Wound Class

[Nips]

How would you classify this wound:

Scenario: your patient is scheduled to have a right BKA. The doctor's pre-op DX is gangrene of the right foot. The patient is draped out for a normal extremity case with extra care being given to the patient's foot which is draped with an impervious stockinette that is wrapped with coban to create a seal around the foot. The actual incision is not made on the foot, rather it is made just below the knee where there is no sign of gangrene, inflammation, infection or open wounds.

The debate: :argue:

1. :down:some people feel that the wound class is contaminated because of the pre-op DX. Is this because it is assumed that somehow the set up/sterile field was contaminated by the gangrenous foot?
   
2. :up:others feel that the wound class is clean because the area in which the actual incision was made was free of infection, gangrene, etc. Also, they take into consideration the fact that the foot is covered and wrapped up.
   

So I ask. How would you classify this wound?

[GadgetRN71, ASN, RN]

You could ask the doctor what he considers the wound class to be..that's how we're supposed to do it. But to answer your qustion..

Personally, I think i would consider the wound/incision clean. Hopefully, they are changing their gloves after touching or handling the gangrenous part. You really want that amp site to be dealt with using the best sterile technique. In ortho, it's not uncommon for docs and staff to change gloves even after draping..they'll change gloves and set up also after washing out an open wound, before they start the fixation.

[Nips]

Thanks for your reply SquirrelRN71. This is for a project that I am doing at work to guage if nurses understand wound classes in situations like the one I listed.

We do ask the doctors for their wound class but we all know that some are not 100% honest. For example, even with a break in technique (like a hole in their glove) the doctor will still consider the wound class as clean, which is incorrect. The doctors and staff at my facility change gloves after draping as well when it comes to cases like these and in ortho cases.

We also have people that look over our paperwork and make us correct wound classifications that they feel were put in the wrong class. For example, I did a rectal case. There was feces present around the incision site (the case was for a fissurotomy) so I put the wound class as contaminated like the MD instructed me to. I later received a note that I should have put the wound class as clean/contaminated. The nurse reviewing my chart did not know that feces was present, nor was their an area for me to justify my wound class. It is problems like these that we are trying to correct at my job.

Thanks again.