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![Page 1: General Vascular Surgery Wound Class Review Quiz Bruce Ryon, RN, MS, PhD KPSF NSQIP SCNR 415-833-0987.](https://reader035.fdocuments.net/reader035/viewer/2022062413/5a4d1b927f8b9ab0599c2068/html5/thumbnails/1.jpg)
General & Vascular Surgery Wound Class Review & Quiz
Bruce Ryon, RN, MS, PhDKPSF NSQIP [email protected]
415-833-0987
![Page 2: General Vascular Surgery Wound Class Review Quiz Bruce Ryon, RN, MS, PhD KPSF NSQIP SCNR 415-833-0987.](https://reader035.fdocuments.net/reader035/viewer/2022062413/5a4d1b927f8b9ab0599c2068/html5/thumbnails/2.jpg)
Bruce Ryon, RN, MS, PhD
Wound Class Review
Defined by the CDC- Largely related to bacteria presence & activity
![Page 3: General Vascular Surgery Wound Class Review Quiz Bruce Ryon, RN, MS, PhD KPSF NSQIP SCNR 415-833-0987.](https://reader035.fdocuments.net/reader035/viewer/2022062413/5a4d1b927f8b9ab0599c2068/html5/thumbnails/3.jpg)
Bruce Ryon, RN, MS, PhD
Wound Class Review
Defined by the CDC- Largely related to bacteria presence & activity
#1 - Clean- Any incision thru non-infected material NOT in major tracts
![Page 4: General Vascular Surgery Wound Class Review Quiz Bruce Ryon, RN, MS, PhD KPSF NSQIP SCNR 415-833-0987.](https://reader035.fdocuments.net/reader035/viewer/2022062413/5a4d1b927f8b9ab0599c2068/html5/thumbnails/4.jpg)
Bruce Ryon, RN, MS, PhD
Wound Class Review
Defined by the CDC- Largely related to bacteria presence & activity
#1 - Clean- Any incision thru non-infected material NOT in major tracts
#2 - Clean, Contaminated- Baseline in GI, respiratory, reproductive, urinary tracts
![Page 5: General Vascular Surgery Wound Class Review Quiz Bruce Ryon, RN, MS, PhD KPSF NSQIP SCNR 415-833-0987.](https://reader035.fdocuments.net/reader035/viewer/2022062413/5a4d1b927f8b9ab0599c2068/html5/thumbnails/5.jpg)
Bruce Ryon, RN, MS, PhD
Wound Class Review
Defined by the CDC- Largely related to bacteria presence & activity
#1 - Clean- Any incision thru non-infected material NOT in major tracts
#2 - Clean, Contaminated- Baseline in GI, respiratory, reproductive, urinary tracts
#3 - Contaminated- Presence of contained acute inflammation (not chronic)- Dry, but not wet and active gangrene- Example: inflamed, non-perforated appendix
![Page 6: General Vascular Surgery Wound Class Review Quiz Bruce Ryon, RN, MS, PhD KPSF NSQIP SCNR 415-833-0987.](https://reader035.fdocuments.net/reader035/viewer/2022062413/5a4d1b927f8b9ab0599c2068/html5/thumbnails/6.jpg)
Bruce Ryon, RN, MS, PhD
Wound Class Review Defined by the CDC
- Largely related to bacteria presence & activity
#1 - Clean- Any incision thru non-infected material NOT in major tracts
#2 - Clean, Contaminated- Baseline in GI, respiratory, reproductive, urinary tracts
#3 - Contaminated- Presence of contained inflammation- Dry, but not wet and active gangrene- Example: inflamed, non-perforated appendix
#4 – Dirty/Infected- Incision into infected material- Spilled purulence or fecal material, wet gangrene - Example: perforated and inflamed appendix with presence
of purulence outside of appendix
![Page 7: General Vascular Surgery Wound Class Review Quiz Bruce Ryon, RN, MS, PhD KPSF NSQIP SCNR 415-833-0987.](https://reader035.fdocuments.net/reader035/viewer/2022062413/5a4d1b927f8b9ab0599c2068/html5/thumbnails/7.jpg)
Bruce Ryon, RN, MS, PhD
Wound Class Review Defined by the CDC
- Largely related to bacteria presence & activity
#1 - Clean- Any incision thru non-infected material NOT in major tracts
#2 - Clean, Contaminated- Baseline in GI, respiratory, reproductive, urinary tracts
