Surgical wound classification

Clean

• An uninfected operative wound in which no inflammation is encountered and no systemic tracts entered (respiratory, alimentary)
• Closed by primary intention and are usually not drained

Clean, contaminated

• An operative wound in which systemic tract(s) are entered under controlled conditions and without contamination

Contaminated

• Includes:
  • Open traumatic wounds (open fractures, penetrating wounds)
  • Operative procedures involving:
    • Spillage from the GI, GU or biliary tracts
    • A break in aseptic technique (open cardiac massage). 
• Microorganisms multiply so rapidly that a contaminated wound can become infected within 6 hours.

Dirty/Infected

• Heavily contaminated/infected wound before an operation
• Includes:
  • Perforated viscera
  • Abscesses
  • Wounds with undetected foreign body/necrotic tissue.¹

Most wounds are usually easy to manage and result in desirable secondary outcome if appropriate steps are taken during contact with medical care.

Learning Bite:

Most ED presentation will fall within the clean-contaminated or contaminated wound classification. While clean-contaminated wounds can be closed by primary intention, contaminated and dirty wounds will be referred to the appropriate speciality for irrigation, debridement and formal closure in theatre.