Management of Simple Abrasion Wounds in Primary Care
After cleaning a simple abrasion with copious tap water or saline, cover it with a topical antibiotic ointment and a clean occlusive dressing to maintain wound moisture and promote optimal healing. 1
Immediate Wound Cleaning
The cornerstone of abrasion management is thorough irrigation to remove debris and prevent infection:
- Irrigate the wound with large volumes (100-1000 mL) of warm or room temperature tap water or sterile saline until all foreign matter is removed 1
- Tap water is as effective as sterile saline and superior to antiseptic solutions for initial irrigation 1, 2
- Higher irrigation volumes and pressures are more effective than lower volumes at reducing infection rates 1
- Soap and water may be used during irrigation and are more effective than saline alone 1
- Remove all visible debris, foreign bodies, and dead tissue before applying any topical agents 3
The evidence strongly supports tap water over antiseptic irrigation—multiple high-quality trials demonstrate no superiority of antiseptic solutions, and tap water is readily available and cost-effective 4.
Wound Coverage and Dressing
After thorough cleaning, proper wound coverage is essential:
- Apply a topical antibiotic ointment or cream to keep the wound moist 1, 5
- Cover with a clean occlusive dressing 1, 5
- Occlusive dressings significantly reduce healing time compared to leaving wounds exposed to air 1, 2
- Moist wound healing is the established standard and prevents wound drying 1, 6
- Hydroactive colloid gels are particularly suitable as they work for both dry and exuding wounds 6
The 2010 and 2015 American Heart Association guidelines consistently emphasize that wounds heal better with less infection when covered with antibiotic ointment and occlusive dressings 1.
Tetanus Prophylaxis
- Evaluate and update tetanus vaccination status 2
- Administer tetanus toxoid if the patient has not received a booster in the past 10 years 4
- This should be done as soon as possible during the initial visit 4
What NOT to Do
Critical pitfalls to avoid:
- Do not use antiseptics for wound irrigation—they should only be used after initial cleaning with water/saline 3
- Do not pack simple abrasions—packing increases pain and costs without improving healing 7
- Do not apply ice directly to abrasions as this can cause tissue ischemia 1
- Do not use antiseptics on wounds with granulation tissue 3
- Avoid povidone iodine in pregnant women and neonates 3
Follow-Up and Warning Signs
Instruct patients to seek immediate medical attention if they develop:
- Progressive redness, swelling, or increasing pain around the wound 2
- Red streaks extending from the wound 2
- Foul-smelling drainage 2
- Fever or systemic symptoms 2
- Enlarged lymph nodes 2
Special Considerations
- Prophylactic oral antibiotics are not indicated for simple, clean abrasions 4
- Superficial mild wound infections can be treated with topical antibiotics if they develop 4
- The wound can get wet within 24-48 hours without increasing infection risk 4
- Wounds covering large areas or involving joints, tendons, or nerves should be referred to specialists 4