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.