From the Guidelines
For a skin puncture wound from metal, immediate cleaning with soap and water for at least 5 minutes is crucial to remove dirt and bacteria, followed by application of an antibiotic ointment and coverage with a sterile bandage. The most recent and highest quality study 1 emphasizes the importance of determining the presence or absence of a retained foreign body in puncture wounds, which can trigger a granulomatous reaction and subsequent soft-tissue infection. Key steps in managing a skin puncture wound from metal include:
- Cleaning the wound immediately with soap and water for at least 5 minutes to remove dirt and bacteria.
- Applying gentle pressure with a clean cloth if bleeding occurs.
- Applying an antibiotic ointment like Neosporin or Polysporin and covering with a sterile bandage.
- Changing the bandage daily or when it becomes wet or dirty.
- Monitoring the wound for signs of infection such as increasing redness, swelling, warmth, pus, or red streaks extending from the wound.
- Seeking medical attention for a tetanus booster if the last tetanus shot was more than 5 years ago, ideally within 48 hours of the injury, as recommended by 1 and 1.
- Seeking medical care if the wound is deep, contains embedded debris, shows signs of infection, or if there are underlying conditions like diabetes or immunocompromised status, as these factors can increase the risk of complications. Puncture wounds are particularly prone to infection because they create deep, narrow channels where bacteria can thrive with limited oxygen, making proper cleaning and monitoring essential for preventing complications, as noted in 1.
From the Research
Immediate Response to Skin Puncture with Metal
If you have a skin puncture wound from metal, the first step is to evaluate the severity of the lesion and determine whether it is necessary to attend a health center or not 2.
Cleaning the Wound
For simple wounds, the recommended course of action is cleansing with serum or water after washing your hands, followed by wound disinfection with the most appropriate antiseptic 2. However, antiseptics should not be used for wound cleansing; instead, physiological serum or tap water should be used 2.
Considerations for Wound Care
There is no evidence that antiseptic irrigation is superior to sterile saline or tap water for wound cleaning 3. Occlusion of the wound is key to preventing contamination, and suturing can be completed up to 24 hours after the trauma occurs, depending on the wound site 3.
Preventing Infection
Tetanus toxoid should be administered as soon as possible to patients who have not received a booster in the past 10 years 3. Superficial mild wound infections can be treated with topical agents, whereas deeper mild and moderate infections should be treated with oral antibiotics 3.
Specific Considerations for Puncture Wounds
Puncture wounds are common and most are uncomplicated, but for children who have a delayed presentation or signs of infection, consider the possibility of a retained foreign body 4. The diagnosis of P aeruginosa osteochondritis should be considered in any child who exhibits persistent signs and symptoms after puncture wounds 4.
Wound Healing and Infection
The effect of cleansing with tap water compared with normal saline on wound healing and infection is uncertain, with very low-certainty evidence 5. However, cleansing with tap water may make little or no difference to wound healing compared with no cleansing, and there are no data relating to the impact on wound infection 5.
Additional Considerations
It is essential to remove all inorganic residues (foreign bodies) and dead tissue before applying an antiseptic to aid healing and the action of antiseptics 2. Antibacterial biomaterials, including antibacterial agents and nanoparticles, can be used to promote wound healing and prevent infection 6.