Cuts and grazes are common injuries seen by first aid providers. They do not usually require emergency medical care. They may include wounds such as a laceration, puncture wound or abrasion. There may be a risk of infection including for example bacteria or tetanus.
Guidelines
- Superficial cuts and grazes should be cleaned with potable (clean) water, preferably from a tap to provide pressurised water flow. **
- After cleaning it, covering the wound (with tape, hydrogel, film, hydrocolloids) may decrease wound size and redness, and increase healing. *
Good practice points
- If no clean water is available, use a disinfectant to clean a simple skin wound.
- Advise the person to seek medical help if you suspect they are not (sufficiently) protected against tetanus.
- If the skin around the wound becomes red, purple, or darker, and is warm and painful, or if the person develops a fever advise them to seek medical advice, as this is an indication of infection.
Chain of survival behaviours
Prevent and prepare
- Wear appropriate protective clothing for the activity.
- Learn safe techniques to carry out activities that may cause harm.
Early recognition
After a small incident, the person has a cut, graze, wound, puncture, tear or scrape on their skin.
First aid steps
- If the wound is bleeding heavily, apply pressure to the wound to stop the bleeding. Follow the steps for Bleeding. Once the bleeding has stopped, complete the rest of the steps listed here.
- Clean the abrasion or wound with potable (clean) water, preferably lukewarm and from a tap to provide pressurised water flow. If no clean water is available, use a disinfectant to clean the wound.
- Use sterile compresses to remove any dirt that is left in the wound. When using a disinfectant to clean the wound, regularly change compresses.
- Dry the area around the wound and cover the wound itself with a dressing such as tape, hydrogel, plastic film or hydrocolloids. If you have no access to such dressings, apply a sticking plaster.
Local adaptation
- If you have no access to a tap with potable water, a clean unused water bottle can be pierced and used to apply a gently pressurised stream of water to the wound.
Access help
Advise the person to seek medical help if they are not (sufficiently) protected against tetanus.
Recovery
Cuts and grazes usually heal within a few days. Check the outside of the dressing each day:
- If it is still clean, don’t change it.
- If it is visibly stained with a bit of blood or some clear fluid, remove the dressing. Clean the wound again (using tap water or a disinfectant) and put on a new dressing.
Monitor the wound for any signs of infection. If the skin around the wound becomes red, purple, or darker, and is warm and painful, or if the person develops a fever, this indicates an infection. Never cover an infected wound; seek medical help.
Education considerations
Context considerations
- Programme designers should consider particular local risks that may cause cuts and grazes, as well as access to potable water and dressings.
- The use of topical antibiotic ointment depends on local laws, regulations and processes, including liability protection. Educators may need to vary the treatment options according to the local context.
Learner considerations
- Different populations respond to wounds (particularly minor abrasions) in different ways. While children can react to the shock of the injury by demonstrating high levels of pain, adults might be embarrassed to ‘cause a fuss’. Explore with learners how different people might respond by discussing experiences and different severities of wounds, and how they would approach providing care.
Facilitation tips and tools
- Most people have experienced or seen a wound. Work with these personal experiences to deconstruct prior knowledge and create a new collective understanding that is based on the evidence-based first aid techniques (i.e. clean and cover).
- There are myths and social conventions for wound treatment. Allow learners to share these in order to dispel any incorrect practice. However, facilitators should be careful not to dismiss local treatments without evidence as they might be effective. Facilitators will lose credibility if locally effective treatments or traditional practices are ignored without good reason.
- Prepare well for this topic to enable it to be as experiential and hands-on as possible. If possible, create a range of different types of wound simulations that can promote critical thinking about the help to provide. Give learners the experience of cleaning the wounds (making sure that foreign objects do not enter the wound when cleaning them) and dressing the wounds (including use of a range of dressing types).
- The use of a first aid kit can be an easy and practical way to explain the first aid for wounds. As the kit is built, explain the correct use of each of the contents.
- Alternatives to items contained in a first aid kit can be used for developing the confidence of learners to improvise using objects around them, such as a clean cloth as an alternative to a bandage. Facilitate an exercise where learners think of as many items as they can that they have in their homes or workplaces which they could use as alternatives to items in a first aid kit.
- The use of images that show wound healing processes can be useful to illustrate when it is important to go seek medical advice for an infection. Comparison can be used of wounds healing properly with wounds with infection. Images should be shared sensitively and only after careful consideration of the learner audience.
Learning connections
- Make connections to other topics which may also involve a wound such as Severe bleeding, Head injury, Chest and abdominal injuries and Mammal bite.
- Localised application of ice or something cold may be beneficial for a minor, closed bleeding injury such as bruising or a haematoma.
- Emphasise good Hand hygiene. The first aid provider should wash their hands before caring for the wound.
- Place this topic within the General approach to practise skills such as assessing the person, communication and empathy.