#3 - Contaminated- Presence of contained inflammation- Dry, but not wet and active gangrene- Example: inflamed, non-perforated appendix
#4 – Dirty/Infected- Incision into infected material- Spilled purulence or fecal material, wet gangrene - Example: perforated and inflamed appendix with presence
of purulence outside of appendix
![Page 8: General Vascular Surgery Wound Class Review Quiz Bruce Ryon, RN, MS, PhD KPSF NSQIP SCNR 415-833-0987.](https://reader035.fdocuments.net/reader035/viewer/2022062413/5a4d1b927f8b9ab0599c2068/html5/thumbnails/8.jpg)
Baseline Procedures & Wound Class
Non-tracts
• Orthopedics – 1
• Breast – 1
• Vascular – 1
• Cardiovascular – 1
• Plastics – 1
• Hernia - 1
Tracts
• Head & Neck – 2
• Thoracic (lung) - 2
• OB/GYN – 2
• Colorectal – 2
• Hepatobiliary – 2
• Urology – 2
Bruce Ryon, RN, MS, PhD
![Page 9: General Vascular Surgery Wound Class Review Quiz Bruce Ryon, RN, MS, PhD KPSF NSQIP SCNR 415-833-0987.](https://reader035.fdocuments.net/reader035/viewer/2022062413/5a4d1b927f8b9ab0599c2068/html5/thumbnails/9.jpg)
Bruce Ryon, RN, MS, PhD
Wound Class Quiz
• 1st Slide – actual KPSF cases– Scenario explained with choices– Circulator recording marked by *asterisk– Think about the baseline of the procedure– Then think about anything that would
change that baseline
• 2nd Slide– Shows the answer in multiple asterisks– Note on key or important criteria
Bruce Ryon, RN, MS, PhD
![Page 10: General Vascular Surgery Wound Class Review Quiz Bruce Ryon, RN, MS, PhD KPSF NSQIP SCNR 415-833-0987.](https://reader035.fdocuments.net/reader035/viewer/2022062413/5a4d1b927f8b9ab0599c2068/html5/thumbnails/10.jpg)
Bruce Ryon, RN, MS, PhD
What is the wound class?
A patient under went a Whipple for cancer. Surgery included a cholecystectomy. Gallbladder was documented as having changes consistent with chronic cholecystitis.
1.Clean 2.Clean/contaminated *3.Contaminated 4.Dirty/Infected
![Page 11: General Vascular Surgery Wound Class Review Quiz Bruce Ryon, RN, MS, PhD KPSF NSQIP SCNR 415-833-0987.](https://reader035.fdocuments.net/reader035/viewer/2022062413/5a4d1b927f8b9ab0599c2068/html5/thumbnails/11.jpg)
Bruce Ryon, RN, MS, PhD
What is the wound class?
A patient under went a Whipple for cancer. Surgery included a cholecystectomy. Gallbladder was documented as having changes consistent with chronic cholecystitis.
1.Clean ******* 2.Clean/contaminated ******* 3.Contaminated 4.Dirty/Infected
Note: Chronic inflammation would not bump it to a 3
![Page 12: General Vascular Surgery Wound Class Review Quiz Bruce Ryon, RN, MS, PhD KPSF NSQIP SCNR 415-833-0987.](https://reader035.fdocuments.net/reader035/viewer/2022062413/5a4d1b927f8b9ab0599c2068/html5/thumbnails/12.jpg)
Bruce Ryon, RN, MS, PhD
What is the wound class?
An 18 year old patient with extensive Crohns disease underwent a total colectomy with a colostomy.
1.Clean 2.Clean/contaminated*3.Contaminated 4.Dirty/Infected
![Page 13: General Vascular Surgery Wound Class Review Quiz Bruce Ryon, RN, MS, PhD KPSF NSQIP SCNR 415-833-0987.](https://reader035.fdocuments.net/reader035/viewer/2022062413/5a4d1b927f8b9ab0599c2068/html5/thumbnails/13.jpg)
Bruce Ryon, RN, MS, PhD
What is the wound class?
An 18 year old patient with extensive Crohns disease underwent a total colectomy with a colostomy.
1.Clean ******* 2.Clean/contaminated ******* 3.Contaminated 4.Dirty/Infected
Note: Chronic inflammation would keep it at a 2 and not bump it to a 3
![Page 14: General Vascular Surgery Wound Class Review Quiz Bruce Ryon, RN, MS, PhD KPSF NSQIP SCNR 415-833-0987.](https://reader035.fdocuments.net/reader035/viewer/2022062413/5a4d1b927f8b9ab0599c2068/html5/thumbnails/14.jpg)
Bruce Ryon, RN, MS, PhD
What is the wound class?
