From the Guidelines
I strongly recommend immediate removal of the splinter from the right hand, followed by wound cleaning and antibiotic treatment, as the presence of pus indicates infection has developed, and prompt treatment is crucial to prevent further complications, such as cellulitis or deeper tissue infection, which can significantly impact morbidity, mortality, and quality of life. The patient's history of working with pressure-treated wood and attempting to dislodge the splinter with tweezers increases the risk of infection.
- The splinter should be carefully extracted using sterile tweezers after cleaning the area with antiseptic solution, as recommended by general medical practice.
- After removal, the wound should be thoroughly cleaned with soap and water, then topical antibiotic ointment such as Bacitracin or Neosporin should be applied three times daily for 5-7 days, to reduce the risk of infection.
- The wound should be covered with a sterile bandage, changing it daily, to promote a clean environment for healing. According to the guidelines for tetanus prophylaxis in routine wound management, as outlined in 1, since the patient's last tetanus vaccination was in 2019 (within 10 years), and the wound is not clean and minor, no tetanus booster is needed at this time, but the patient should be monitored for signs of tetanus infection. If the infection worsens with increasing pain, redness, swelling, or red streaking up the arm, oral antibiotics like cephalexin 500mg four times daily for 7 days may be necessary, as indicated by general medical practice for treating bacterial infections. The infection is likely caused by bacteria introduced by the pressure-treated wood splinter, which contains chemicals that can further irritate the wound, and prompt treatment is essential to prevent the infection from progressing, as supported by the principles of wound management and infection control 1.
From the Research
Patient Presentation
- The patient presents with a splinter in the right hand, which was obtained while working with pressure-treated wood.
- The patient attempted to dislodge the splinter with tweezers but was unable to do so.
- The patient presents with mild swelling, pus drainage, and a pain level of 1/10.
- The patient's last Tdap vaccination was in 2019.
Relevant Studies
- There are no studies directly relevant to the patient's presentation with a splinter and potential infection.
- However, studies have shown the importance of appropriate antibiotic use and vaccination in preventing infections 2, 3, 4, 5.
- A study on tetanus, diphtheria, and acellular pertussis vaccine coverage in adults with chronic respiratory conditions found that vaccination rates were low overall, but slightly higher in asthma patients compared to the general population 5.
Potential Treatment Options
- The patient may require antibiotic treatment to prevent infection, but the choice of antibiotic should be guided by local susceptibility patterns and the patient's medical history.
- Studies have shown that amoxicillin-clavulanate is a broad-spectrum antibacterial agent that can be effective in treating various infections, including those caused by beta-lactamase-producing pathogens 2, 4.
- However, the use of broad-spectrum antibiotics should be judicious and guided by antimicrobial stewardship principles to minimize the risk of resistance development 3.