Splinter Removal 101 (and How to Prevent Infection)

Ouch! If you’re working outdoors or in the kitchen, at some point in your lifetime you’ll encounter a splinter. Whether a sharp sliver of wood, a glass shard or other debris, splinters can be a real nuisance.

You may be tempted to ignore a splinter, especially if it doesn’t hurt. But a foreign object embedded in your skin can put you at risk for an infection—and no one should ever want that.

“Our skin is our natural barrier against the outside world. So when the skin is broken by a cut or puncture, that barrier is broken, and bacteria can then enter the body,” said Daniel Bates, MD, a physician lead at Banner Urgent Care. “If your body’s immune system can’t destroy them fast enough, the bacteria will start feeding off your body’s nutrients, growing, multiplying and damaging surrounding tissue. That’s why it’s important to clean out wounds to remove as much contaminating bacteria as possible.”

The more you can remove, the less there is for your immune system to clean up, and the better chances you have to prevent an infection.

While many incidents of splinters turn out to be no big deal and can be safely removed at home with a good pair of tweezers, there are cases where you’ll need to see a health care specialist. Dr. Bates shared what tools you’ll need and the steps to take to safely remove a splinter at home, and when you should leave it to the experts.

The first-aid supplies you’ll need to safely remove a splinter

• Soap and water. The best thing you can do to prevent infection in any wound is to wash it out with clean running water. You can use tap water or bottled water but avoid disinfectants like alcohol, iodine and hydrogen peroxide. “This actually kills the healthy tissue in your wound and can increase (not decrease) your risk of infection,” Dr. Bates said.
• Gauze, clean tissues, paper towel or cloth. You can use these to dry up the wound, apply pressure and clean up any bleeding.
• A good pair of tweezers. Tweezers have many uses, from self-care to pulling pesky splinters. A “good” pair will have a fine tapered point and the jaws should close evenly so you can grab fine objects like splinters and hairs.
• A fine sewing needle. This should have a thin enough point to stab into the side of a splinter and not simply push it around. It should also be long enough that you can get a good grip and have control. Too short, and you may not be able to get it out effectively.
• A good source of light. Having a good source of light is a must. Use a bright reading light, head lamp or other focused light source.
• Disinfectants (for the tools, not your wound). “These really have one purpose: to clean,” Dr. Bates said. “They should be used to disinfect your tools and skin that hasn’t been broken to remove bacteria before any invasive procedure.” If used in a wound and you’ll kill the healthy tissue you need to start the defense and repair process.

Steps to safely remove a splinter

Step 1: Rinse the area

A good rule of thumb is to run the wound under cold running water for 30 seconds. If you’re not near a water source, use about 20 ounces of bottled water to flush out the area. If the wound is dirty or greasy, use a gentle soap to clean the wound. As well, don’t forget to wash your hands with soap and water.

Step 2: Sterilize your tools

Use the disinfectant (iodine, hydrogen peroxide, rubbing alcohol) to sanitize your tweezers and/or needle.

Step 3: Remove the splinter

If the splinter is shallow enough, you can use a needle to gently scratch or pick the skin open above the splinter. Then you can either use the needle to back out the splinter or grasp the end with tweezers to pull it out.

Step 4: Rewash the area

Once you’ve removed the glass or wood splinter, clean the wound as well as you can with soap and water.

Step 5: Cover

Cover the wound with gauze or a clean bandage to stop bleeding and prevent contamination of the wound. If you prefer, you can use an antibiotic ointment, but it’s not necessary.

What to do when a splinter is no longer a DIY

“Keep a close eye on the wound for signs of infection,” Dr. Bates said. “If you begin to have increased redness and pain or puslike discharge, seek medical care as soon as possible.”

As well, if you’re not able to remove the pesky splinter, it occurs on a joint or it’s deeply embedded in your skin, you should see your health care provider or go to your local urgent care and have it removed to prevent infection.

“In general, any splinter that penetrates through the full thickness of the skin into the tissue below needs to be seen by a health care provider to determine whether the wound needs to be explored and whether preventive antibiotics need to be prescribed,” Dr. Bates said. “This is particularly true for treated wood products.”

Treated lumber is coated with antifungal chemicals to prevent rot. Without the natural wood fungus, more aggressive bacteria tend to grow in the wood, and they can cause some devastating infections.

Also, patients who have diabetes should be very careful with wounds on the feet. “I would recommend any diabetic patients who have any foot wound that goes through the full thickness of the skin should be evaluated,” advised Dr. Bates.

To find a Banner Health specialist or to find the nearest urgent care, visit bannerhealth.com.

