Clean and dress wounds without a medical kit, recognise infection progression to sepsis, irrigate correctly, use improvised antiseptics, and know when infection has become life-threatening.
A wound that is well-managed in the first few hours is dramatically less likely to become infected than one left to chance. In a disaster or resource-limited setting, where access to antibiotics and professional wound care may be delayed by days, the difference between a wound that heals and one that becomes life-threatening often comes down to the quality of initial cleaning and dressing.
Sepsis — the body's overwhelming systemic response to infection — kills approximately 11 million people worldwide annually. In a disaster context, wounds that become infected and progress to sepsis without early recognition are a major cause of preventable death. This guide covers the mechanics of correct wound cleaning, wound assessment, dressing technique, and the signs that infection has progressed beyond local tissue to systemic threat.
Before cleaning, assess:
| Wound Type | Infection Risk | Notes |
|---|---|---|
| Clean laceration (e.g., knife cut) | Moderate | Relatively low contamination |
| Dirty laceration (debris in wound) | High | Aggressive cleaning essential |
| Puncture wound | High | Narrow entry, deep penetration; hard to clean; high anaerobic risk (tetanus) |
| Animal or human bite | Very high | Extensive bacterial contamination; consider rabies risk |
| Avulsion (tissue torn away) | High | Irregular edges, contaminated |
| Crush injury | Very high | Damaged tissue is poor environment for healing; ideal for infection |
| Wound with foreign body (gravel, glass) | Very high | Must remove foreign body or infection is certain |
Even without a medical kit, certain wounds need professional attention as soon as available:
High-pressure wound irrigation removes bacteria, debris, and devitalised tissue more effectively than any antiseptic. This is the single most important step in infection prevention.
Prepare the irrigating fluid — clean water is the most accessible and is effective. Ideal options in order:
Create irrigation pressure — a 35–60 ml syringe with a 19-gauge needle produces the ideal pressure. Improvised equivalents:
Irrigate directly into the wound — aim the stream into the wound cavity, not just onto the surface
Volume — use significant volumes: at minimum 50–100 ml per cm of wound length; for heavily contaminated wounds, 200–500 ml total. More is better.
Duration — irrigate until all visible debris is removed and the wound looks clean
⚠️ Do not inject irrigating fluid into a sealed puncture wound under high pressure — this can drive bacteria deeper into tissue planes. For puncture wounds, gentle irrigation at the opening is appropriate.
Visible debris, gravel, and glass should be removed with clean tweezers or clean fingers before dressing. Missed foreign bodies are a leading cause of wound infection failure.
If a foreign body cannot be removed (too deep, too fragile), document its presence and ensure professional care is sought.
Antiseptics are useful for surface decontamination but are not a substitute for mechanical irrigation.
| Antiseptic | Appropriate Use | Notes |
|---|---|---|
| Povidone-iodine 10% (Betadine) | Wound surface and skin around wound | Dilute 10x with water (1%) for wound irrigation — full-strength is tissue-toxic |
| Chlorhexidine 0.05% | Wound and skin cleaning | Avoid in ear canals, eye contact |
| Isopropyl alcohol (70%) | Skin preparation only | Toxic to healing tissue in open wounds; do not pour into wounds |
| Hydrogen peroxide (3%) | Limited; can loosen dried blood and debris | Toxic to granulation tissue; destroys healing cells; avoid in healing wounds |
| Honey (raw, unpasteurised — manuka type) | Wound dressing for infected wounds | Antimicrobial properties; evidence base for use on chronic infected wounds |
Alcohol (spirits — whisky, vodka): Useful for skin around the wound as a disinfectant. Painful and damaging to open wound tissue — do not pour into wounds.
After irrigation, cover the wound:
Improvised options when no medical dressings are available:
⚠️ Never apply adhesive dressings or tape directly to a wound surface — these pull healing tissue off when removed. Use a clean pad as the primary layer and tape the edges of the dressing to intact skin.
Change the dressing every 24–48 hours, or when it becomes saturated or soiled. Before each change:
Signs appear 24–72 hours after injury or can develop in existing wounds:
Treatment: If antibiotics are available and indicated by a healthcare provider, start them. Continue wound cleaning and dressing. Immobilise and elevate the affected limb. Monitor closely for systemic spread.
These signs indicate the infection is extending beyond local tissue:
Sepsis is the body's dysregulated systemic response to infection. It can develop from a wound infection when bacteria or their toxins enter the bloodstream.
Suspect sepsis when a wound infection is accompanied by two or more of:
| Sign | Detail |
|---|---|
| Fever | Temperature above 38°C (100.4°F) |
| Hypothermia | Temperature below 36°C (96.8°F) |
| Rapid heart rate | Over 90 beats per minute |
| Rapid breathing | Over 20 breaths per minute |
| Confusion | New confusion or altered consciousness |
| Extreme weakness | Sudden severe weakness out of proportion |
⚠️ Sepsis is a medical emergency. A person who has a wound infection and is developing confusion, rapid breathing, or extreme weakness needs emergency hospital care immediately. Septic shock (sepsis with falling blood pressure) has a mortality of 30–50% even with intensive hospital care.
Field response for suspected sepsis:
Tetanus (caused by Clostridium tetani) is a wound infection risk for dirty, deep, or puncture wounds in people whose tetanus immunisation is not current. In a post-disaster setting with no immediate medical access, a tetanus-prone wound in an unvaccinated person is a serious risk.
In the field: thorough irrigation reduces (but does not eliminate) risk. Medical evaluation and tetanus prophylaxis (vaccine + immunoglobulin) should be sought at the earliest opportunity for:
| Step | Action |
|---|---|
| Wound assessment | Type, contamination, severity, foreign bodies |
| Irrigation | High pressure; clean water; 50–100 ml/cm wound length |
| Antiseptic | Dilute povidone-iodine or chlorhexidine; not alcohol directly in wound |
| Dressing | Non-adherent layer; clean pad; secure with tape to intact skin |
| Dressing change | Every 24–48 hours; inspect for infection |
| Local infection signs | Expanding redness; warmth; increasing pain; pus |
| Spreading infection | Red streaking; swollen nodes — urgently seek care |
| Sepsis signs | Fever/hypothermia + rapid pulse + rapid breathing + confusion |
| Tetanus-prone wound | Seek vaccination/immunoglobulin at earliest opportunity |
This guide provides general wound care information for resource-limited or emergency situations. Wound infections and sepsis are medical emergencies requiring hospital-level care. Always seek professional wound assessment as soon as it becomes accessible.
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