A puncture wound is a forceful injury caused by a sharp, pointed object that penetrates the skin. A puncture wound is usually narrower and deeper than a cut or scrape. Many people accidentally get puncture wounds with household or work items, yard tools, or when operating machinery. Most puncture wounds are minor, and home treatment is usually all that is needed.

Sharp objects, such as nails, tacks, ice picks, knives, teeth, and needles, can all cause puncture wounds. Puncture wounds increase your risk of infection because they are hard to clean and provide a warm, moist place for bacteria to grow. The bacteria Pseudomonas are a common cause of infections when a puncture wound occurs through the sole of an athletic shoe.

Some punctures are done for health reasons. For example, a puncture may be used by a doctor to draw blood or to give fluid or medicines directly into a vein (intravenous, or IV).

Health professionals have an increased risk of needle-stick injuries. A puncture from a used needle increases the risk of infection or for transmitting a blood-borne disease, such as hepatitis or human immunodeficiency virus (HIV). Home treatment may be all that is needed for puncture wounds from clean needles.

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What to do if you get a puncture wound?

When you have a puncture wound:

• Determine if any part of the object that caused the wound is still in the wound, such as a splinter or lead (graphite) from a pencil. A pencil lead puncture wound is less worrisome, so it is not necessary to check blood levels for lead or worry about lead toxicity or poisoning.
• Determine if underlying tissues, such as blood vessels, nerves, tendons, ligaments, bones, joints, or internal organs, have been injured by the object .
• Clean the wound and remove any dirt or debris to prevent infections, both bacterial skin infections and tetanus (“lockjaw”).
• Determine whether you need a tetanus shot .
• Check your symptoms to decide if and when you should see a doctor.
• Managing puncture wounds in the health care context
• Many healthcare workers do not know how to handle puncture wounds, especially if they occur after hours, with the danger of transmitting viral diseases such as HIV and hepatitis B and C.

Puncture wounds are common in the health care setting. For instance, between 2004 and 2013, in the United Kingdom, a total of 4,830 occupational exposures to body fluids associated with healthcare were reported, 71% of which were percutaneous wounds. As major exposure case registry information systems improve, the current burden of puncture wounds is likely to be much higher. Health workers must be familiar with immediate self-management of injuries to themselves or to colleagues. Many healthcare workers do not know how to handle puncture wounds, especially after hours.

What is a puncture wound?

A puncture wound is a wound produced by a sharp object such as a needle, a scalpel, bone or tooth fragments that penetrate the skin. Another form of exposure to body fluids that could have a similar consequence is splashing the fluid onto a mucous membrane or non-intact skin.

Where do puncture wounds occur?

Puncture wounds related to health care are not limited to hospitals as 3-7% occur outside of them. The most common wound is associated with venipuncture. Injuries to nurses and caregivers accounted for 42% of all reports, while medical and dental professionals accounted for 41% and 5%, respectively. It is concerning that auxiliary health workers who have not had direct contact with patients were also injured by improper disposal of sharps.

The most common wound is associated with venipuncture

Aside from the trauma of the wound itself, one of the main concerns with these injuries is the risk of infection. In Western countries, the 3 most common blood-borne infections, generally related to transmission through puncture wounds, are HIV, Hepatitis B, and Hepatitis.

Rarely, other infections such as malaria, T-cell leukemia virus (types I and II), hemorrhagic fever virus, and Ebola virus may be involved. The risk of transmission of hepatitis B viruses (when the HBe antigen is positive), hepatitis C and HIV through puncture wounds is quantified as 1: 3; 1:30 and 1: 300, respectively. Exposure of the mucosa to body fluids carries a much lower risk (<1: 1,000 for HIV).

The actual risk of transmission during an incident depends on several factors: type of injury, viral load of the primary patient, the immune status of the recipient, and the strategies for risk reduction implemented in the medical setting.

Since 1997, in the UK there has only been one documented case of HIV seroconversion in a healthcare worker after occupational exposure. Although the hepatitis B virus is highly infectious, in recent years in the UK, transmission through puncture wounds has not been reported. This is probably related to the high percentage of healthcare workers who are vaccinated against the hepatitis B virus.

Hepatitis C virus is most commonly associated with sharps injuries, as it is in 50% of all reported cases. In the United Kingdom, a total of 21 cases of hepatitis C virus seroconversions have been reported in healthcare workers since 1997. As these infections have a relatively long incubation period (3-6 months), the psychological impact and anxiety associated with the infection during the follow-up period should not be underestimated.

Current concepts

• First aid should be given as soon as possible and a risk assessment should be done urgently by a trained person.
• If post-exposure prophylaxis is considered necessary, it should begin as soon as possible without waiting for the results of the primary patient tests.
• Post-exposure prophylaxis with antiretroviral drugs within one hour of injury can significantly reduce the risk of HIV transmission.
• The hepatitis B vaccine is highly effective in preventing hepatitis B.

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