Wound Classification

Wound Classification

• Class I wounds: only skin microflora may contaminate the operative field, with a low risk of infection (1-4%).
• Class I wounds may include prosthetic material, such as mesh or a cardiac valve, and the consequences of wound infection can be severe.

Clean Contaminated Wounds

• Class II clean contaminated wounds: a hollow viscus with resident microbes is entered, resulting in a higher risk of infection (3-6%).
• Both skin microflora and resident microbes may be present in the wound.

Contaminated Wounds

• Class III wounds: substantial microbial contamination is present (e.g., fecal soilage; traumatic heavily contaminated wound), with a higher risk of infection (4-20%).
• The risk of infection is particularly high if the skin edges of the superficial wound are opposed.

Wound Infection Prevention

• Preoperative patient skin preparation: scrubbing the prospective wound area and showering with a topical microbicide.
• Hair clipping, but avoidance of shaving the skin of the prospective wound site, to prevent microbial proliferation in areas of epidermal damage.
• Surgeon hand scrubbing and patient skin preparation with a topical microbicide immediately before the procedure.
• Instrument sterilization and avoidance of breaks in aseptic technique.
• Use of mechanical preparation, intraluminal antibiotics, or antiseptics for selected procedures to reduce the microbial inoculum within a hollow viscus.