Treatment of Infected Splinter with Pus-Filled Blister and No Systemic Symptoms
For a localized infected splinter with a pus-filled blister and no systemic symptoms, drain the blister using sterile technique, remove the splinter, apply topical antibiotic ointment, and use warm soaks with elevation—systemic antibiotics are not required for this superficial infection. 1, 2, 3
Immediate Blister Management
Pierce the blister at its base with a sterile needle (bevel up) and apply gentle pressure with sterile gauze to drain the purulent fluid completely. 1, 4 Select a drainage site that allows gravity-assisted drainage.
Do not remove the blister roof after drainage—it serves as a natural biological dressing that protects against secondary infection and promotes re-epithelialization. 1, 5, 4 This is a critical step that many clinicians get wrong.
Clean the area gently with an antimicrobial solution before and after drainage, taking care not to cause additional trauma. 1, 4
Splinter Removal
After draining the blister, remove the splinter completely using sterile technique. 2, 3 Incomplete removal is a common cause of persistent infection.
Ensure the entire foreign body is extracted, as retained splinter fragments will perpetuate the infection regardless of other interventions. 2, 3
Topical Antibiotic Application
Apply a small amount of topical antibiotic ointment (such as bacitracin) 1 to 3 times daily to the affected area. 6, 7 Topical antibiotics reduce the risk of surgical site infection with a number needed to treat of 50 (RR 0.61,95% CI 0.42 to 0.87). 7
The amount should equal the surface area of a fingertip. 6
Avoid prolonged use of topical antibiotics beyond 5-7 days to minimize the risk of allergic contact dermatitis and antimicrobial resistance. 8, 7 While the evidence for dermatitis risk is uncertain, limiting duration is prudent clinical practice.
Supportive Care Measures
Apply warm water or saline soaks 3-4 times daily to promote drainage and improve local blood flow. 2, 3 This is a cornerstone of treatment for superficial hand infections.
Splint the finger in the position of function and elevate the hand above heart level to reduce swelling and promote healing. 2, 3
Apply a bland emollient (such as petroleum jelly) around the wound to support barrier function and reduce transepidermal water loss. 1, 4
Cover with a sterile, non-adherent dressing and change daily using aseptic technique. 1, 5
When Systemic Antibiotics Are NOT Needed
For this localized superficial infection without systemic symptoms (no fever, spreading erythema, lymphangitis, or constitutional symptoms), systemic antibiotics are not indicated. 2, 3 The infection is confined to the epidermis and superficial dermis.
Empiric oral antibiotics would only be warranted if signs of spreading cellulitis, lymphangitis, or systemic toxicity develop. 2, 3
Monitoring and Follow-Up
Reassess within 24-48 hours to ensure appropriate response to treatment. 1 Look for reduction in erythema, swelling, and pain.
Document the size and appearance of the wound to track progression. 1, 5
Instruct the patient to return immediately if they develop fever, increasing pain, spreading redness beyond the immediate area, red streaking up the arm, or purulent drainage despite treatment. 2, 3
Tetanus Prophylaxis
- Verify tetanus immunization status and provide tetanus prophylaxis if the patient's last dose was more than 5 years ago (for contaminated wounds) or 10 years ago (for clean wounds). 2 This is frequently overlooked in minor hand infections.
Common Pitfalls to Avoid
Do not deroof the blister completely—the blister roof is protective and should remain in place after drainage. 1, 5, 4 This is the most common technical error.
Do not prescribe systemic antibiotics for this localized infection without systemic symptoms. 2, 3 Overuse of antibiotics contributes to resistance and exposes patients to unnecessary adverse effects.
Do not apply topical antimicrobials prophylactically to intact skin—reserve them only for the infected area. 1, 8
Ensure complete splinter removal, as retained foreign material will prevent healing regardless of antibiotic therapy. 2, 3