Patient underwent a breast biopsy. The operative report noted multiple areas of fatty necrosis on the large mass. There was also necrotic tissue around the mass.
1.Clean 2.Clean/contaminated 3.Contaminated *4.Dirty/Infected
![Page 15: General Vascular Surgery Wound Class Review Quiz Bruce Ryon, RN, MS, PhD KPSF NSQIP SCNR 415-833-0987.](https://reader035.fdocuments.net/reader035/viewer/2022062413/5a4d1b927f8b9ab0599c2068/html5/thumbnails/15.jpg)
Bruce Ryon, RN, MS, PhD
What is the wound class?
Patient underwent a breast biopsy. The operative report noted multiple areas of fatty necrosis on the large mass. There was also necrotic tissue around the mass.
1.Clean 2.Clean/contaminated ******* 3.Contaminated *******4.Dirty/Infected
Note: Necrotic, ischemic dead tissue, without infection is a 3
![Page 16: General Vascular Surgery Wound Class Review Quiz Bruce Ryon, RN, MS, PhD KPSF NSQIP SCNR 415-833-0987.](https://reader035.fdocuments.net/reader035/viewer/2022062413/5a4d1b927f8b9ab0599c2068/html5/thumbnails/16.jpg)
Bruce Ryon, RN, MS, PhD
What is the wound class?
Patient underwent laparoscopic appendectomy. The pre op CT scan reported the appendix contained a fecalith. There was no mention of infection, rupture or inflammation on the operative report.
1.Clean 2.Clean/contaminated*3.Contaminated4.Dirty/Infected
![Page 17: General Vascular Surgery Wound Class Review Quiz Bruce Ryon, RN, MS, PhD KPSF NSQIP SCNR 415-833-0987.](https://reader035.fdocuments.net/reader035/viewer/2022062413/5a4d1b927f8b9ab0599c2068/html5/thumbnails/17.jpg)
Bruce Ryon, RN, MS, PhD
What is the wound class?
Patient underwent laparoscopic appendectomy. The preop CT scan reported the appendix contained a fecalith. There was no mention of infection, rupture or inflammation on the operative report.
1.Clean ******* 2.Clean/contaminated ******* 3.Contaminated4.Dirty/Infected
Note: Fecalith contained within GI tract w/o infection, inflammation is a 2
![Page 18: General Vascular Surgery Wound Class Review Quiz Bruce Ryon, RN, MS, PhD KPSF NSQIP SCNR 415-833-0987.](https://reader035.fdocuments.net/reader035/viewer/2022062413/5a4d1b927f8b9ab0599c2068/html5/thumbnails/18.jpg)
Bruce Ryon, RN, MS, PhD
What is the wound class?
Patient underwent a laparoscopic appendectomy. The operative report states “inflamed appendix without perforation”.
*1.Clean 2.Clean/contaminated 3.Contaminated 4.Dirty/Infected
![Page 19: General Vascular Surgery Wound Class Review Quiz Bruce Ryon, RN, MS, PhD KPSF NSQIP SCNR 415-833-0987.](https://reader035.fdocuments.net/reader035/viewer/2022062413/5a4d1b927f8b9ab0599c2068/html5/thumbnails/19.jpg)
Bruce Ryon, RN, MS, PhD
What is the wound class?
Patient underwent a laparoscopic appendectomy. The operative report states “inflamed appendix without perforation”.
1.Clean 2.Clean/contaminated ******* 3.Contaminated ********4.Dirty/Infected
Note: Acute inflammation is a 3
![Page 20: General Vascular Surgery Wound Class Review Quiz Bruce Ryon, RN, MS, PhD KPSF NSQIP SCNR 415-833-0987.](https://reader035.fdocuments.net/reader035/viewer/2022062413/5a4d1b927f8b9ab0599c2068/html5/thumbnails/20.jpg)
Bruce Ryon, RN, MS, PhD
What is the wound class?
Patient underwent a laparoscopic appendectomy. The operative report states “inflamed appendix without perforation with exudates”.
