A Case That Changed Wound Class

In practice

A planned removal of the gallbladder begins as a clean-contaminated case: the biliary tract will be entered under controlled conditions. During the dissection, the gallbladder tears and bile and stones spill into the abdomen. The surgeon suctions the spill and retrieves the stones, and the team discusses the change. By the classification, gross spillage or a major break can move a wound into a higher class, so the circulating nurse notes the event for the record. The surgeon asks for a closing set of fresh instruments and for the team to change gloves before closure, as the facility's practice is for contaminated cases. Avery, the scrub person, has the closing set ready because the facility's policy anticipates this request, sets the used instruments aside away from the closing field, and changes gloves with the surgeon. The surgeon decides to irrigate the area. At closure, the counts are done as usual. In the recovery report, the circulating nurse includes the spillage, so the team following the patient knows the infection risk has changed.