A laparoscopic cholecystectomy with no complications would be classified as which wound class?

Class II (Clean-Contaminated). A cholecystectomy is a Class II (Clean-Contaminated) wound because it involves controlled entry into the GI tract (biliary system). Even though the case was uncomplicated, any surgery that enters the GI, GU, or respiratory tract in a controlled manner without unusual contamination is classified as Clean-Contaminated.

A Jackson-Pratt (JP) drain functions by:

Active suction created by a compressed bulb. The Jackson-Pratt (JP) drain is a closed, active drainage system. The bulb is compressed (squeezed flat) and then connected to the drain tubing. As the bulb expands, it creates gentle suction that draws fluid from the wound. The closed system reduces the risk of infection compared to open drains.

When should the initial surgical dressing be applied?

Before removing the drapes, while sterile technique is still maintained. The initial surgical dressing is applied BEFORE the drapes are removed, while sterile technique is still maintained. This protects the fresh incision from contamination during drape removal and patient transfer. The surgical technologist prepares the dressing materials and applies them as directed.

Which drain type poses the highest infection risk?

Penrose (open, passive). The Penrose drain is an open, passive drainage system — it is a flat rubber tube that drains by gravity into gauze dressings. Because it is not a sealed system, there is a pathway for bacteria to enter the wound, resulting in a higher infection risk compared to closed drainage systems like JP, Hemovac, and Blake drains.

Key Takeaways

Wound classification determines infection risk: Class I (Clean), Class II (Clean-Contaminated), Class III (Contaminated), Class IV (Dirty/Infected)
Class I wounds have the lowest infection rate (~1-5%); Class IV has the highest (~30-40%)
Wound healing occurs by first intention (primary closure), second intention (granulation), or third intention (delayed primary closure)
Dressings protect the wound, absorb drainage, provide compression, and maintain a moist healing environment
The three-layer dressing consists of a contact layer (non-adherent), an absorbent middle layer, and an outer securing layer
Wound drains (Jackson-Pratt, Hemovac, Penrose) remove fluid collections and prevent hematoma/seroma formation
The surgical technologist applies the initial dressing under sterile conditions before the drapes are removed
Sterile technique is maintained until the dressing is secure and the drapes are removed

Postoperative Wound Care & Dressing

The postoperative phase begins when the last suture or staple is placed. The surgical technologist's responsibilities continue until the patient safely leaves the operating room.

Wound Classification

Surgical wounds are classified according to their contamination level, which predicts the risk of surgical site infection (SSI):

Class	Name	Definition	SSI Risk	Example
I	Clean	No entry into GI, GU, or respiratory tract; no inflammation; no break in technique	1-5%	Total knee replacement, hernia repair
II	Clean-Contaminated	Controlled entry into GI, GU, or respiratory tract without unusual contamination	3-11%	Cholecystectomy, appendectomy (non-ruptured)
III	Contaminated	Open traumatic wound (<4 hrs), major break in sterile technique, GI spillage	10-17%	Ruptured appendix, open fracture
IV	Dirty/Infected	Old traumatic wound (>4 hrs), existing infection, perforated viscus	30-40%	Abscess drainage, perforated bowel

Wound Healing Types

Type	Name	Description	Example
First intention	Primary closure	Wound edges are approximated with sutures/staples; minimal scarring	Surgical incision closed immediately
Second intention	Granulation	Wound left open to heal from the bottom up; filling with granulation tissue	Abscess cavity, pressure ulcer
Third intention	Delayed primary closure	Wound left open initially (for debridement or drainage), then closed later	Contaminated wound closed after 3-5 days

Dressing Application

The surgical technologist prepares and applies the initial surgical dressing:

Three-Layer Dressing

Contact (inner) layer: Non-adherent material (e.g., Adaptic, Xeroform) placed directly on the wound — prevents tissue from sticking
Absorbent (middle) layer: Gauze sponges (4x4s) or ABD pads — absorbs drainage
Outer (securing) layer: Tape, elastic bandage (Ace wrap), Montgomery straps, or transparent film — secures the dressing

Dressing Principles

Apply the dressing before removing the drapes (sterile technique maintained)
The wound is gently cleaned with sterile saline before dressing
The dressing should extend beyond the wound edges to fully protect the incision
Montgomery straps are used when frequent dressing changes are anticipated (prevents repeated tape removal)

Surgical Drains

Drain	Type	Mechanism	Use
Jackson-Pratt (JP)	Closed, active	Bulb creates suction	General surgery, breast, plastic
Hemovac	Closed, active	Disc creates suction	Orthopedic, abdominal
Penrose	Open, passive	Gravity drainage through a flat rubber tube	Abscess cavity, soft tissue
Blake	Closed, active	Round, channeled silicone	Abdominal, thoracic
Chest tube	Closed, active	Connected to drainage system (Pleur-Evac)	Thoracic (air/fluid removal)
Foley catheter	Closed, continuous	Gravity drainage of urine	Urinary drainage

Key distinction: Closed drains (JP, Hemovac) reduce infection risk because they are sealed systems. Open drains (Penrose) are passive and have a higher infection risk.

CST Certified Surgical Technologist Exam

1Introduction: CST Exam Overview

2Chapter 1: Perioperative Care — Preoperative Preparation

3Chapter 2: Perioperative Care — Intraoperative Procedures

4Chapter 3: Postoperative Procedures & Ancillary Duties

5Chapter 4: Basic Science

6Chapter 5: Exam Strategy & Practice