Purell instead of Triple Antibiotic Ointment?

Hartley, that's a good post by Patrick you linked to. Roger is australian, land of nappy rash, so who knows what goes on over there…kidding Roger.

Patrick's writeup is helpful. Thanks Hartley.

A couple questions..

(1) Patrick uses the terms "close the wound" and "open wound" without defining them. What is the precise definition of these terms?

(2) What is a good weight to shoot for a 20 cc syringe that one could include in a first aid kit?

I figured I'd ask in this thread, since the thread with Patrick's writeup has only one response since '08.

No offense folks, but I think carrying syringes is getting a bit overkill for a basic backpacking first aid kit. We're not going out and fighting VC in the jungle…

If it's a bad enough wound that it can't be cleaned well enough by pouring water on it and washing then I it might be time to get evacuated for real medical care anyway.

I have a hard time imagining cutting myself on anything on a backpacking trip that is filthy enough to cause some sort of rapid and serious infection.

I think irrigation is key. If you are near a waterfall great you can stick your wound under, great. Or if you can pour water in the wound and rub it with a clean finger, great. But cleaning the wound is key. And a small syringe is very helpful for that.

Hike your own hike, but I would rather have a properly cleaned cut and use a old t-shirt for a bandage then not irrigate the wound and use a sterile bandage.

Just my two cents.

I think the post is sound advice. Again, not an MD, but my first aid training and other experience seem to concur. The main points:

1) Get the bad stuff out. That means scrubbing and flushing. I remember some advice for dealing with road rash from biking where they suggest getting a clean brush and scrubbing the scrape with it. Yes, it will hurt but will hopefully get the germs/dirt/rocks out. Also, it's less an issue of how much bacteria are present on the granite rocks at altitude that you fall on (probably very few since it's UV exposed), it's the bacteria on YOUR SKIN that's at issue. It's what you brought with you.

2) Keep the remaining bad stuff from growing. If it's a surface scrape or cut, then antibiotic ointment might help prevent infection. Deep wounds are harder to deal with, irrigation with dilute iodine, as suggested in the article, may help if you have it. Alcohol and peroxide will damage tissue. Closing the wound means holding the skin together so there's no gaping hole and sealing it up from air. This can turn bad if some anaerobic (non-oxygen) bacteria start to grow inside and make pus. Then you have to open the skin and clean it out again.

3) Keep more bad stuff from getting in. Closing the wound does this, but can lead to infection. Certainly covering the wound with something clean would help.

So does everybody else who it happens to. A NOLS instructor in a podcast said an irrigation syringe was in her top five things in a first aid kit.

Craig said,
"I have a hard time imagining cutting myself on anything on a backpacking trip that is filthy enough to cause some sort of rapid and serious infection."

If you are in the backcounrty and need to irrigate a wound but didn't bring your syringe (or like me you just don't carry one)here is a good substitute. Rinse out a zip-lock baggie and fill with clean water. Snip the corner or poke a pin-hole and squeeze!

I know about nappy rash too. LOL

Best to defer the question to Patrick though I will give a general answer. I believe closing a wound in this context implies "surgical closure" of some sort — sutures, steristrips, butterfly adhesives, "glues" etc. Leaving the wound open would be NOT closing it — basically cleaning it out best you can and just leaving it open (perhaps with some packing — the cleaner the better — and pressure to stop bleeding) until it can be properly addressed. Off hand, here are a couple considerations — nature and extent of the wound, dirtiness of the wound, the care available at the scene (is the ER doc there with his full kit?), the time it will take to receive more formal medical care. Generally, dirty wounds are best not closed until they are well-irrigated and assessed. Bites and punctures would probably almost never be closed on the scene. They also require specific antibiotic treatment depending on the animal or in the case of a puncture — what it was and did it go through a sneaker (nasty pseudomonas lives in the "rubber" sole). If you must close a dirty wound, you want to open it back up in controlled settings as soon as possible, REALLY irrigate it and take any further action that might be necessary at that point. Just a couple examples. It's much more complex than this. Bet Patrick would be keen to take this on! Would be interested in what he has to say! And of course, his kit!

Did a winter hike in Tasmania — met up with an Ozzie ICU specialist who brought next to nothing in terms of a medical kit — Tegaderm for blisters and some Panadol maybe. Note: he had 50+ lbs and lots of camera equipment so I doubt he was attempting to save weight. He had some nasty stuff going on in terms of blisters but refused any of my quality blister supplies out of pride, I suppose. Admired my collection but refused to take any. We only had 2 days left, and I had a week's worth — I had needed none. I left them out that night — hope he snuck some. After all, he spent about 3 hours building a fire from wet wood and fuel blocks so we could attempt to dry stuff while I curled up in my bag with a Nalgene bottle of hot water. He was with another bloke and I think he was keen to show off his fire making skills — lined up all the materials like he was doing a medical procedure and then proceeded in a very orderly fashion. Works for me!

