Sample Surgical Wound Classification Form

It is critical for surgery centers to properly classify surgical wounds as they are an important predictor for the possible risk of development of a postoperative surgical site infection, which is why the Laser Spine Institute uses a detailed surgical wound classification form at its ambulatory surgery centers.


The form includes four different types of classification, which cover "no apparent inflammation" through "acute inflammation with pus formation, break in aseptic technique".


The form also includes descriptions of several different types of contaminating factors which can be assigned to wound, as well as space to identify the physicians and staff members working with the patient and postoperative follow-up steps for addressing the wound.


To download a copy of this form you can adapt for use in your ASC, click here (pdf).


Source: Laser Spine Institute


Read about more valuable infection control and quality tools:


- Patient Safety Tool: Guidelines and Procedures for Surgical Site Infections


- Sample Sterile Processing Department Testing and Load Form and QI Worksheet


- Sample Surgery Center Hand Washing Flier for Patients

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