Purell instead of Triple Antibiotic Ointment?

[Andrew Shapira]

Triple antibiotic ointment is on several gear lists. I have this in my first aid kit too. Mostly I do day hikes, and am wondering if I could reasonably stop carrying the ointment, with the idea of using Purell in its place. (Maybe I would replace the Purell with alcoholic wipes.) What do you think?

[Jeff Antig]

Well, the Purell will sanitize a cut thoroughly once and then it would be open to infection again (even after bandaging). I suppose for day hikes it is less crucial but triple antibiotics is not the area where you want to cut your weight from.

[Andrew Shapira]

Thanks. What exactly does the triple antibiotic ointment do to help prevent infection after the wound is sanitized? Is the idea that the ointment stays in place under and around the edges of the bandage, keeping bacteria from nearby skin and the environment from getting in? This is what I surmise from reading about it online, but I haven't found definite statements that this is what it's for.

A half ounce container seems like an enormous amount of ointment. If a first aid kit should contain this kind of ointment, what's the smallest amount that you think would be safe to take on long day hikes?

[Jeff Antig]

Yes, it does a much better job of inhibiting bacterial growth than a single dose of alcohol does. Alcohol/Purell is just a cleaning agent. The antibiotic is for dressing. I think I remember someone on here (Ryan Jordan?) had dressed up a wound w/ triple antibiotics before being escorted to a hospital and was praised by the nurses for it.

For day hikes, you are pretty much set with the smallest container you could find. I usually carry it in those small zip lock packets found in craft stores.

[Jim Colten]

Triple Antibiotic ointment contains neomycin. "Of the 47,559 patients tested, 2.5% had positive reactions to neomycin sulfate" Reference

I suppose it might be possible to test yourself for this but if you are packing first aid for a group you might want to go with double antibiotic ointment instead of triple.

[Thomas Burns]

For minor wounds (i.e., the kind we are most likely to get on the trail), a little antibiotic ointment or, even better, a couple of wipes soaked in them in their own small foil or plastic packets cannot hurt. Disinfect the wound with Purell, lay the wipe right on the wound and wrap with duct tape.

In other words, you may never have to use antibiotics, but there are some items in the "JIC" category that we shouldn't be without, UL philosophy notwithstanding.

Stargazer

[Roger Caffin]

The overuse of antibiotics is what has caused all the problems with resistant bugs.

I just wash with water and stick a band-aid on. Never had any problems.

If you are really desperate, try some Bismuth Formic Iodide (BFI) powder.

Cheers

[Rick Dreher]

It can be very difficult, even impossible to effectively clean a wound (wash away all dirt, dead tissue and bacteria) in the field and the antibiotic ointment's role is to control bacterial growth. Secondarily it keeps the bandaged wound moist, which can enhance healing and reduce scarring.

I spent some "quality" hours in a rural emergency room last month and there was a lot of wound treatment occurring. One fellow had cleaned all of his multiple wounds but only dressed some of them (with neosporin). Per the ER doc, those were healing fine but the others had already developed deep infections that required scrubbing and lots of disinfectant irrigation and further, could not be stitched due to the bacterial growth. The elapsed time was less than 24 hours.

To sum up, we can't anticipate what wounds we might receive nor how many days out they might occur. Small "single-use" antibiotic packets weigh mere grams and should be part of any first aid kit. Alcohol swabs or gel are not a replacement; however, they're quite useful for cleaning wounds. Be careful, because alcohol contact can damage exposed tissue and add to the problem.

Cheers,

Rick

[Greg Mihalik]

"It can be very difficult, even impossible to effectively clean a wound (wash away all dirt, dead tissue and bacteria) in the field…"

Somewhere in the last year on BPL it was mentioned that the most effective way to clean a wound in the field is "…15 minutes of irrigation..", either with a syringe or a Ziplock with a punctured corner.

After that it will be some sort of 'triple antibiotic' and a loose dressing for me. I have carried SteriStrips in the past, but am now thinking that closing up a deep wound is a bit risky.

[Lori P]

"I just wash with water and stick a band-aid on. Never had any problems."

Neither did I, until I did. I had a trip and fall that left me with a grazed heel – just half an inch of skin loss. Washed it out, disinfected it after showering for a couple days and figured it would heal on its own just like every other little cut, scrape or random thing I ever did to myself… the next day my foot swelled, the day after it swelled more, a funny red streak started up the back of my leg, and the end result was a week of daily hospital visits as they pumped antibiotics into my system to avoid a blood infection. Obviously I missed some microscopic little whatever in my initial cleaning. Nothing like getting a crazy little skin tear ten feet from your front door on the way to the car and ending up with an IV in your arm.

These days I put triple antibiotic cream in open wounds of any severity. I'd rather not go there. It may be random and the odds against it, but I seem rather prone to beating odds. Also had a weird post-tick bite infection.

