Page 1 of 3

Sources:
VIHA intranet search under wound classification:
https://intranet.viha.ca/departments/surgery/operating_room/Documents/phase_2/Phases
%202.3.2%20Surgical%20Wound%20Classification.pdf
https://intranet.viha.ca/departments/surgery/operating_room/Documents/perioperative_program/wo
und_classification.pdf
ACS NSQIP Chapter 4
BCPSQC Resources and Webex Power Point Presentations
http://home.earthlink.net/~kremmert/p0034.txt
VIHA Surgical Wound Classification and GUIDELINES
CHARTING WOUND CLASSIFICATIONS CHART WOUND CLASSIFICATION AT THE END
OF A PROCEDURE - Changes can occur during procedure that may affect the classification. If
unsure, ask the surgeon for clarification. Classify each procedure separately
DEFINITIONS
ABSCESS- Localized collection of pus in a cavity
CYST- Any sac containing liquid
FISSURE- A groove of natural division
DEBRIDEMENT- Debridement is the process of removing nonliving tissue from pressure ulcers,
burns, and other wounds.
SINUS- a canal passage leading to an abscess or a cavity within a bone
CLASSIFICATION DEFINITIONS: When in doubt, ask the Surgeon
CLEAN WOUNDS
Uninfected operative wounds
No inflammation
Respiratory, alimentary, genital, urinary tracts not entered
Clean wounds closed and/or drained with closed drainage
CLEAN CONTAMINATED WOUNDS
Controlled conditions of operative procedures re: Respiratory, Alimentary / Biliary tract and
Genital/urinary
Without unusual contamination
CONTAMINATED WOUNDS
Acute
Non-purulent of: Open, Fresh or Accidental wounds less than 8 hours old from relatively clean
source
Major breaks in sterile technique
Gross spillage of GI
DIRTY AND INFECTED WOUNDS
Old traumatic wounds over 24 hours old with retained devitalized tissue
Purulent
Existing clinical infection
Perforated viscera
Existing pre-op infection
Fecal contamination
Foreign body or retained devitalized tissue
Perforated Bowel
Incision and Drainage of Abscess
Peritonitis
Ruptured Appendix

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CLEAN
GEN

GYNE

URO

ORTHO

CLEAN
CONTMINATED
Breast biopsy/mastectomy Cholecystectomy
Vein ligation
(chronic)
Thyroidectomy
Appendectomy(no
Hernia-Inguinal,
inflammation, no
Umbilical, Ventral,
perforation)
Epigastric
Bowel surgery
Exploratory laparotomy
colectomy, colostomy
Lumbar Sympathectomy
reversals, roux-e-Y, SB
Insertion of Broviac
resection
Nissen Fundoplication
Gastric surgery
Mediastinoscopy
Vagotomy/pyloroplasty
Laparoscopy if not
Endoscopy
entering GI/GU tract
Hemorrhoidectomy
Adrenalectomy
Rectal polypectomy
Splenectomy
Laparoscopy if entering
the GI/GU tract
Whipple procedure
Some Complex Liver
resection
Resection of an Ovary
Abdominal
Laparoscopy if not
Hysterectomy
entering GI/GU tract
Vaginal Hysterectomy
Laparotomy
Laparoscopic Assisted
Salpingo-Oophorectomy
Vaginal Hysterectomy
Tubal Ligation if clips used Cone Biopsy
(Abdominal)
Dilatation and
Tubal Plasty
Curettage
Ova
A & P Repair
ian Cyst
Tubal Ligation if tube
Cystectomy that does not
resected
incise ovarian tract
Cystectomy that incises
ovarian tract

CONTAMINATED

Testicular Biopsy
Orchidectomy or
orchiectomy or orchiopexy
Hydrocelectomy
Reduction torsion of testis
Renal Biopsy
Marshall Marchetti/Burch
Vasectomy
Circumcision
Insertion of Penile
Prosthesis
Laparoscopy if not
entering GI/GU tract
Reconstructive procedures:
- Hip
- Knee, etc.

May include some

Acute trauma, fresh
wounds

Presence of
EXISTING
infection
Presence of
PURULENT
Drainage

Acute compound
(open) fractures
May include some

Presence of
PURULENT
drainage

Cystoscopy/Pyelogram
Prostatectomy-all
TVT Bladder
Nephrectomy
Pyeloplasty
Ureterolithotomy
Bladder Neck Repair
Cystectomy
Ileo Conduit
Hypospadius
TURP

DIRTY &
INFECTED
Cholecystectomy
Incision &
(acute) or with gross drainage of
spillage.
abscess
Appendectomy(infla Perforated bowel
mmation or acute
Peritonitis
May include some
Ruptured
Acute trauma, fresh
Appendix
wounds less than 8
Purulent Drainage
hours old from
Debridement of
relatively clean
wound with
source.
EXISTING
Dry Gangrene
clinical infection
Necrotic tissue
Traumatic wound
without purulent
over 24 hours old
drainage.
with retained
Fistula without
devitalized tissue.
purulent drainage
Wet Gangrene
? Pilonidal cyst/sinus ? Pilonidal
Bile spillage
cyst/sinus
May include some
Presence of
Acute trauma, fresh
PURULENT
wounds
Drainage
? Bartholins cyst
Presence of
? drainage Labial
EXISTING
cyst
infection
Bartholins
Abscess
? Bartholins cyst
? drainage Labial
cyst

Page 3 of 3

PLAS

ENT

Arthroscopy
Bunionectomy
Amputation
Open Reductions
Fusions (eg):
- Knodt Rods
- Harrington Rods
Repair Ligaments
Arthroplasty
Menisectomy/Patellectomy
Repairs Tendon/Cruciate/
Ligament
Osteotomy
Abductor Release
Hip/Knee
Silastic Joint arthroplasty
Otoplasty,
Mammoplasty
Abdominoplasty
Nerve/tendon repairs
ORIF Zygoma
Thyroglossal Duct Cyst
Radical Neck (trachea or
mouth not entered)
BAHA

Any procedure done

through the mouth is
included here.
Septoplasty
Rhinoplasty

Acute trauma, fresh

wounds

Presence of
EXISTING
infection

Acute Trauma with

breaks in skin, fresh
wounds

Presence of
PURULENT
drainage
Presence of
EXISTING
infection
Presence of
PURULENT
drainage
Presence of
EXISTING
infection

Ear Surgery (eg):

May include some
-Mastoidectomy
Acute trauma, fresh
-Stapedectomy
wounds
-Stapes Mobilization
-Tympanoplasty
-Myringotomy
Nasal Surgery (eg):
-Intra-Nasal
-Septoplasty
-Nasal Polypectomy
/Cautery
-Rhinoplasty
Neck (eg):
-Tracheostomy
-Radical Neck (trachea
entered)
Endoscopies
Tonsillectomy and
Adenoidectomy
References: http://medical-dictionary.thefreedictionary.com/debridement
http://findarticles.com/p/articles/mi_m0FSL/is_2_80/ai_n6159709/pg_5/
http://www.worldwidewounds.com/2005/september/Gottrup/Surgical-Site-Infections-Overview.html