What is the treatment for a puncture wound caused by a rusty nail?

From the Guidelines

If you step on a rusty nail, immediately clean the wound with soap and water for at least 5 minutes to remove dirt and bacteria, as recommended by the 2010 American Heart Association and American Red Cross guidelines for first aid 1. This is crucial in preventing infection and promoting healing.

• Apply gentle pressure with a clean cloth to stop any bleeding.
• After cleaning, apply an antibiotic ointment or cream to the wound, but only if the wound is an abrasion or a superficial injury and the victim has no known allergies to the antibiotic, as suggested by the same guidelines 1.
• Cover the wound with a sterile bandage and change the dressing daily or whenever it gets wet or dirty.
• Monitor the wound for signs of infection such as increasing pain, redness, swelling, warmth, pus, or red streaks extending from the wound. The main concern with rusty nail injuries isn't the rust itself but the tetanus bacteria that may be present in soil and dust.
• If you haven't had a tetanus shot in the last 5 years, seek medical attention within 24 hours to get a tetanus booster, as recommended by the practice guidelines for the diagnosis and management of skin and soft-tissue infections 1.
• People who have never been vaccinated against tetanus may also need tetanus immune globulin.
• Deep puncture wounds may require medical evaluation regardless of tetanus status, as they can be difficult to clean properly and may need antibiotics to prevent infection, as suggested by the 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections 1.
• If the wound is on your foot, elevate it when possible to reduce swelling and pain.

From the Research

Rusty Nail Puncture Wound Treatment

• The primary goal of treating a puncture wound, such as one caused by a rusty nail, is to prevent infection and promote healing 2.
• Irrigation and cleaning of the wound are crucial, and there is no evidence that antiseptic irrigation is superior to sterile saline or tap water 2.
• Occlusion of the wound is key to preventing contamination, and suturing can be completed up to 24 hours after the trauma occurs, depending on the wound site 2.
• Tetanus toxoid should be administered as soon as possible to patients who have not received a booster in the past 10 years, as tetanus is a potential complication of puncture wounds 2, 3, 4, 5.
• The treatment of tetanus typically involves reducing muscle spasms, rigidity, and autonomic instability, as well as neutralizing the tetanus toxin with human antitetanus immunoglobulin or equine antitetanus sera 3, 4, 5.
• Wound debridement and administration of antibiotics to eradicate locally proliferating bacteria at the wound site are also important aspects of tetanus treatment 3, 5.
• Pharmacological management of tetanus may include the use of benzodiazepines, baclofen, and magnesium to control spasms and rigidity, as well as beta-blockers and other agents to manage autonomic dysfunction 4.