From the Guidelines
For a 63-year-old female who stepped on a rusty nail, immediate medical attention is recommended to prevent tetanus infection and other potential complications. The wound should be cleaned thoroughly with soap and water, and an antiseptic like hydrogen peroxide or povidone-iodine should be applied, followed by covering with a clean bandage 1.
Key Considerations
- Tetanus prophylaxis is likely needed, especially if it's been more than 5 years since the last tetanus booster, as the risk of tetanus infection is significant in deep puncture wounds from rusty objects 1.
- The doctor will likely administer a tetanus shot (Tdap or Td) and may prescribe antibiotics such as amoxicillin-clavulanate (875/125 mg twice daily for 7 days) or cephalexin (500 mg four times daily for 7 days) to prevent infection 1.
- Deep puncture wounds from rusty objects carry a significant risk of tetanus infection, caused by Clostridium tetani bacteria which thrive in anaerobic conditions 1.
- Watch for signs of infection including increasing pain, redness, swelling, warmth, pus, or red streaks extending from the wound, which would require immediate medical attention 1.
Management Approach
- Clean the wound thoroughly with soap and water, then apply an antiseptic like hydrogen peroxide or povidone-iodine, and cover with a clean bandage 1.
- Seek medical care promptly for tetanus prophylaxis and potential antibiotic prescription 1.
- Monitor for signs of infection and seek immediate medical attention if they occur 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Wound Care for a Rusty Nail Injury
- The patient should receive immediate wound care to prevent infection, including irrigation and cleaning of the wound 2.
- There is no evidence that antiseptic irrigation is superior to sterile saline or tap water for cleaning the wound 2.
- The patient should receive a tetanus toxoid booster as soon as possible if they have not received one in the past 10 years 2, 3.
Prevention of Infection
- Occlusion of the wound is key to preventing contamination 2.
- The patient can get the wound wet within the first 24 to 48 hours without increasing the risk of infection 2.
- Prophylactic antibiotics are not recommended for most simple wounds, but may be necessary for deeper or more severe infections 2.