Wound Care & Infection Prevention

Preparation
1

Wound Care & Infection Prevention

Difficulty: Beginner
Time to Complete: 45 minutes to read

Overview

In a survival or grid-down scenario, a wound that would be a minor inconvenience today can become life-threatening within days. Infection is still one of the leading causes of death in developing nations and was the #1 killer of wounded soldiers before antibiotics. This guide gives you the knowledge and practical skills to clean, treat, and monitor wounds — and most importantly, to prevent them from becoming infections — when professional medical care is nowhere to be found.

Why This Matters

Every year, wound infections cause approximately 150,000 deaths globally. In a modern hospital, the infection rate for clean surgical wounds is about 1–5%. Without proper care, that same wound in a survival scenario can have an infection rate of 20–40%. The difference isn’t the wound itself — it’s how it’s treated in the first 24–72 hours.

Understanding basic wound care is non-negotiable for anyone preparing for emergencies. You will get cuts, scrapes, burns, and puncture wounds. Knowing what to do in the first minutes after an injury separates recovery from catastrophe.

Types of Wounds

Before treating a wound, you need to know what you’re dealing with. Different wound types require different approaches.

Wound Type Description Risk Level Key Concern
Abrasion Surface scraping of skin (road rash) Low Dirt/contaminants ground into tissue
Laceration Deep cut from sharp object Medium-High Bleeding, depth, possible tendon/nerve damage
Puncture Narrow, deep wound from pointed object Very High Low surface area hides deep infection; tetanus risk
Avulsion Tissue torn away (degloving) Very High Massive tissue damage, bleeding, shock risk
Burn Thermal, chemical, or electrical damage Varies by degree Infection, shock, fluid loss
Incision Clean cut (knife, glass) Medium Bleeding, depth, closure needed if deep
Bite Animal or human bite Extreme Massive bacterial load; rabies risk from animals

The First Three Minutes: Immediate Response

Your actions in the first three minutes after an injury dramatically affect the outcome.

Step 1: Ensure Safety

  • Don’t become a second casualty
  • If the scene is dangerous, move yourself or the injured person to safety first
  • Wear gloves if available (any clean barrier: plastic bag, cloth)
  • Remember: blood is a biohazard

Step 2: Stop the Bleeding

This is always your priority. You can clean a wound after it stops bleeding.

Method — Direct Pressure:

  1. Apply firm, direct pressure with the cleanest material available
  2. Hold continuously for at least 5 minutes (most people check too early)
  3. If blood soaks through, add more material on top — don’t remove the original
  4. Elevate the wound above the heart if possible
  5. If pressure alone isn’t working after 10 minutes, add a pressure dressing

Tourniquet (extreme cases only):

  • Use only for limb bleeding that cannot be controlled by direct pressure
  • Apply 2–3 inches above the wound (not over a joint)
  • Tighten until bleeding stops
  • Note the time of application
  • Do not release — this is life-saving, not a suggestion

Step 3: Assess the Damage

Once bleeding is controlled:

  • How deep is the wound?
  • Is there debris inside?
  • Can you see fat (yellow), muscle (red-brown), or bone (white)?
  • Is there loss of function (can’t move fingers/toes)?
  • Is the wound on the face, neck, chest, or abdomen? (These require different protocols)

:warning: Seek professional medical help immediately if: You can see fat, muscle, or bone; the wound is gaping and won’t close; there’s loss of function; the wound is on the face; bleeding won’t stop after 15 minutes of direct pressure; there’s an embedded object (don’t remove it); or it’s an animal or human bite.

Cleaning the Wound: The Golden Window

You have approximately 6–8 hours to properly clean a wound before infection risk increases significantly. After that window, bacteria have already begun to colonise.

What You Need

Standard Supply Field Substitute
Clean running water Bottled water, boiled then cooled water
Mild soap Any clean soap (not antibacterial — it’s not more effective for wound cleaning)
Sterile gauze Clean cloth, boiled and cooled t-shirt material
Tweezers Clean needle, small clean pliers
Antiseptic (see below) Honey (raw, unprocessed), sugar paste
Antibiotic ointment Not essential — cleaning matters far more than ointment

Step-by-Step Cleaning

1. Wash Your Hands First

  • Soap and water for 20 seconds minimum
  • If no water: hand sanitiser with 60%+ alcohol