1.Clean 2.Clean/contaminated 3.Contaminated *4.Dirty/Infected
![Page 21: General Vascular Surgery Wound Class Review Quiz Bruce Ryon, RN, MS, PhD KPSF NSQIP SCNR 415-833-0987.](https://reader035.fdocuments.net/reader035/viewer/2022062413/5a4d1b927f8b9ab0599c2068/html5/thumbnails/21.jpg)
Bruce Ryon, RN, MS, PhD
What is the wound class?
Patient underwent a laparoscopic appendectomy. The operative report states “injected appendix without perforation with exudates”.
1.Clean 2.Clean/contaminated ******* 3.Contaminated *******4.Dirty/Infected
Note: Exudates outside of non-perforated injected appendix is a 3
![Page 22: General Vascular Surgery Wound Class Review Quiz Bruce Ryon, RN, MS, PhD KPSF NSQIP SCNR 415-833-0987.](https://reader035.fdocuments.net/reader035/viewer/2022062413/5a4d1b927f8b9ab0599c2068/html5/thumbnails/22.jpg)
Bruce Ryon, RN, MS, PhD
What is the wound class?
Patient underwent a laparoscopic appendectomy. The operative report states “acute appendix with perforation”.
1.Clean *2.Clean/contaminated 3.Contaminated 4.Dirty/Infected
![Page 23: General Vascular Surgery Wound Class Review Quiz Bruce Ryon, RN, MS, PhD KPSF NSQIP SCNR 415-833-0987.](https://reader035.fdocuments.net/reader035/viewer/2022062413/5a4d1b927f8b9ab0599c2068/html5/thumbnails/23.jpg)
Bruce Ryon, RN, MS, PhD
What is the wound class?
Patient underwent a laparoscopic appendectomy. The operative report states “acute appendix with perforation”.
1.Clean 2.Clean/contaminated 3.Contaminated ******* 4.Dirty/Infected *******
Note: Perforated appendix assumes contents have spilled into abdominal cavity
![Page 24: General Vascular Surgery Wound Class Review Quiz Bruce Ryon, RN, MS, PhD KPSF NSQIP SCNR 415-833-0987.](https://reader035.fdocuments.net/reader035/viewer/2022062413/5a4d1b927f8b9ab0599c2068/html5/thumbnails/24.jpg)
Bruce Ryon, RN, MS, PhD
What is the wound class?
Patient underwent an exploratory laparoscopic for possible small bowel obstruction. The procedure performed was terminal ileum resection. The operative report states “necrotic cecum and appendix”.
1.Clean 2.Clean/contaminated 3.Contaminated * 4.Dirty/Infected
![Page 25: General Vascular Surgery Wound Class Review Quiz Bruce Ryon, RN, MS, PhD KPSF NSQIP SCNR 415-833-0987.](https://reader035.fdocuments.net/reader035/viewer/2022062413/5a4d1b927f8b9ab0599c2068/html5/thumbnails/25.jpg)
Bruce Ryon, RN, MS, PhD
What is the wound class?
Patient underwent an exploratory laparoscopic for possible small bowel obstruction. The procedure performed was a terminal ileum resection. The operative report states surgeon found a “necrotic cecum and appendix”.
1.Clean 2.Clean/contaminated ******* 3.Contaminated ******* 4.Dirty/Infected
Note: Necrosis, ischemic dead tissue, is generally not infected
![Page 26: General Vascular Surgery Wound Class Review Quiz Bruce Ryon, RN, MS, PhD KPSF NSQIP SCNR 415-833-0987.](https://reader035.fdocuments.net/reader035/viewer/2022062413/5a4d1b927f8b9ab0599c2068/html5/thumbnails/26.jpg)
Bruce Ryon, RN, MS, PhD
What is the wound class?
With a patient in significant abdominal pain, a preop CT scan indicated patient had SBO (small bowl obstruction). An ex-lap was performed and adhesion lysis freed up a SBO.
1.Clean *2.Clean/contaminated 3.Contaminated 4.Dirty/Infected
![Page 27: General Vascular Surgery Wound Class Review Quiz Bruce Ryon, RN, MS, PhD KPSF NSQIP SCNR 415-833-0987.](https://reader035.fdocuments.net/reader035/viewer/2022062413/5a4d1b927f8b9ab0599c2068/html5/thumbnails/27.jpg)
Bruce Ryon, RN, MS, PhD
What is the wound class?
With a patient in significant abdominal pain, a preop CT scan indicated patient had SBO (small bowl obstruction). An ex-lap was performed and adhesion lysis freed up a SBO.
