Management of Superficial Cuts and Scrapes
After cleaning superficial cuts and scrapes with tap water, cover them with a topical antibiotic and an occlusive dressing to keep the wound moist and accelerate healing. 1
Step 1: Immediate Wound Irrigation
- Irrigate the wound thoroughly with large volumes (100-1000 mL) of tap water until all visible foreign matter and debris are completely removed 1
- Tap water is as effective as—or superior to—sterile saline in reducing infection rates 1
- Use warm or room-temperature water for patient comfort, though cold water is equally effective 1, 2
- Adding soap to the water enhances cleaning effectiveness compared to water alone 1
- Higher irrigation volumes and pressures are more effective than lower volumes for debris removal 1
Clinical Pearl: The American Heart Association guidelines emphasize that tap water irrigation is sufficient and cost-effective—there's no need for sterile saline in the initial management of simple superficial wounds 1
Step 2: Wound Dressing Application
- Apply a topical antibiotic ointment or cream directly to the cleaned wound to maintain moisture 1
- Cover with a clean occlusive dressing that prevents the wound from drying out 1
- Evidence demonstrates that occlusive dressings with topical antibiotics significantly shorten healing time compared to leaving wounds exposed to air 1
- The moist wound environment created by occlusive dressings promotes faster epithelialization 3
Important Caveat: Remove only superficial debris during cleaning—deeper debridement is unnecessary for simple abrasions and may actually impair healing 2
Step 3: Tetanus Prophylaxis
- Verify tetanus vaccination status and administer tetanus toxoid if the patient's vaccination is outdated or unknown 2, 4
- This is particularly critical for contaminated wounds or those occurring outdoors 5
Step 4: Antibiotic Considerations
- Systemic antibiotics are NOT routinely needed for properly cleaned and dressed superficial wounds 2
- Consider oral antibiotics only if signs of infection develop: increasing pain, progressive redness, swelling, warmth, purulent discharge, or fever 2, 4
Warning Signs Requiring Medical Attention
Patients should return immediately if they develop: 4, 6
- Progressive redness or red streaks extending from the wound
- Increasing pain or tenderness
- Purulent or foul-smelling drainage
- Fever or systemic symptoms
- Growing swelling or inflammation
Follow-Up Protocol
- Schedule routine follow-up within 48-72 hours to assess wound healing progress 2
- Earlier return is warranted if any warning signs develop 2, 4
Common Pitfall to Avoid: Do not leave superficial wounds uncovered or allow them to dry out—this significantly delays healing compared to moist wound management with occlusive dressings 1, 3