[Luke Schmidt]

I'm going to second the motion that you carry Triple Antibiotic for several reasons. First I have personal experience with the joys of serious infection. I got infected when I was 14 from a blister I popped on my thumb. In a couple of days it was really infected and I was in the ER. Proper treatment would almost certainly have helped. I got a MRSA (staph) infection twice working at a wilderness camp. One of the boys got one from a blister hiking on the AT .
Botom line I don't mess around with infections. On a short hike you could probably make it back fine but early treatment is good.
Another thing is that good first aid can mean the differance between continueing a trip or bailing out because you cannot deal with a nasty cut.

[Tohru Ohnuki]

I have these:

I forget where I got them, they are marked Clay-Park Labs, New York on the back.

[Anonymous]

"To sum up, we can't anticipate what wounds we might receive nor how many days out they might occur. Small "single-use" antibiotic packets weigh mere grams and should be part of any first aid kit. Alcohol swabs or gel are not a replacement; however, they're quite useful for cleaning wounds. Be careful, because alcohol contact can damage exposed tissue and add to the problem."

+1

In addition, I always carry a 5 day supply of Bactrim, or its generic, SMO/TMP, just in case the bacteria in a wound
go "systemic". Bactrim, one of an older generation of antibiotics, is effective against staph infections in general, and MRSA in particular. MRSA has not been exposed to it frequently enough to develop resistance, YET….. It was part of my treatment when I contracted MRSA several years ago, and has been part of my 1st aid kit ever since. I don't worry about MRSA in the backcountry, but skin is very frequently colonized by other staph bacteria, which can cause nasty infections if they get into the bloodstream. The first line of defense is cleansing a wound, followed by dressing with an antibiotic ointment. Most of the time that does the trick. However, if the wound goes septic and/or red streaks start to move up the affected limb, it's time to start taking the Bactrim and head for civilization.

My medical sources concur with Rick's point about alcohol damaging tissue and say the same applies to iodine or mercury compounds such as mercurochrome. Roger, do you know for sure that the compound you suggest does not fall in this category?

[Dean F.]

For an initial cleaning I suppose that a spritz of alcohol won't hurt much, but please don't put a Purell-soaked dressing on one. Alcohol is cytotoxic and will actually INHIBIT healing if used repeatedly, as will hydrogen peroxide solution. I can't think of many worse ideas for a dressing.

[Lori P]

Just got back from a weekend campout that included short trip cross country to a geographical feature that involved steep granite and class 2 scrambling… I had an unfortunate incident that left me with a bunch of shallower abrasions that are now scabbed over without incident, and two more alarming injuries – at first I thought I had torn my thumb in two and broken my wrist. A loose rock that looked like a part of a larger, near vertical granite slab shot out from under my boot and down I went, taking a lot of my weight on my left hand – apparently my thumb was slightly bent and the bone along my thumb is still sore, but not broken or fractured (no significant pain). I have a two inch open area on my palm and a fairly deep open place along the left side of my thumb nail.

We field dressed it the best we could. I had to use water from my bite valve to wash away all the blood. I was the only one of us with tape, gauze, disinfectant swabs, antibiotic cream and the ace bandage with which I wrapped the whole hand just to keep the gauze/tape in place on my palm. The palm is a very difficult place to tape up or keep a bandage on, too many flex points and bends. I did not have my leukotape with me, alas – it gets wrapped around my eyeglass case and I left that in camp. That would have adhered even to the bends in the palm.

I redressed it that evening in camp, examining it closely with my glasses on, picking out a few stray bits, shooting my palm with Purell (the scream echoed for a bit), and redressing it with antiobiotic cream before bandaging with clean nonstick gauze and tape, then stuffing the hand in a glove. (It got down to 25F and snowed that night, I slept in an extra layer.)

24 hours later, neither area appears swollen, no pus, doesn't seem infected; there will be dead skin coming off eventually as the wounds heal up, but we appear to have gotten out the bits of rock that were driven in and the edges seem clean. The thumb injury looks icky but doesn't hurt. I'm optimistic that it will turn out okay, since it's not my first run in with granite. Anyone who goes scrambling in granite knows better than to leave the gloves on the table at home, but apparently there's nothing you can put in your first aid kit to counter forgetfulness.

[Andrew Shapira]

I'm glad you're ok.

It's very nice to be able to read over your description of what happened, and think about how I might deal with a simlar situation with what's in my pack.

For now, the half-ounce triple antibiotic is in my pack. I'll probably look for some single-use packets to reduce the weight a bit.

I still dunno about the gauze paad. Is substituting for a gauze pad with a sock a good option, even though the sock isn't sterile? For me this would be mainly for (long) day hikes.

[Lori P]

I think there is no substitute for gauze – your sock will not be sterile, and using a sock in my example would have left me with a really bloody sock. You can't apply enough pressure with a sock to stop bleeding, if you need to, as the sock will absorb and absorb, and leave bits of sock in the wound. I briefly entertained the notion of wrapping it with my bandanna but that too is not sterile.

