Table 2 Classification of wound contamination levels according to CDC [19]

Class I/clean

These are uninfected operative wounds in which no inflammation is encountered and the respiratory, alimentary, genital, or uninfected urinary tracts are not entered. In addition, clean wounds are primarily closed and, if necessary, drained with closed drainage. Operative incisional wounds that follow non-penetrating (blunt) trauma should be included in this category if they meet the criteria. Laparoscopic surgeries, surgeries involving the skin (such as biopsies), eye, or vascular surgeries are good examples.

Class II/clean-contaminated

An operative wound in which the respiratory, alimentary, genital, or urinary tracts are entered under controlled conditions and without unusual contamination. Specifically, operations involving the biliary tract, appendix, vagina, and oropharynx are included in this category, provided no evidence of infection or major break in technique is encountered.

Class III/contaminated

Open, fresh, accidental wounds. In addition, operations with major breaks in sterile technique (e.g. open cardiac massage) or gross spillage from the gastrointestinal tract, and incisions in which acute, non-purulent inflammation is encountered are included in this category. Contaminated wounds are also created when an outside object comes in contact with the wound (e.g. a bullet, knife blade, or other pointy object).

Class IV/dirty-infected

Old traumatic wounds with retained devitalized tissue and those that involve existing clinical infection or perforated viscera or a foreign object lodged in the wound or any wound that has been exposed to pus or faecal matter. This definition suggests that the organisms causing postoperative infection were present in the operative field before the operation.