Scientific foundation
Systematic reviews
The Centre for Evidence-Based Practice (CEBaP) developed four evidence summaries in 2019 to inform this topic.
Tap water
An evidence summary was made by CEBaP about cleansing skin wounds with tap water compared to no cleansing or cleansing with another solution. There is limited evidence from seven experimental studies, neither in favour of cleansing with tap water nor no cleansing or cleansing with another solution. A statistically significant decrease in infection, using normal saline solution compared to tap water, could not be demonstrated. In one study, a statistically significant increase in healing, using tap water compared to saline, could not be demonstrated. Evidence is of moderate certainty and the results of these studies are imprecise due to the limited event size and large variability of results.
Disinfectants
In another evidence summary, cleansing a skin wound with disinfectant was compared to no cleansing or cleansing with a different type of disinfectant. There is limited evidence from two experimental studies, neither in favour of cleansing with disinfectant nor no cleansing or cleansing with another disinfectant. A statistically significant decrease in infection, using povidone-iodine compared to normal saline, could not be demonstrated. Evidence is of moderate certainty and results of these studies are imprecise due to the limited event size and large variability of results.
Covering the wound
Another summary looked at covering a skin wound (with a sterile compress, wound plaster or bandage) compared to leaving the wound exposed to air. There is limited evidence from five small experimental studies in favour of covering the wound (e.g. with tape, hydrogel, film and hydrocolloids). It was shown that covering the wound resulted in a statistically significant decrease in wound size after 3 days or after 7 to 14 days, a statistically significant decrease in wound redness after 10 to 14 days, and a statistically significant increase in epithelium thickness and coverage after 2 to 7 days, compared to exposing the wound to air. However, a statistically significant decrease in wound width or wound area after 1 to 5 days, a statistically significant decrease in wound redness after 2 to 7 days, and a statistically significant increase in epithelium thickness and coverage after 3 to 9 days and after 14 days, could not be demonstrated. Moreover, a statistically significant decrease in inflammation could not be demonstrated. Evidence is of low certainty and results cannot be considered precise due to limited sample size, lack of data and/or large variability of results.
Ointments and creams
An evidence summary was made about the use of ointments or hydrating cremes on skin wounds, but no studies on simple skin wounds could be identified. Most evidence is currently available for people with chronic wounds (ulcers and surgical wounds) or in animal models.
Non-systematic review
Two prospective, randomised controlled trials compared the effectiveness of triple antibiotic ointment with both single antibiotic ointment and no ointment in conditions similar to those seen in first aid situations. In one study, the ointment was applied to intradermal (between layers of skin) chemical blisters infected by bacteria (staphylococcus aureus). Contaminated blisters treated with triple antibiotic ointment healed significantly faster and had a lower infection rate than blisters treated with single antibiotic ointment or without ointment at all. Both triple and single antibiotic ointments were more effective than no ointment. In several of these studies, the wounds were initially cleaned with antiseptic solutions and this may have compromised the results shown for antibiotic ointment. However, this complication may support the value of antibiotic solutions (Berger, 2000; Caro,1967).
References
Systematic reviews
Centre for Evidence-Based Practice (2019). Evidence summary. Cuts and grazes – Tapwater. Belgian Red Cross-Flanders. Available from:
https://www.cebap.org/knowledge-dissemination/first-aid-evidence-summaries/
Centre for Evidence-Based Practice (2019). Evidence summary. Cuts and grazes – Disinfectants. Belgian Red Cross-Flanders. Available from:
https://www.cebap.org/knowledge-dissemination/first-aid-evidence-summaries/
Centre for Evidence-Based Practice (2019). Evidence summary Skin wounds – Covering the wound. Belgian Red Cross-Flanders. Available from: https://www.cebap.org/knowledge-dissemination/first-aid-evidence-summaries/
Centre for Evidence-Based Practice (2019). Evidence summary. Skin wounds – Ointments and cremes. Belgian Red Cross-Flanders. Available from: https://www.cebap.org/knowledge-dissemination/first-aid-evidence-summaries/
Non-systematic reviews
Atiyeh, B. S., Ioannovich, J., Magliacani, G., Masellis, M., Costagliola, M., Dham, R., & Al-Farhan, M. (2002). Efficacy of moist exposed burn ointment in the management of cutaneous wounds and ulcers: a multicenter pilot study. Annals of plastic surgery, 48(2), 226-227.
Berger, R. S., Pappert, A. S., Van Zile, P. S., & Cetnarowski, W. E. (2000). A newly formulated topical triple-antibiotic ointment minimizes scarring. Cutis, 65(6), 401-404.
Caro, D., Reynolds, K. W., & De, J. S. (1967). An investigation to evaluate a topical antibiotic in the prevention of wound sepsis in a casualty department. The British journal of clinical practice, 21(12), 605-607.
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