Page 20 Perioperative Services Competency Assessment - Vanderbilt University Medical Center Wound Class Interpretation Rationale 1. Verbalizes 1. Wound classification began in 1964. 1. Wound classes identify clusters of infections. History and 2. The Center for Disease Control and Prevention (CDC) 2. Wound classes identify potential risk factors for Significance of recommended four classifications based on risk factors. infections. Wound 3. Four wound classes are used as predictors of Postoperative 3. Wound classes allow comparisons of rates of infections Classification. infections. among institutions or surgical specialties. B. Verbalizes the 1. Class 1- Clean – (1-5% rate of infection) 1. Wound classes establish baseline infection rates for each criteria for the a. Uninfected wound class. Class 1- Clean b. No inflammation encountered wound class. c. Closed primarily d. Drained with closed drainage 2. Examples of Clean Cases: a. CAB b. Most Cardiac Cases c. Closed ortho cases d. Most neuro cases e. Mastectomy f. Splenectomy g. Vascular surgery h. Heart transplant i. Hip/knee prosthesis j. Hernia C. Verbalizes the 1. Class II- Clean- Contaminated (8-11% rate of infection) 1. Wound classes establish baseline infection rates for each criteria for the The following tracts entered under controlled conditions and wound class. Class II- Clean- no unusual contamination occurs: Contaminated 2. Examples of Clean-Contaminated Cases: a. Appendectomy wound class. b. Liver transplant c. Cholecystectomy d. Colorectal surgery e. C-Section f. Head and neck surgery g. Hysterectomy h. Nephrectomy i. Kidney transplant j. Gastric surgery k. Prostate surgery l. GU & GYN surgery D. Verbalizes the 1. Class III Contaminated (12-20% infection rate). 1. Wound classes establish baseline infection rates for each criteria for the a. Open fresh accidental wounds of less than 4 hours wound class. Class III- b. Surgical procedures with major breaks in sterile Contaminated technique c. Acute nonpurulent inflammation of tissue wound class. d. Examples of Contaminated Cases: i. Appendectomy for ruptured appendix ii. Gunshot wound to the abdomen iii. Penetrating wounds iv. Bile spillage during cholecystectomy v. Diverticulitis vi. Compound fractures E. Verbalizes the 1. Class IV- Dirty/Infected 1. Wound classes establish baseline infection rates for each criteria for the a. Old traumatic wounds of over 4 hours. wound class. Class IV- b. Existing clinical infection Dirty/Infected c. Perforated viscera. 2. Examples of Dirty-Infected Cases wound class. a. Incision and Drainage of abscess b. Delayed primary closure of wound after ruptured appendix. c. Positive pre-operative blood cultures. d. Perforated bowel. e. Peritonitis f. Wound debridement. VUMC Perioperative Services 0617- Wound Classification Page 21 Vanderbilt University Medical Center: Perioperative Services F. Verbalizes 1. Document wound class in VPIMS 1. Wound classes are often classified at the beginning of nursing 2. Reclassify as needed during a procedure case but are rarely reclassified when previously unknown responsibilities 3. Verify wound class with surgeons at completion of clinical information becomes available. in identifying/ procedure. 2. Unexpected inflammation/pus is encountered. verifying 3. Planned exploratory laparotomy converts to small bowel wound class. resection. 4. Errors in documentation can occur when wound class is not verified. VUMC Perioperative Services- Wound Class 0617 .