Wound Classification for Certified Perioperative Nurse (CNOR)

Wound Classification

Definition/Etiology:

• Class 1, Clean
  • Not actively infected
  • Not from penetrating trauma
  • No entry to GI/GU/resp tracts
  • Wound closed primarily
• Class 2, Clean Contaminated
  • GI/GU/Resp tract entered
  • Evidence of contamination
• Class 3, Contaminated
  • Trauma/open wound
  • GI contents spillage
  • Acute Inflammation present
  • Break in sterile technique
• Class 4, Dirty, infected
  • Active infection/gangrene/necrosis

Considerations:

• Wound class may delay surgical timing
  • Acute appy-wait if possible
  • Infected joint-avoid implants
    • Infected implants= bad bad
• Wound classes often used for clinical order sets
  • 2+ consider broad preoperative abx
  • 3+ attempt to isolate organism and targeted abx (e-coli?, MRSA?)
• Consider sterile environment requirements
  • Infected washout in ER? (4, OK for bedside)
  • Wound class may change

Nurse’s Role:

• Documentation!
• Facility guidance per wound class
  • If applicable
• Cultures wherever possible
• Patient education pre and post
• Antibiotic stewardship!

Pitfalls:

• Combo cases
  • Field is at highest level
    • (Nexplanon removal, hysteroscopy = class 2)
  • Separate fields possible!
    • Clean -> dirty
    • Cannot go dirty -> clean
    • Regown!
      • Light handles!
    • Consider need for 2 cautery

Examples:

• Open ended question examples
  • EGD? (2)
  • Closed femur fracture (1)
  • Percutaneous nephro tube (2)
  • Acute appy (3)
  • Chronic gallbladder? (2)
  • Oral abscess and wisdom teeth extraction: cultures positive (4)

Linchpins (Key Points):

• Wound classes can change during surgery
• Identifies the level of infectious risk
• Often guides treatment decisions