2. Rinse the Wound

  • Use copious amounts of clean water — this is the single most important step
  • 500ml–1L of water for a moderate wound
  • The goal is mechanical removal of dirt, debris, and bacteria
  • If available, gently scrub around the wound with soap — don’t put soap directly in the wound

3. Remove Debris

  • Use cleaned tweezers to remove visible particles
  • If debris is deeply embedded, leave it — forcing it deeper causes more damage
  • Irrigation with water pressure (syringe or squeeze bottle) is the preferred method

4. Pat Dry

  • Clean gauze or cloth
  • Blot, don’t rub — rubbing re-opens tissue

5. Apply Antiseptic (see Antiseptic Guide below)

  • Choose ONE appropriate antiseptic
  • Don’t combine multiple antiseptics — they can interact and damage tissue

6. Dress the Wound

  • See Dressing protocols below

Antiseptic Guide: What Works and What Doesn’t

Antiseptic Effectiveness Tissue Damage Best Use Notes
Soap and Water Excellent None Initial cleaning The gold standard — use FIRST
Chlorhexidine Excellent Minimal Wound cleaning before dressing Preferred over iodine for routine use
Povidone-Iodine (Betadine) Good Moderate (at full strength) Initial wound cleaning, pre-surgery Dilute to 1:10 with water for wound irrigation
Hydrogen Peroxide (3%) Poor High :cross_mark: Avoid for wound care Damages healthy tissue; only use for surface cleaning around wound
Rubbing Alcohol Poor (for wounds) Extreme :cross_mark: Never in a wound Only for cleaning skin around the wound or cleaning instruments
Raw Honey Good None Dressing adjunct, alternative Medical-grade honey (Manuka) is best; raw honey is acceptable in a pinch
Sugar Paste Good None Packing deep wounds Sugar creates osmotic pressure that kills bacteria
Irrigation with water Excellent None Deep wounds, field conditions Pressure irrigation removes more bacteria than any chemical

:warning: Critical: Despite what you’ve seen in movies, hydrogen peroxide and alcohol are not good wound antiseptics. They destroy healthy tissue, delay healing, and increase scarring. Use them to clean instruments and skin around the wound only.

Dressing a Wound

A proper dressing protects the wound from contamination, absorbs excess fluid, and creates the right environment for healing.

Choosing a Dressing

Wound Type Recommended Dressing Change Frequency
Minor cuts and scrapes Adhesive bandage or gauze + tape Daily
Moderate wounds Non-stick gauze pad + rolled bandage Every 1–2 days
Deep or heavily draining wounds Absorbent pad + pressure bandage Every 12–24 hours
Burns Non-stick, sterile dressing (cling film works in a pinch) Every 2–3 days
Puncture wounds Light, breathable dressing (don’t seal — they need to drain) Daily

Applying a Dressing

  1. Wash hands again
  2. Apply thin layer of antibiotic ointment if available (optional — clean wounds heal fine without)
  3. Place non-stick dressing over the wound
  4. Secure with medical tape or rolled bandage
  5. Not too tight — you should fit two fingers underneath a bandage
  6. Mark the dressing with the date and time of application

Signs of a Good Healing Wound

  • Edges are coming together
  • Light pink colour (new tissue)
  • Mild soreness decreasing day by day
  • No excessive drainage after the first 24–48 hours
  • No spreading redness
  • No fever

Recognising Infection: When Trouble Is Coming

Infection typically develops 2–5 days after injury. You may feel fine the first day — don’t let that fool you. This is why monitoring is essential.

Watch for These Red Flags :police_car_light:

Sign What It Means Urgency
Increasing pain after 48 hours Infection developing Moderate — reassess treatment
Spreading redness from wound edges Bacterial spread High — action needed
Red streaks travelling up skin Lymphangitis (infection spreading through lymphatic system) EMERGENCY — seek help
Pus (yellow, green, or foul-smelling drainage) Active infection High — wound needs re-cleaning and possibly antibiotics
Swelling increasing after 48 hours Infection or inflammation Moderate to High
Fever above 38°C (100.4°F) Systemic infection possible High
Warmth spreading around wound Local infection Moderate to High
Foul odour Bacterial infection, possibly anaerobic High
Wound edges pulling apart Poor healing, possible infection Moderate

:warning: Seek emergency help if you see: Red streaks, fever, confusion, rapid heartbeat, or breathing difficulties. These are signs of sepsis — a life-threatening systemic infection. Sepsis can kill within hours without treatment.