******* 1.Clean ******* 2.Clean/contaminated 3.Contaminated 4.Dirty/Infected
Note: Bowel was never incised, therefore surgery is on par with hernia repair
![Page 28: General Vascular Surgery Wound Class Review Quiz Bruce Ryon, RN, MS, PhD KPSF NSQIP SCNR 415-833-0987.](https://reader035.fdocuments.net/reader035/viewer/2022062413/5a4d1b927f8b9ab0599c2068/html5/thumbnails/28.jpg)
Bruce Ryon, RN, MS, PhD
What is the wound class?
Patient had necrotic foot d/t complications from peripheral ischemia r/t 150 pack years of smoking. Surgeon performed below knee amputation where the incision was clean without infection.
1.Clean 2.Clean/contaminated 3.Contaminated *4.Dirty/Infected
![Page 29: General Vascular Surgery Wound Class Review Quiz Bruce Ryon, RN, MS, PhD KPSF NSQIP SCNR 415-833-0987.](https://reader035.fdocuments.net/reader035/viewer/2022062413/5a4d1b927f8b9ab0599c2068/html5/thumbnails/29.jpg)
Bruce Ryon, RN, MS, PhD
What is the wound class?
Patient had necrotic foot d/t complications from peripheral ischemia r/t 150 pack years of smoking. Surgeon performed below knee amputation where the incision was clean without infection.
******* 1.Clean ********2.Clean/contaminated 3.Contaminated 4.Dirty/Infected
Note: Incision was in a clean area, therefore on par with ortho baseline surgery
![Page 30: General Vascular Surgery Wound Class Review Quiz Bruce Ryon, RN, MS, PhD KPSF NSQIP SCNR 415-833-0987.](https://reader035.fdocuments.net/reader035/viewer/2022062413/5a4d1b927f8b9ab0599c2068/html5/thumbnails/30.jpg)
Bruce Ryon, RN, MS, PhD
What is the wound class?
Long term diabetic patient had infected gangrenous below-the-knee-amputation stump after vascular grafts failed to improve leg perfusion. Surgeon performed above the knee amputation where the initial incision expressed lymphatic pus. AKA surgery successful.
1.Clean 2.Clean/contaminated *3.Contaminated 4.Dirty/Infected
![Page 31: General Vascular Surgery Wound Class Review Quiz Bruce Ryon, RN, MS, PhD KPSF NSQIP SCNR 415-833-0987.](https://reader035.fdocuments.net/reader035/viewer/2022062413/5a4d1b927f8b9ab0599c2068/html5/thumbnails/31.jpg)
Bruce Ryon, RN, MS, PhD
What is the wound class?
Long term diabetic patient had infected gangrenous below-the-knee-amputation stump after vascular grafts failed to improve leg perfusion. Surgeon performed above the knee amputation where the initial incision expressed lymphatic pus. AKA surgery successful.
1.Clean 2.Clean/contaminated 3.Contaminated ******* 4.Dirty/Infected *******
Note: Incision cut into infected material
![Page 32: General Vascular Surgery Wound Class Review Quiz Bruce Ryon, RN, MS, PhD KPSF NSQIP SCNR 415-833-0987.](https://reader035.fdocuments.net/reader035/viewer/2022062413/5a4d1b927f8b9ab0599c2068/html5/thumbnails/32.jpg)
Bruce Ryon, RN, MS, PhD
What is the wound class?
Patient underwent a rectopexy procedure (rectal prolapse) where a portion of the rectum was resected. The anastamosis was checked for patency/leaks by rigid sigimoidoscopy.
1.Clean 2.Clean/contaminated 3.Contaminated *4.Dirty/Infected
![Page 33: General Vascular Surgery Wound Class Review Quiz Bruce Ryon, RN, MS, PhD KPSF NSQIP SCNR 415-833-0987.](https://reader035.fdocuments.net/reader035/viewer/2022062413/5a4d1b927f8b9ab0599c2068/html5/thumbnails/33.jpg)
Bruce Ryon, RN, MS, PhD
What is the wound class?
Patient underwent a rectopexy procedure (rectal prolapse) where a portion of the rectum was resected. The anastamosis was checked for patency/leaks by rigid sigimoidoscopy.
1.Clean ******* 2.Clean/contaminated ******* 3.Contaminated 4.Dirty/Infected
Note: Anal & rectum procedures are 2, unless infection present, e.g. abscess/fistula