Questions and Answers
Who developed the surgical wound classification system?
the CDC
What are the 2 reasons surgical wound classification is important? (Select all that apply)
What is an example of preventative SSI measures?
pre-op prophylactic antimicrobial therapy
Who is responsible for classifying surgical wounds?
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What are the types of surgical wound classification?
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What class is an operative incisional wound that follows nonpenetrating (blunt) trauma?
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What wound classification is an inguinal hernia repair?
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What wound classification is a thyroidectomy?
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What class of surgical wounds either has a major break in sterile technique or major GI spillage?
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What wound classification is an incision and drainage of an abscess?
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What is the infection risk percentage associated with Class 4: Dirty wounds?
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How does surgical wound classification affect cost?
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True or false: Monitoring for hyperglycemia is part of the implementation of wound classification.
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What does documentation of surgical wound classification include?
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Study Notes
Surgical Wound Classification Overview
- Developed by the CDC as a systematic approach to categorize surgical wounds.
- Essential for predicting postoperative surgical site infections (SSIs) and guiding preventative strategies.
Importance of Classification
- Functions as a predictor for potential postoperative SSIs.
- Aids surgeons in implementing effective preventative measures.
Roles in Classification
- Surgeons classify surgical wounds, while circulating nurses collect and document this classification data.
Types of Surgical Wound Classifications
- Clean: Uninfected wounds without inflammation, no entry into respiratory, alimentary, genital, or urinary tracts.
- Clean-Contaminated: Controlled entry into the tracts mentioned above without unusual contamination.
- Contaminated: Open fresh accidental wounds or those with a major break in sterile technique.
- Dirty: Wounds present before surgery with evidence of existing infection or devitalized tissue.
Clean Wound Examples (Class 1)
- Includes surgeries like inguinal hernia repair, thyroidectomy, mastectomy, and total knee replacements, among others, all typically presenting a 1-5% infection risk.
Clean-Contaminated Wound Examples (Class 2)
- Examples include cholecystectomy, appendectomy, and small bowel resection, with infection risks ranging from 3-11%.
Contaminated Wound Examples (Class 3)
- Characterized by a break in sterile technique or GI spillage. Incidence includes appendectomy for appendicitis or bile duct spillage during cholecystectomy, with an infection risk of 10-17%.
Dirty Wound Examples (Class 4)
- Reflects pre-existing infections or trauma, including abscess drainage or perforated bowel, with a significant infection risk exceeding 27%.
Factors Influencing Classification
- Factors that affect classification include:
- Type of surgical procedure
- Pathologic findings
- Condition related to the surgical procedure
- Organ involved
- Adherence to sterile techniques by the surgical team.
Infection Risk Percentages
- Infection risks vary by wound class:
- Class 1: 1-5%
- Class 2: 3-11%
- Class 3: 10-17%
- Class 4: >27%
Importance of Patient Record Review
- Reviewing medical records is crucial to identify potential infection risks from old wounds or pre-existing conditions prior to surgery.
Classification Implementation
- Use combined clinical judgment for unclear cases, often in pediatric situations.
- Classifications are determined both at the beginning and the end of procedures to reflect new findings.
Prophylactic Measures
- Antimicrobial therapy is essential before surgery, ideally administered one hour in advance for most antibiotics, with special guidelines for vancomycin and fluoroquinolones.
- Ensure meticulous preoperative hygiene and patient preparation to reduce infection risk.
Monitoring and Environment
- Maintaining normothermia is vital; hyperthermic conditions can increase infection risk.
- Monitoring for hyperglycemia is a key part of implementation practices.
Documentation Practices
- Important to accurately document wound classification, influencing factors, and any alterations with justifications throughout the patient's medical record.
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Description
Enhance your knowledge of surgical wound classification with these flashcards. This quiz covers key concepts, including the origin of the classification system and its significance in predicting and preventing postoperative surgical site infections (SSI). Test your understanding of preventative measures through targeted questions.
