Clean and dress a wound

In a household without easy access to medical care, a minor wound that gets infected is one of the likeliest routes to a serious problem. Before antibiotics, that was how ordinary people died from ordinary injuries.

The good news is that the single most effective intervention costs nothing, needs no supplies, and is available to anyone with running water.

Why cleaning is the whole thing

Infection happens when contamination gets into tissue and multiplies. Everything else, dressings, antiseptics, honey, herbs, is secondary to physically removing the contamination in the first minutes.

Irrigation removes bacteria by mechanical force, not by killing them. That is why volume and time matter more than what is in the water, and why the humble tap outperforms the expensive antiseptic.

Get this right and most wounds heal uneventfully. Get it wrong and no dressing rescues it.

Stop the bleeding first

1. Direct pressure, firmly, with a clean cloth or dressing, over the wound.
2. Keep pressing for at least 10 minutes without lifting to peek. Lifting restarts the clock.
3. Elevate the injured part above the level of the heart if you can.
4. If blood soaks through, add another layer on top. Do not remove the first, which takes the forming clot with it.

Do not use a tourniquet for ordinary bleeding. Direct pressure controls the overwhelming majority of wounds.

Irrigation

1. Wash your own hands first, thoroughly, and wear gloves if you have them.
2. Hold the wound under running water for 5 to 10 minutes. Cool or lukewarm.
3. Let the water get into the wound, opening it gently if needed rather than just rinsing over the top.
4. Remove visible debris: grit, splinters, gravel, glass, fragments of clothing. Clean tweezers, and take your time. Anything left in the wound will cause infection, and road grit left in a graze also tattoos the skin permanently.
5. If there is no running water, use the cleanest water you have, poured with force. A syringe without a needle, or a plastic bottle with a small hole pierced in the cap, gives you pressure, and pressure is what does the work. Boiled and cooled water is ideal.
6. Dry the surrounding skin, not the wound bed, by patting with clean gauze.

Deep or dirty wounds need more irrigation, not less. Animal bites, punctures, anything agricultural, anything with soil in it: irrigate longer and more forcefully, and read the "needs more than you" section, because several of those categories should not simply be cleaned and dressed at home.

Antiseptic goes around, not in

The exception worth knowing: medical-grade honey is a genuine wound dressing with evidence behind it, and is used in the NHS. That is sterilised medical honey on a dressing, not a spoonful from the cupboard, which carries its own bacterial load including, occasionally, botulism spores. Never put ordinary honey in a wound, and never give honey at all to a child under one.

Dressing it

1. Leave a small clean wound open if it is superficial and not going to be knocked or dirtied. Air is fine for a graze that has stopped weeping.
2. Otherwise cover it with a non-adherent dressing, sterile if you have one.
3. A moist wound heals faster than a dry one. The old idea of letting a wound scab hard in the air is outdated: a scab is a barrier that healing cells have to migrate under. A non-adherent dressing that keeps the surface slightly moist gives faster healing and a better scar.
4. Change it daily, or whenever it becomes wet or dirty.
5. Do not use cotton wool or fluffy material directly on a wound. The fibres embed.
6. Do not tape all the way round a finger or limb. Swelling then constricts the blood supply.
7. Steri-strips or butterfly closures can hold together a small, clean, low-tension wound with straight edges. Apply across the wound with a gap between each, never sealing it completely, so it can drain.

Wounds that need more than you

Tetanus is worth planning for now. It is present in soil everywhere, gardening and farming injuries are the classic route, and the disease has a very high mortality with no home treatment. Check that everyone's vaccination is current, because in a long emergency this is a preventable death you can prevent today for free.

Watching it

Check the wound daily. Infection generally declares itself between 24 hours and a few days.

Draw around the edge of any spreading redness with a pen and write the time. It costs nothing and turns a vague impression into a measurement, which is the single most useful thing you can do to tell whether it is progressing. Nobody can reliably judge by memory whether redness has spread since yesterday.

Increasing pain after the first day or two is the sign to trust most, and the one most often dismissed. A wound that hurt yesterday and hurts more today is going the wrong way.

Any of the urgent signs, plus any of the red flags on recognising sepsis, means stop watching and start seeking help.