What is the recommended treatment for a patient with a scratch on their arm?

Treatment of Arm Scratch

Clean the scratch thoroughly with copious amounts of water or soap and water, apply topical antibiotic ointment (such as bacitracin or triple-antibiotic ointment), and cover with a clean occlusive dressing. 1, 2

Immediate Wound Care

Irrigation and Cleaning

• Irrigate the scratch thoroughly with a large volume of warm or room temperature potable water with or without soap until there is no foreign matter in the wound 1
• Cold water is as effective as warm water but less comfortable 1
• If running water is unavailable, use any source of clean water 1
• Avoid high-pressure irrigation as it may drive bacteria into deeper tissue layers 1

Topical Antibiotic Application

• Apply a small amount of topical antibiotic ointment (an amount equal to the surface area of the tip of a finger) to the cleaned wound 1 to 3 times daily 2
• Triple-antibiotic ointment (neomycin/polymyxin B/bacitracin) or bacitracin alone significantly reduce infection rates compared to no treatment (infection rate 4.5-5.5% vs 17.6%) 3
• Wounds heal better with less infection when covered with antibiotic ointment or cream and a clean occlusive dressing 1
• Only apply antibiotic ointment if the wound is superficial and the patient has no known allergies to the antibiotic 1

Dressing

• Cover the wound with a clean occlusive dressing to maintain moisture and prevent contamination 4
• May be covered with a sterile bandage 2

Tetanus Prophylaxis

• Ensure tetanus vaccination status is current 4
• Administer tetanus toxoid if the last dose was >10 years ago for clean wounds or >5 years for contaminated wounds 4

Monitoring and Follow-up

Signs of Infection to Watch For

• Follow up within 24 hours to assess for signs of infection 4
• Watch for increasing pain, redness, swelling, warmth, or purulent discharge 4
• Fever >38.5°C or erythema >5cm indicates established infection 4

Antibiotic Prophylaxis Decision

• Prophylactic oral antibiotics are NOT routinely needed for simple scratches that are properly irrigated and cleaned 4
• Antibiotics should only be considered if there are signs of established infection 4

Common Pitfalls to Avoid

• Do not apply ice directly to the wound - it can produce tissue ischemia 1
• Avoid using hot water for cleaning as repeated exposure may increase risk of dermatitis 1
• Do not use products containing topical antibiotics like neomycin or bacitracin if the patient has known allergies to these agents 1
• Avoid occluding the wound with adhesive bandages impregnated with bacitracin or benzalkonium chloride if there is concern for allergic contact dermatitis 1