Related Articles:

• 10 Situations When a Wound Needs More Than a Band-Aid
• Bad Sunburn? Eight Tips to Treat and Find Some Relief
• How to Treat a Chemical Burn
• Scorpion Stings: Myths and Facts

Wellness

Splinters and Other Foreign Bodies in the Hand

If you or your doctor cannot confirm the location of a foreign body in your hand, medical technology is another method of finding a foreign body. X-rays are often the first test ordered. Some types of metal that can be seen on x-ray include copper, iron, aluminum, steel, or tin. Materials such as teeth, tooth fragments, and some fish spines include calcium and can be visible on x-rays. Also, most gravel, plastics, coral spicules, and some types of glass may be visible on x-rays. Keep in mind that though x-rays can show some materials, they don’t show all objects, so a normal x-ray does not mean you are in the clear.

Other tests can be ordered if x-rays do not clearly show a foreign body. Performed by an experienced technician, an ultrasound is a very effective, low-cost, and comfortable test that bounces sound waves off the foreign body to create a brighter area on the screen. Wood, thorns, and other materials can be detected with ultrasound. Ultrasound can demonstrate if you are dealing with one or multiple foreign bodies, and this test can also determine their size, shape, location, direction, and depth. Ultrasound can also detect changes in the surrounding soft tissues and whether fluid is present to suggest an abscess.

Computerized tomography (CT) scans and magnetic resonance imaging (MRI) can also show foreign bodies. If the foreign body is deeper or near a bone, a CT may be required. CTs and MRIs are more expensive and may be considered based on the injury location and other patient-specific characteristics.

Many factors determine the treatment of foreign bodies. These include the kind of foreign material, the location, the patient’s symptoms, and the likelihood of infection.

Foreign bodies from plants, bite wounds, and marine creatures are more likely to cause reactions or infections. Bite wounds involve the crushing of tissue and other injury. This lowers the body’s ability to fight bacteria from the wound. Spines and spicules from marine animals can carry poisonous material. Some infections are caused by bacteria, which divide quickly and cause more severe symptoms early. Fungal and atypical mycobacterial infections often are slower-growing organisms, so those might not cause symptoms for weeks or months. These types of infections are much harder to grow in a laboratory to identify the cause of infection, and they are also harder to cure and may require medication for weeks or months, including one or more surgeries.

Wood slivers and thorns may cause inflammation, which makes the area swollen, red, warm, and painful. These symptoms mimic infection, so it can be difficult to separate inflammation from infection. Glass, metal, and plastic are synthetic products, not biologic structures, so they are less likely to cause inflammation and/or infection.

The location of the foreign body can dictate the need for removal. If it is deep, without symptoms, and non-reactive, no invasive treatment may be needed. It may only be followed with occasional office exams to monitor for developing problems. Examples are small pieces of metal or glass. Those close to the skin, tendons, nerves, or joints may be more painful with light pressure and will require removal. This could be due to symptoms or concern about further injury. Sharp glass and metal foreign bodies have caused injuries to vital structures.

Pain or suspected infection are the most common reasons for foreign body removal. Most foreign bodies that cause symptoms do not go away without a procedure. It is rare for the body to be able to break down the foreign body and get rid of it.

During a foreign body removal, the doctor may swab the wound to obtain a specimen and then send it to the lab to determine if an infection is present. Sometimes, the presence of an infection is obvious, and other times, it can be hard to tell just by looking at the wound. When infection is suspected, the doctor may prescribe the patient one or two antibiotics to start based on common organisms in your geographic location. If the wound culture grows bacteria in the lab, this can make picking an effective antibiotic easier.

Bacteria from human, dog, or cat bites often require different antibiotics than a thorn puncture. Microorganisms from marine animals are also very different from land animals. Deeper fluid collections or abscesses need surgical drainage and antibiotics. Infected joints, tendons, and bones require more involved surgeries and sometimes intravenous antibiotics for several weeks. Infected joints are opened and cleansed. Infected tendons and bones require the removal of very infected tissue, as well as pills or intravenous antibiotic medication.

Nerve injuries require exploration and repair because they do not usually heal without surgery. However, when nerve fibers are cut, residual numbness or weakness can be expected, even if the nerve could be repaired. Partial tendon tears can heal without surgery but may develop scarring that can limit motion. Sometimes, therapy alone can improve motion. Other times, a surgery called a tenolysis may be worth trying. Many completely severed tendons have an immediate loss of motion. Early wound exploration can help determine if there is an infection. If no infection is suspected, an early tendon repair can be performed. If an infection is present or suspected, the tendon repair would need to be delayed. When the infection is cured, a late repair can be performed.

Finally, after a puncture wound, a lump can form. This may take months or years to develop. The patient may not remember the puncture. The lump or mass can be tender. The most common post-traumatic mass is an epidermal inclusion cyst. It is thought that some skin cells get driven under the surface and survive. They continue to grow and secrete normal oils and protein, which gradually form a mass. Another post-traumatic mass is a pyogenic granuloma, which is a raised, red lump that easily bleeds. It usually requires removal and cauterization with silver nitrate or another electrocautery.

© 2022American Society for Surgery of the Hand.

