18. Classification of surgical wounds and use of antibiotics

100 000/gram

1. clean 2. clean-contaminated 3. contaminated 4. dirty

noninflamed, wounds in which the respiratory, gastrointestinal, genitourinary and oropharyngeal tract are not entered eg. exploratory laparotomy, hip replacement

0-6%, antibiotics usually not warranted

operative wounds in which the respiratory, GI or genitourinary tract is entered under controlled conditions eg. bronchoscopy, enterotomy

4.5-9.3%

open, fresh, accidental eg. cardiac massage, lacerations

5.8-28.6% have potential for infection

old traumatic wounds with purulent discharge, devitalized tissue or foreign bodies eg. peritonitis, perforated intestinal tract, excision or drainage of an abscess