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Wound Infection Prevention: Evidence-Based First Aid & Care Protocol

Skin breach = portal for pathogens. Staphylococcus aureus (including MRSA) and Streptococcus pyogenes are predominant skin flora invaders. Infection risk: 2-5% for clean lacerations repaired <6h; up to 20% for delayed/contaminated wounds.

Immediate First Aid (First 5 Minutes)

  1. HEMOSTASIS: Direct pressure with clean gauze 5-10 min continuous. Elevate extremity.
  2. IRRIGATION: High-volume (>500 mL) normal saline or potable water under pressure (syringe 18G catheter or commercial irrigator). No hydrogen peroxide, iodine, alcohol in wound bed—cytotoxic.
  3. DEBRIDEMENT: Remove visible debris/foreign material. Do not probe deeply.
  4. DRESSING: Non-adherent primary (Adaptic, Telfa) + absorbent secondary + occlusive border. Change in 24h.

Ongoing Care (Days 1-14)

DayAction
1Remove dressing; inspect for infection signs. Re-dress.
2-3Daily inspection. Keep moist (petrolatum/antibiotic ointment) + occlusive.
4-7q2-3d dressing if clean. Expose to air if scabbed & no drainage.
7-14Suture removal (face 5-7d, scalp 7-10d, trunk/extremities 10-14d).

Infection Surveillance – Seek Care If:

  • Erythema spreading >1 cm from edge
  • Increasing pain/swelling after Day 2
  • Purulent drainage
  • Fever >100.4°F (38°C)
  • Red streaks (lymphangitis)
  • Wound dehiscence

Antibiotic Indications (Not Routine)

  • High-risk wounds: bite (human/animal), crush, >6h delay, gross contamination, immunocompromised, prosthetic joint/valve nearby.
  • Prophylaxis: Cephalexin 500 mg QID x5d (or clindamycin/doxycycline if MRSA risk/penicillin allergy).
  • Established infection: Culture-directed; empiric coverage for Staph/Strep.

Special Populations

  • Diabetes: Offload pressure; daily foot checks; lower threshold for referral.
  • Anticoagulation: Longer pressure holds; avoid NSAIDs.
  • Tetanus: Update if >10 years (clean) or >5 years (dirty); Tdap preferred.

Healing Optimization: Protein 1.5-2 g/kg/day, Vitamin C 500 mg/day, Zinc 15-30 mg/day, smoking cessation (vasoconstriction impairs healing 40-60%).

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