitourinary tracts or oropharyngeal cavity have been entered under controlled conditions without significant spillage or unusual contamination

3. Class III -- CONTAMINATED WOUNDS a. An open, fresh traumatic wound b. A major break in aseptic technique occurred c. Acute non-purulent inflammation is present d. Gross spillage/contamination from gastrointestinal tract has occurred e. Entrance into genitourinary or biliary tracts with infected urine or bile present

4. Class IV -- DIRTY AND INFECTED WOUNDS a. Old traumatic wound from dirty source or with retained necrotic tissue, foreign body, or fecal contamination. b. Organisms are present in the surgical field before the procedure (perforated viscera) c. Organisms that cause postoperative infection are present in these wounds before surgery d. The patient has an existing clinical infection e. Acute bacterial inflammation encountered, with or without purulence f. An incision is made to drain the abscess Title: Surgical Wound Classification Date Page Policy # Issued: 3 of 4 SS.40 2/6/02

B. The above information is available to the Infection Control Department.

C. Surgeon Specific total caseload by category is available to the Infection Control Department.

VI. Protocol - N/A

VII. Documentation Wound Classification will be documented on the Perioperative Record KH00006 Urology KH00305, KH00301, KH00444 Minor Surgery KH00065 or in the Electronic Medical Record

VIII. References Addendum A: CDC Classification of Surgical Wounds

L J Atkinson, N H Fortunato, Berry & Kohn's Operating Room Technique, ninth edition (St Louis: Mosby-Year Book, Inc, 2000.) 565-566.

Standards of Recommended Practices, and Guidelines; AORN Inc. 2007, “Standards of Patient Outcomes”; “Recommended Practices Documentation of Care.”

APIC—Association for Professionals in Infection Control and Hospital Epidemiology 2005.

Kaleida Health developed these policies and procedures in conjunction with administrative and clinical departments. These documents were designed to aid the qualified health care team in making clinical decisions about patient care. These policies and procedures should not be construed as dictating exclusive courses of treatment and/or procedures. No health care team member should view these documents and their bibliographic references as a final authority on patient care. Variations of these policies and procedures in practice may be warranted based on individual patient characteristics and unique clinical circumstances. Please contact the print shop regarding any associated forms. Title: Surgical Wound Classification Date Page Policy # Issued: 4 of 4 SS.40 2/6/02

PLEASE SEE FOLLOWING CLASSIFICATION OFSURGICAL WOUNDS as listed by Center for Disease Control:

Example of WOUND CLASSIFICATION OF COMMON CASES CLEAN (Classification I) CLEAN-CONTAMINATED (Classification II) Arthroscopy Amputation Blephoroplasty Appendectomy-elective Cataract with IOL Bowel Resection Closed Fracture Cystoscopy Contracture release Fracture open under 4 hours Herniorrhaphy Gastrectomy Hydrocelectomy Gallbladder Laminectomy Thoracotomy for Lung resection Laparoscopy Myringectomy - BMT Lipoma Excision New Burns Mastectomy Nephrotomy Orchiopexy Nephrectomy Pacemaker insertion Open Lung Biopsy (Thoracotomy) Reconstructive (ortho) Open traumatic wounds under 4 hours Rytidectomy Oral Surgery without infection Salpingoopherectomy Otopharyngeal Spleenectomy Pyelolithotomy Tubal Ligation Renal Transplant Tuboplasty Rhinoplasty Vitrectomy Suprapubic prostatectomy Tracheostomy Tubal ligation with Manipulator TURP CONTAMINATED (Classification III) DIRTY AND INFECTED (Classification IV)

Bowel Resection with perforation Bartholin Cyst Colostomy Closure Sinus infection Empyema Pelvic Abscess Bowel Resection with Peritonitis Pilonidal Cyst infected Hemorrhoidectomy Old Burn Open fracture over 4 hours