Surgical Wound Classification Decision Tree

No
No Wound
Wound
Is
Is there
there a
a wound?
wound? NO
NO Classification
Classification

YES
YES
IsIsthe
thewound
wound
• clean
• clean(ie,
(ie,not
notinfected
infectedor
orinflamed)
inflamed);oror
• the result of a non-penetrating, blunt trauma?
• did the incision follow non-penetrating, blunt trauma?
Class
Class II
Was the procedure free from entry into the respiratory, alimentary,
Was the procedure free from entry into respiratory, alimentary, or or YES
YES Clean
genitourinary tract?
genitourinary tract? Clean
Was
Wasthethewound
woundprimarily
primarilyclosed
closedorordrained
drainedwith
withclosed
closeddrainage
drainage
(eg, bulb drain)?
(eg, chest tubes)?

NO
NO

Was
Wasthe
therespiratory,
respiratory,alimentary,
alimentary,or
orgenitourinary
genitourinarytract
tractentered
enteredunder
under Class
Class IIII
controlled
controlledconditions
• evidence
conditionswithout
without
• evidenceofofinfection
infectionor
orcontamination
contamination;oror
YES
YES Clean
Clean --
• major
• major break in technique(eg,
break in technique (eg,spillage
spillagefrom
fromthe gastrointestinal tract)?
gastrointestinal tract)? Contaminated
Contaminated

NO
NO
IsIsthe
thewound
wound
• fresh,
• fresh,open,
open,or
oraccidental;
accidental;or or
• is
• isthere
theregross
gross(ie,
(ie,visible)
visible)spillage
spillagefrom
fromthe gastrointestinal
GI tract; or tract; or Class
Class III
III
• is
• isthere
therenon-purulent
non-purulentinflammation
inflammationpresent?
present? YES
YES Contaminated
Contaminated
Was
Wasthere
thereaamajor
majorbreak
breakininsterile technique
technique (eg, unsterile
(eg, unsterile instruments
instruments used)
used) during the procedure?
during the procedure?

NO
NO
IsIsthis
thisan
anold
oldwound
wound(ie,(ie,greater
greaterthan
than44toto66hours)
hours)with
with
• retained
• retained devitalized tissue (eg, gangrene,necrosis),
devitalized tissue (eg, gangrene, necrosis);oror Class
Class IVIV
• existing YES
YES
• existingclinical
clinicalinfection
infection(eg,
(eg,purulence),
purulence);oror Dirty, Infected
Dirty, Infected
• perforated viscera?
• perforated viscera?

REFERENCES
1. Mangram AJ, Horan TC, Pearson ML; Hospital Infection Control Practices Advisory Committee. Guidelines for prevention of surgical
site infection, 1999. Am J Infect Control. 1999;27(2):97-132.
2. Garner, JS. CDC guideline for prevention of surgical wound infections, 1985. Supercedes guideline for prevention of surgical wound
infections published in 1982. (Originally published in 1985). Revised. Infect Control. 1986;7(3):193-200.
http://wonder.cdc.gov/wonder/prevguid/p0000420/p0000420.asp. Accessed July 31, 2011.
3. Altemeier WA. Surgical infections: incisional wounds. In: Bennett JV, Brachman PS, eds. Hospital Infections. Boston, MA:
Little, Brown and Co; 1979:287-306.
4. Howard JM, Barker WF, Culbertson WR, et al. Postoperative wound infections: the influence of ultraviolet irradiation of the operating
room and various other factors. Ann Surg. 1964;160(Suppl2):1-192.
NOTE: These are the original source documents for development of the CDC surgical wound classification system.

Copyright © AORN, Inc., 2011