Dr. Dene W. Daugherty aims to decrease postoperative complications by accurately identifying risk factors for infection through wound classification. Wound classification predicts infection risk based on bacterial load at surgery, assisting surgeons in postoperative care. It categorizes wounds as clean (class I), clean-contaminated (class II), contaminated (class III), or dirty (class IV) based on degree of contamination, with infection risks of 2%, 5-15%, >15%, and >30% respectively. The classification should be documented after surgery to account for any events influencing wound status.

1. Dr. Dene W. Daugherty
Department of Surgery

2. Goal
- To increase positive surgical outcomes for
patients by decreasing perioperative
complications from misidentified risk factors
for infection and sepsis

3. Importance
 Predictor of postsurgical site infection
 Risk adjusted data will impact healthcare statistics and grades
 Drives quality improvement initiatives

4. Risk of Post-Operative Infection
• Class I (Clean): 2%
• Class II (Clean Contaminated): 5-15%
• Class III (Contaminated): >15%
• Class IV (Dirty): >30%

5. Wound Classification
Predicts risk of postoperative
infection based on assessment of
bacterial load at time of surgery
Assists surgeon determine his/her
approach to postop care

6. Class I: Clean
 Respiratory, gastrointestinal, genital and urinary tracts not entered
 No break in aseptic technique
 No inflammation

7. Class I: Examples
Breast surgery
C-section with non-ruptured membranes
Exploratory lap with no bowel resection
Eye Surgery (unless inflamed, infected, or
with foreign body)
Hernia repair
Total joint arthroplasty

8. Class II: Clean-Contaminated
Respiratory, gastrointestinal, genital, or urinary
tract is entered under controlled conditions
No major break in aseptic technique
No acute inflammation
No spillage

9. Class II: Examples
Cholecystectomy (chronic inflammation)
Gastrointestinal procedures
Gynecological procedures
Urological procedures

10. Class III: Contaminated
Acute, nonpurulent inflammation encountered
Open, fresh, accidental wounds
Operations with major breaks in sterile technique
Visible spillage from intestinal tract
Necrotic tissue without evidence of purulent
drainage

11. Class III: Examples
Appendectomy (no rupture, no pus)
Bowel resection for infarcted and/or
necrotic bowel
Cholecystectomy with acute inflammation
or bile spillage
Compromised integrity of sterile field

12. Class IV: Dirty
Presence of frank pus or abscess
Perforated viscera
Fecal contamination
Traumatic wounds with retained devitalized tissue
Wet gangrene

13. Class IV: Examples
Amputation in the presence of infection
Laparotomy for intra-abdominal abscess
Incision & Drainage for infection / abscess
Ruptured appendicitis
Ruptured bowel with or without fecal
contamination
Ruptured gastric ulcer

14. When to document class
 At the end of the surgical procedure; during surgical team debriefing
 This ensures any events that occurred during the surgery that may
influence wound class are considered