This content is written, edited and updated by hand surgeon members of the American Society for Surgery of the Hand. Find a hand surgeon near you.

Soft tissue wounds – health articles

11/10/2022

What are soft tissue wounds?

Soft tissue injuries include injuries to the skin, mucous membrane, deep-lying tissues (subcutaneous tissue, muscles, etc.), as well as tendons, vessels and nerves. As a result of violation of the integrity of the skin, microbial contamination of the wound surface occurs, which can lead to the development of infection.

According to the damaging factor, wounds are divided into mechanical, thermal (burn) and chemical; on the instrument of injury – on wounds from blunt, sharp objects, tools and weapons, firearms and weapons; according to the nature of the damage, the wounds are classified into bruised, torn, combined, bitten, stab, cut, stab-cut, chopped, sawn, combined bullet, shot, fragmentation.

According to the depth of damage, superficial wounds are distinguished, located in different layers of the skin, and deep, passing in deeper tissues. Wounds of internal organs and joints that communicate with the external environment through a wound channel are called open wounds, and wounds whose wound channels pass through cavities or terminate in them are called penetrating wounds. Wounds of internal organs that do not communicate with the external environment are classified as closed.

Causes

Cut wounds result from the direct impact of a sharp weapon on the surface of the skin.

Chopping wounds are caused by lowering a sharp weapon on the skin at an angle.

Puncture wounds are the result of deep penetration of a sharp thin instrument. Possible injury to the cavities or joints.

Contusion wounds occur when some part of the body comes into contact with a hard obstacle and there is a solid support in the form of the bones of the skull or other bone.

Crushed, crushed wounds are formed due to the impact of a blunt instrument with a wide surface when opposed to a solid support.

Bite wounds. As a result of a bite by an animal or a person, highly virulent causative agents of wound infection can enter the wound.

Symptoms

A closed injury can be suspected by knowing the mechanism of injury (eg, blunt force impact) and by the presence of one or more of the following: bruising, swelling, pain.
Some signs suggest the nature of the injury. For example, swelling and deformity may indicate a closed fracture. A bruise on the head, bloody discharge from the nose, ears and mouth – an injury to the cervical spine or brain is possible. Bruises on the chest, deformation, violation of symmetry – a chest injury is possible with damage to the ribs and sternum. Respiratory failure may indicate lung injury. Large bruises on the abdomen – possible injury to the internal organ.

Signs of a wound vary depending on the type and depth of tissue damage. As a rule, any damage accompanies pain, possibly a violation of the integrity of the skin, as well as bleeding.

Diagnosis

For small, superficial wounds that are not accompanied by general symptoms, the diagnosis is made on the basis of the clinical picture. A detailed study is carried out during the primary treatment of the wound. With extensive and deep wounds with a violation of the general condition, additional studies are needed, the list of which is determined taking into account the location of the damage. In case of injuries in the chest area, a chest x-ray is prescribed, in case of damage to the abdomen, an x-ray of the abdominal cavity, ultrasound or laparoscopy, etc. If a violation of the integrity of blood vessels and nerves is suspected, a consultation of a neurosurgeon and a vascular surgeon is required.

Treatment

First medical aid consists of primary surgical treatment of the wound, during which foreign bodies are removed from the wound, bleeding stops, the wound is washed with antiseptics, and non-viable tissues are excised. The issue of prevention of tetanus and rabies (if the wound is bitten) is also being resolved. Wounds with a pronounced inflammatory process are not sutured, they are drained. An infected wound heals by secondary intention. Dressings and drains are changed daily. General treatment consists of anti-inflammatory therapy, the introduction of hemostatic agents, painkillers.

In case of profuse blood loss, the issue of compensating the volume of circulating blood (CBV) is solved, blood substitutes, blood components are introduced. Subsequently, with severe cicatricial contractures and deformities, a restorative operation can be repeated.

Most superficial wounds do not bleed much. Therefore, help consists in bandaging the wound. Before this procedure, the edges are smeared with an antiseptic, making sure that it does not get into the wound.

The wound is covered with a sterile dressing and bandaged. If the edges of the wound are strongly dispersed, before applying the bandages, they must be brought together (but not until they close) and fixed in this position with 2-3 strips of adhesive tape.

The wound must not be washed with water (risk of infection), nor with alcohol or tincture of iodine. The disinfectant solution, getting into the wound, causes the death of damaged cells, and also causes significant pain. No ointment should be applied to the wound, and cotton should not be placed directly into the wound.

Vitamin therapy should not be forgotten. Vitamin deficiency sharply slows down reparative (restorative) processes.

To accelerate wound healing, proper nutrition of patients is important, especially those who have undergone traumatic shock, severe infection or major surgery. They need a complete diet with an increased amount of protein and vitamins. Physiotherapy exercises are indicated primarily for purulent wounds of the upper extremities. Physiotherapeutic procedures play an important role: UV, UHF, etc.

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