Wounds clinical guidelines and recommendations for Uganda

Minor Cuts and Bruises (HC2)

First aid, tetanus prophylaxis, dressing, and pain management. Antibiotics not usually required. If grossly contaminated: Cloxacillin or Amoxicillin 500 mg every 6 hours. Child: 125–250 mg every 6 hours.

Deep and/or Extensive Wounds (HC4)

Identify cause. Wash with plenty of water or saline (may use Chlorhexidine 0.05% or diluted Hydrogen Peroxide 3%). Explore under local anaesthesia to ascertain extent and remove foreign bodies. Surgical toilet: debridement to freshen the wound. Tetanus prophylaxis, pain management, immobilisation.

Clean Fresh Wound (<8 hours old, HC3)

Primary closure by suturing under local anaesthetic. Use Lignocaine HCl 2% (dilute to 1% with equal volume of water for injection).

Dirty or >8 Hours Old Wound

Clean thoroughly and dress daily. Check wound state for 2–3 days. Carry out delayed primary closure if clean (for wounds up to 2–4 days old).

Wound >4 Days Old or Complex (deep puncture, contaminated, bite, gunshot, abscess)

Allow healing by secondary intention (granulation tissue). Dress daily if contaminated/dirty, every other day if clean. Pack cavities (e.g., abscesses) with saline-soaked gauze.

Extensive/Deep Wounds

Consider closure with skin graft or flap.

Infection Control Note

Collect wound discharge or deep tissue for lab culture and sensitivity. Start empiric treatment; change when results return. If MDR, gram-negative, MRSA, or VRE: implement respective transmission-based precautions. Use chlorine-based agents for environmental decontamination.

Caution

Do not suture bite wounds.