Principles of management of water-immersed wounds

Careful cleaning, and debridement if necessary, of wounds that have been immersed in water is important to prevent infection.

For patients with traumatic water-immersed wounds, ensure that tetanus immunisation is up-to-date (see Requirement for tetanus prophylaxis).

Preventative antibiotics are not routinely required for wounds that have been immersed in water. Prophylaxis is required for traumatic water-immersed wounds that require surgical management or are significantly contaminated. Presumptive therapy is required for marine animal bite wounds at high risk of infection (see Principles of management of bites and clenched fist injuries for risk factors).

Consider early empirical therapy for patients with risk factors for developing severe infections (eg liver disease, iron overload, immune compromise due to immunosuppressive medications, diabetes or malignancy).

Water-immersed wound infections can progress rapidly and even localised infections require close monitoring. Combined medical and surgical management is often required. Seek expert advice if infection is associated with systemic symptoms or involves deeper tissues (such as bones, joints or tendons), or if localised infection progresses.

The appropriate antibiotic regimen for definitive therapy depends on the pathogen. Collect samples of infected tissue or wound exudate for Gram stain, culture and susceptibility testing before antibiotic therapy is started. Modify therapy based on the results of culture and susceptibility testing.

For nonantibiotic management of penetrating venomous marine wounds, see Marine envenoming and penetrating injuries: causes and general management.