I really wished I'd had a roll of gauze. I could have wrapped the thumb with something breathable and sterile. But, like you, I got in a mind to reduce the bulk of my first aid kit… it's going back in.

I have found boxes of Neosporin single use packets at several chain drugstores, also quick dissolve strips of Benadryl and other handy one shot items.

http://www.neosporin.com/neotogo/neotogo.asp?sec=0&page=0&from=0

[Andrew Shapira]

How much does your gauze roll weigh, and do you have a link for it? I'd be curious to see what you settled on.

One drugstore here didn't have single use packets the other day – will keep looking.

[Lori P]

pick a size: http://www.curadusa.com/products/Gauze/stretch-rolled-gauze.asp

Gauze is really light; a small roll doesn't register on my (admittedly imprecise) scale. There are different kinds and they are useful for different stages of healing. I try to have a few nonstick patches for fresh injuries, as as blood coagulates anything you put on the wound tends to stick to it. The roll gauze would either go on after the wound has started to heal, to avoid tearing open the scabbing on a high use area like my palm, or it would get rolled on over a nonstick pad to keep it in place while the wound is still wet. Right now I have some plain ol' gauze taped around the end of my thumb so I don't snag the skin while I'm sleeping. I want it to breathe so it doesn't stay moist enough to breed infection, but I'd rather it didn't break open and start bleeding again while I'm asleep.

One of the things to think about is, how will you handle seemingly minor injuries to prevent them becoming major? I am rather cavalier about cuts and scrapes at home but get two days out and it becomes a real pain in several senses of the word to not have everything you need. Some people get by with aspirin and a band aid. I have the feeling as I gear up for volunteering for the local SAR that my kit will only get bigger. I already carry more than most of the people I hike with, but that only means people have been able to take advantage of my checkered past of trips, falls, aches and pains by "borrowing" those pain pills or tape and gauze to patch their skinned body parts.

I've been trimming weight in my kitchen and sleeping gear – the only thing I don't intend to sacrifice are first aid items. So far the only thing in there I haven't used yet this year is the moleskin, but that's only because the folks in my hiking group seem to be getting better shoes.

[Lori P]

FYI –

http://www.minimus.biz/Pharmacymain.aspx

They also have great packets of condiments and single servings of many food items – backpacker heaven.

[Andrew Shapira]

If you're carrying gauze, maybe you could ditch the mole skin, and make something from gauze as needed, attaching it with duct tape.

[Thomas Burns]

>If you're carrying gauze, maybe you could ditch the mole skin, and make something from gauze as needed, attaching it with duct tape.

Gotta agree with this post. I kept cutting the moleskin in half and in half again until there was nothing left. Eventually, I left the gauze behind, as well. I figured a bandaid works just as well for small wounds, and you can always use duct tape and an antibiotic "wipe" for larger wounds.

However, some posts on this thread are making me reconsider reintroducing gauze. especially on longer walks.

BTW, some banaids are treated with antibiotic. Can't hurt to have a few of those along instead of the untreated variety.

Stargazer

[Lori P]

NO duct tape on my skin. Especially on the foot – all that friction rubs it right off. I've never successfully used duct tape in a medical application, it's either been sweated off, rubbed off or rolled off, and not on purpose. Leukotape stays on the skin for a week and protects the hot spot much better. If there is a blister instead of a hot spot, moleskin takes a beating, unlike gauze, and once taped in place it protects better. Cut a hole in moleskin, put over the blister, slap in some antibiotic, add a small piece of nonstick gauze, run a strip of leukotape over the hole, done. If I'm going to take just one type of tape instead of the sports tape, etc. it would be leukotape. I've repaired hydration bladders with the stuff – duct tape just slides right off a Camelbak.

Gauze is too flimsy for use in a boot but it's great for spots that aren't going to see abrasion and need to breathe. Roll gauze wraps on awkward spots like fingers or elbows, keeps things clean and hopefully dry, and an ace bandage provides a good level of protection – I was very grateful to have one because once wrapped around my hand I could continue using the hand in a limited fashion without worrying about re-injuring the palm.

And what's most likely to get injured, due to the endless things you do with it? the hand. What do you rely on the most other than your feet – the hand. Being able to get a cut or scrape clean, and hopefully mostly healed in a couple days, is important. Having stuff that works with a wound when it's wet, and some more stuff that protects it in later stages of healing, leads to a nice dry scab that doesn't need much attention and protects it from infection. It's 48 hours later and my palm has a two inch scab – already the edges are healing inward. Skin is fantastic stuff. No bandages today.

[Lori P]

"figured a bandaid works just as well for small wounds, and you can always use duct tape and an antibiotic "wipe" for larger wounds."

If your antibiotic wipe is an alcohol swab, this would damage your wound. Leave it out to dry for a while and you might reduce the risk.

[John S.]

If the duct tape moves with gauze next to a blister, it could act like sandpaper since it will stick to the bleeding blister base? ..ouch

[Author]

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