title: Wound infections on board ship--prevention, pathogens, and treatment.
abstract: Wounds are common in seafarers and they can easily become infected in the marine environment. Pre-sea tetanus immunization is essential. Without diagnostic facilities and only a limited range of antibiotics onboard, injury prevention and early treatment to reduce the likelihood of infection are important measures. Suturing clean cuts reduces healing time and risk of infection. Fresh, clean cuts, especially on the face or head, can be closed by adhesive tape or sutures, but if infection arises, then one or more sutures should be removed to enable drainage. Most wounds must be considered contaminated and should not be closed, just covered with sterile dressing after cleaning. Antibiotic treatment should be started immediately in seafarers with hand and puncture wounds. The primary treatment for a simple abscess is incision and drainage. Antibiotic treatment is recommended for abscesses if the infection spreads to the surrounding tissue (associated cellulitis), if there is lack of response to incision and drainage alone, or if the abscess is in an area difficult or dangerous to drain (e.g. face, palm, genitalia). Recommended therapy for cellulitis is 5-10 days of dicloxacillin, cephalexin, clindamycin, or erythromycin, but if there is no improvement after 2-3 days, methicillin-resistant Staphylococcus aureus (MRSA) should be suspected. Bites and burn wounds require special attention. Since wound infections can deteriorate rapidly, a telemedicine advice service (TMAS) should be consulted during the early stages, and serial digital photographs of the affected area, transmitted by e-mail to TMAS, are often useful during treatment at sea.
authors.affiliation: Norwegian Centre for Maritime Medicine/University of Bergen, Bergen, Norway. eilifdahl@hotmail.com
authors.forename: Eilif
authors.initials: E
authors.lastname: Dahl
mesh_terms: D000038:Abscess / Q000150:complications; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001733:Bites and Stings / Q000150:complications; D001734:Bites, Human / Q000150:complications; D002056:Burns / Q000150:complications; D006801:Humans; D009792:Oceans and Seas; D012767:Ships; D013745:Tetanus Toxoid; D014946:Wound Infection / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D014947:Wounds and Injuries / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D013745:Tetanus Toxoid