Wound Care Field Kit

Build this kit and check it every 6 months.

Essential Items

  • Nitrile examination gloves (10+ pairs)
  • Trauma shears
  • Tweezers (stainless steel)
  • Irrigation syringe (60ml with splash shield)
  • Sterile gauze pads (various sizes)
  • Non-stick wound pads
  • Rolled gauze bandages (2" and 4")
  • Medical tape (micropore and cloth)
  • Butterfly closures or steri-strips (for wound closure)
  • Triangular bandage (sling)
  • Soap (any mild soap)
  • Chlorhexidine or povidone-iodine solution
  • Antibiotic ointment
  • Pain relief (paracetamol/ibuprofen)
  • Digital thermometer
  • Sharpie/pen (for marking dressings with time)

Advanced Items (If You Want to Level Up)

  • Tourniquet (CAT or SOF-T)
  • Hemostatic gauze (QuikClot or Celox)
  • Wound closure strips + skin glue
  • Needle and suture material (only if trained)
  • Irrigation solution (sterile saline)
  • Antibiotics (amoxicillin, cephalexin — consult GP for supply)
  • Sugar or medical-grade honey (for wound packing)

Special Cases

Burns

Degree Description Treatment
1st Red, painful, no blisters (sunburn-type) Cool water for 20 minutes, aloe or moisturiser
2nd Blisters, severe pain Cool water for 20 min, don’t pop blisters, cover with non-stick dressing
3rd White/black/charred skin, may be numb Don’t cool (risk of hypothermia), cover with clean dressing, seek emergency help

Burn Rule: Cool the burn with running cool water for 20 minutes. Not ice. Ice causes further tissue damage. 20 minutes of cooling within 3 hours significantly improves outcomes.

Chemical Burns: Flush with water for at least 20 minutes — longer for alkali burns (lime, drain cleaner). Remove contaminated clothing while flushing. Seek emergency help.

Animal Bites

Animal bites carry an extremely high infection risk due to the bacteria in animal mouths:

  1. Wash aggressively — 5 minutes of thorough washing with soap and water
  2. Flush with copious water
  3. Don’t close the wound with tape or glue — bite wounds need to drain
  4. Cover with a clean dressing
  5. Seek medical attention — antibiotics are often needed
  6. Rabies risk assessment: Wild animals (especially bats, raccoons, skunks, foxes) require immediate medical evaluation for rabies post-exposure prophylaxis

Puncture Wounds

Puncture wounds are deceptive — small on the surface, dangerous underneath:

  1. Don’t remove embedded objects (stabilise with bulky dressing around the object)
  2. Flush with copious water — you need water inside the wound
  3. Use a syringe if possible for pressure irrigation
  4. Don’t seal the wound — it needs to drain
  5. Tetanus risk: Any puncture wound from a dirty object carries tetanus risk. If your last tetanus shot was more than 5–10 years ago, you need a booster.

Long-Term Wound Care Without Medical Access

In a prolonged grid-down scenario, here’s your daily wound care protocol:

Daily Checklist:

  • Inspect wound for signs of infection (redness, swelling, drainage, odour)
  • Check temperature daily (fever = systemic concern)
  • Change dressing (frequency depends on wound type and drainage)
  • Clean wound gently during dressing changes
  • Keep the wound elevated when possible (reduces swelling)
  • Ensure adequate nutrition (protein, vitamin C, zinc all support wound healing)
  • Stay hydrated
  • Rest — healing requires energy
  • Monitor mental health — chronic wounds are emotionally draining

Quick Reference Checklist

Immediate Wound Care Protocol

  • Ensure scene safety
  • Wear gloves or barrier
  • Stop bleeding (direct pressure, 5+ minutes)
  • Assess wound depth, location, and severity
  • Wash hands
  • Rinse wound with copious clean water
  • Remove visible debris
  • Choose and apply appropriate antiseptic
  • Apply appropriate dressing
  • Mark dressing with date/time
  • Monitor for infection signs for 5+ days

Infection Red Flag Checklist

  • Increasing pain after 48 hours
  • Spreading redness
  • Red streaks
  • Pus or foul drainage
  • Increasing swelling
  • Fever
  • Warmth around wound
  • Wound edges separating
  • Confusion or rapid heart rate (sepsis signs — EMERGENCY)

Sources & Further Reading

Wound Care & Infection Prevention Series — Vivaed @ endscenar.io