What are types of wound based on level of contamination?

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Surgical wound classification is typically based on the level of contamination. The categories include:
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  • Centers for Disease Control and Prevention (CDC) surgical wound classification

    • Class I - Clean

  1. Uninfected operative wound with no inflammation
  2. No entry into the respiratory, alimentary, genital, or urinary tract
  3. Primarily closed, and drained with closed drainage (if necessary)
  4. Includes operative incisional wounds following blunt trauma if above criteria met.

Treatment:

  • Clean and Protect: Rinse with sterile saline or clean water. Apply a sterile dressing.
  • Monitor Healing: Keep an eye on the wound for signs of infection.

Prevention:

  • Maintain Sterility: Ensure clean conditions during surgical procedures or when handling wounds.
  • Hygiene Practices: Wash hands thoroughly before and after touching the wound.

    • Class II - Clean-contaminated

  1. Entry into respiratory, alimentary, genital, or urinary tract under controlled conditions without unusual contamination
  2. Includes operations involving biliary tract, appendix, vagina, and oropharynx if no evidence of infection or major break in technique.

Treatment:

  • Thorough Cleaning: Clean with saline or antiseptic. Debride any non-viable tissue.
  • Dress Properly: Use sterile dressings and change regularly to keep the wound clean.

Prevention:

  • Preoperative Care: Administer prophylactic antibiotics if necessary and maintain sterility during procedures.
  • Patient Education: Teach patients about proper wound care at home.

    • Class III - Contaminated

      1. Fresh, open, accidental wounds
      2. Operations with major breaks in sterile technique or gross spillage from gastrointestinal tracts 
      3. Incisions with acute, non purulent
      4. Inflammation.
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        Treatment:

        • Aggressive Cleaning: Clean thoroughly with saline and antiseptics. Debride any foreign material or dead tissue.
        • Antibiotics: Consider systemic antibiotics if there's a high risk of infection.
        • Regular Dressing Changes: Change dressings daily or if wet or soiled.

        Prevention:

        • Environmental Control: Ensure clean workspaces and avoid exposing wounds to contaminants.
        • Immediate Care: Promptly treat any cuts or scrapes, especially in dirty environments.

    • Class IV - Dirty / Infected

      1. Old traumatic wounds with retained devitalized tissue
      2. Wounds involving existing clinical infection or perforated viscera
      3. Suggests infective organisms present in operative field before operation.

    • Treatment:

      • Surgical Intervention: Often requires surgical cleaning and debridement.
      • Broad-Spectrum Antibiotics: Start with broad-spectrum antibiotics until culture results are available.
      • Close Monitoring: Regularly assess for systemic signs of infection.

      Prevention:

      • Avoid Risky Situations: Educate about risks associated with bites, deep puncture wounds, or contaminated injuries.
      • Immediate Medical Attention: Encourage seeking care for severe or dirty wounds right away.


    • Reference - CDC Hospital Infection Control Practices Advisory Committee guideline on prevention of surgical infection (Infect Control Hosp Epidemiol 1999 Apr;20(4):250), commentary can be found in Infect Control Hosp Epidemiol 1999 Apr;20(4):231

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