Here is a 12 cc irrigation syringe at the NOLS web site that weighs approximately 4.8 ounces:

http://www.nols.edu/store/product.php?productid=16249&cat=0&bestseller

I was hoping for something closer to one ounce.

Here is a 10cc one that weighs 1.7 ounces:

http://www.exploroz.com/Shop/FirstAid/Equip/Curved_Irrigation_Syringe_10ml.aspx

(I have no idea about the reliability of those web sites.)

http://www.amazon.com/20-Disposable-Syringe-without-Needle/dp/B0002YFRA2

You can irrigate with a platypus and hose, under a waterfall. Glad this came up. Never bothered to carry a syringe — would also come in handy for flushing the eye, I would think — low pressure please. Bigger one might be better — more serious irrigation — I'll check the weight differences. Joined here to become obsessive! LOL

Do you actually have that syringe? The product weights at Amazon are often wrong. I hope this one is right!

If anyone cares, I usually bring a few sterile disposable lancets for blisters — you get 'em in the diabetes care aisle of any drugstore. I don't reuse them — one per blister popping session. Really try to soak the feet in warmish water and a little soap first. One of my remaining luxuries will surely be my Sea to Summit 5 L Kitchen Sink.

The Monoject 412 irrigating syringe (12 cc) weighs just .35 oz. in a snack baggie. Your dentist should have a free one to give you. We use them to irrigate tooth sockets and also small intra-oral wounds and lacerations. It has a small opening at the tip, so you can get pretty good pressure coming out of it (but you need a fair bit of soft-touch dexterity when flushing an eye…). Cheap, compact, light, functional.

No, I don't have one…yet. I've used plenty of them — they are real small. Good point re: product weights at Amazon — usually seem to be high though to accommodate packaging. You can just google the syringes — many medical suppliers will carry them. How much does the NOLS one weigh? Haven't checked all the posts yet? Think I may have seen them in Target drugstore. Will update.

Bet a lot of people have already weighed them!

Different Materials. Also, some have locking mechanisms, etc. which no doubt add weight. For this purpose, think the vial and plunger is all you need. That cheapy looking one at amazon is probably lighter than the clear ones. You are just squirting water and don't need to worry about exact measurements etc.

"BTW, what is this stuff about dogs? Pets? Wild dogs? Never heard dogs implicated in this context. We do exchange skin flora –staph in particular — with our pets and with each other — not that big a deal.

Apparently it's getting to be a bigger deal these days. I have come across two articles recently, one in my local newspaper and the other, IIRC, in the NY Times, stating that dogs have become a vector for MRSA. Researchers are not sure yet exactly how, but the speculation is that human colonized with MRSA plays with their dog, who then plays with dog #2 who in turn plays with its owner, etc. Something to ponder.
If a person who has been colonized with MRSA in an urban environment then goes backpacking and cuts their
self, a very serious infection could ensue if the wound is not properly treated. I, personally, as a former MRSA sufferer, would not want to depend on irrigation alone when treating a wound. That is why I carry Bactroban, with Bactrim tablets in reserve. I assume I am colonized with garden variety staph at a minimum, and possibly MRSA. Any of them can result in serious infection if introduced into a wound or, even worse, the bloodstream. I'll take the extra ounce or so of prevention, just in case.

What happened? Were you just labelled as a carrier and treated to eradicate it.? Or are you one of those people who get chronic soft tissue infections from it? I have been following some of the news reports about families that can't seem to eradicate it from their house — members suffering serious soft tissue infection. it has been hypothesized that there may be a genetic immune deficiency in some of these clusters or some additional environmental factor. And yes, the family dog can be in the chain.

MRSA is out there. In some, it is just part of the normal organisms that live on the skin, in the nose and elsewhere. There was a theory at one point that healthcare workers should be tested for such "carriage" especially in the nose– not because MRSA colonization was doing the worker any harm just living there but because the healthcare worker presumably comes into contact with immunosuppressed people and it was assumed MRSA from the nose of the the healthcare worker might infect this already weakened person. Think inadequate hand washing came to be seen as the greater risk — anyway, for most up date info — the CDC maintains a fantastic up to date website — http://www.cdc.gov.

As would be expected, MRSA is developing increasing resistance to Bactroban and some oral antibiotics that were once somewhat effective. Note: community and hospital patterns differ. Extensive info on this is easily found.

