a non-traumaticwound; no inflammationencountered.a minor breakin sterile technique occurredre-operation of clean surgery within 7 daysprocedures following blunt traumaPostoperative infection rates without prophylaxis range from 5 to 25%, and endogenous flora are commonly involved Examples of clean-contaminated surgical procedures:appendectomy(incidental) -no inflammation or pus seenhysterectomyor hysterotomybowel resection -(no spillage into peritoneal cavity)lung surgery- (no infection seen)bladder and ureteral surgerynose/throat/laryngectomycholecystectomy/lap chole (elective)suprapubic prostatectomycesarean section-after trial laborvaginal hysterectomyvag delivery-PROM< 24hr.hemorrhoidectomytherapeutic abortiondental surgerygastrectomyD and CTraChTURPPlacement :patients in this category may be placed together.may be placed with patients at high risk for acquiring infection and other types of non-surgical patients.may be placed with clean surgery patients.do not place with contaminated or dirty patients.class III : contaminated surgery: has increasing chance for postoperative infectious complications. The operatory field contains potentially septic tissues (expecially due to the basal disease for 9
which the patient undergoes surgery). Anaerobic bacteria (Bacteroidesspp., Clostridiumspp., ...).acute nonpurulent inflammationseenoperations with major breaksin sterile techniques.gross spillagefrom GI tract occurs (gastrointestinal content orbile)the GU or biliary tracts are entered in the presence of infected bile or urinetraumatic wound < 4-8 hours old from a relatively clean source.Infection rates without prophylaxis range from 15 to 40%. Examples of Class III surgical procedures include, but are not limited to:appendicectomyin acute appendicitisopening of biliary tractin acute cholecystitisincision and drainage of abscessgun shot wound (fresh, without perforated bowel)rectal surgeryTUR or suprapubic prostatectomywith positive pre-op urine culture.vaginal or cesarean sectiondeliveries with PROM 24 hours.Placement : patients in this category may be placed together. Prevention : mechanical cleaning, washing, antibiotic therapyclass IV : dirty surgery: existing acute bacterial infection or a perforated viscera is encountered (clean tissue is transected to gain access to pus= higher bacterial load).traumatic wound-old(4 < hours < 24) with retained devitalized tissuefecal contamination, foreign body or retained, devitalized tissueis present.Postoperative infection rates in this group exceed 40%. The use of antimicrobials in dirty and some contaminated procedures is not classified as prophylaxis but as treatment for a presumed infection.
- Fall '18