Doubt being labeled as a carrier and having MRSA eradicated from the nasal passages would put one at a significantly increased risk of deep tissue infection. CDC would probably have some good info on this. Still proper wound management is the key. Those who carry it and weren't routinely tested as healthcare workers were for a while, might never know they had it. We don't generally go around testing the noses of healthy people for Staph or more specifically MRSA carriage. We can expect some significant % of healthy people to have Staph and even MRSA happily living alongside them. All sorts of microbes live on our every surface and in our every orifice.

Basic principles stil apply.

I have had occasion to use antibiotic
ointment where nothing else would do.
Both times were in wilderness areas, but with
domestic animals being the carrier.

One was an eye infection from horse manure on the trail,
and contact lenses being left in too long.

You don't put Purel in your eyes.

I aquired Barber's Itch from a cow pond and blister
combination that spread over my whole body wherever
the pack straps rubbed. THAT was miserable. Purel would have
done nothing for that. The water for any irrigation would have
come from that cow pond, tho treated first.

Also, the antibiotic ointment works well for chaffing,
tho staying clean is important prevention.

Lots of Purell stuff on this site! Is it any different form other hand sanitizers? Hand sanitizers are for cleaning hands!

And starting fires.

It's sort of like Kleenex. Everyone will recognize the brand name. My current supply has the brand Walgreens on it, but hand sanitizer is hand sanitizer.

It's the Whole Foods Market brand. Comes in a 32 oz economy bottle and smaller bottles. UNSCENTED!!!

"MRSA "sufferer"?"
"Were you just labelled as a carrier and treated to eradicate it.? Or are you one of those people who get chronic soft tissue infections from it?"

Since you put it in quotes, which typically indicates skepticism, I'll go into some detail for you. I finished a backpacking trip in 2006 with some nasty infected hairs in my nasal passages and what I thought was shin splints. The shin splints turned out to be cellulitis, though there was no visible break in the skin. The cellulitis was successfully treated with Levaquin. Two weeks later I developed a very painful infection on an index finger in a matter of hours, again with no visible break in the skin. It became so painful during the night that I couldn't sleep.
At this point I checked into an emergency ward. They lanced the lesion, took a sample of pus to be cultured, and sent me home with a prescription for Bactrim. About an hour
after I got home, I noticed red streaks moving up my arm and headed back to the E.R. where they administered an antibiotic parenterally. The test came back positive for MRSA. At that point they swabbed my nose and tested for MRSA. Again, positive. You probably know the drill from this point on, so I won't bore you with the details. Suffice it to say it took several weeks to get me totally clean. In the meantime, I did a lot of research to educate myself on what I was dealing with. It's a nasty bug. My particular strain was resistant to 9 front line antibiotics.
My guess is that I picked it up in Harborview hospital where my Mother spent her last days. They have had a lot of trouble with MRSA there. Another possibility is the gym I work out at. 2 other people acquired it there. It has also occurred to me that I was the vector for bringing it into the gym, but I'll never know for sure. So, yes, MRSA is definitely out there, B.C. One of the lessons I learned is that because it is out there, there is a reasonable chance I have it happily coexisting with various other bacteria, including garden variety staph, on my skin. Based on my experience with the infection, I would be a fool to go far into the mountains without carrying the few items necessary to either prophylactically address the issue by treating any significant wound or, in the event the wound gets infected anyway, to start taking Bactrim and buy myself enough time to get to a hospital. As I said in a previous post, it's only an ounce or so. I can live with that. I dont', BTW, go around slathering Bactroban on every little granite cut or mosquito bite, nor have I ever used the Bactrim. I am aware as anybody of encouraging resistance in bacteria. I also check with my primary doc every year as to whether Bactroban/Bactrim are still effective against MRSA and other staph/strep strains.
I hope this lays your skepticism to rest.

"not because MRSA colonization was doing the worker any harm just living there but because the healthcare worker presumably comes into contact with immunosuppressed people and it was assumed MRSA from the nose of the the healthcare worker might infect this already weakened person."

I would observe that health care workers also go home from work and, if they are carriers, potentially spread MRSA into the larger community. Hand washing alone is not an adequate response, IMO. Studies have been done indicating we put hands to nose dozens of times per day. Every time the hand comes away from the nose, it is a potential vector for spreading it to other parts of the body, or inert surfaces, and thus to other people or pets. I doubt people are going to wash their hands every time they touch their nose. If MRSA is detected in a person, they should be decontaminated to help prevent an already serious problem from becoming astronomically more so. My 2 cents.

Hey sorry — just wondering if you were referring to deep tissue infection with MRSA or nasal colonization. So yes, I call what you describe SUFFERING!!!

As for oral antibiotics, when concerned about my personal welfare, larger "resistance" issues be damned! I too am a fan on Bactroban for every scrape. Guess, my point is that simple wound care is probably MORE important. Hope you stay well! :)