Are Patients With a Wound Protected Against Tetanus?

Fewer than 1 in 25 patients get appropriate prophylaxis for tetanus after a wound.

Explain that tetanus infections are rare. But tetanus can lead to permanent neurologic damage…or death in up to 1 in 5 patients.

Continue to ensure patients are current with routine tetanus immunizations. Follow provincial guidance for when to give or recommend routine doses of either Tdap or Td.

For wound management, consider the patient’s tetanus vaccine history…and severity of the wound.

Clarify that patients with a clean, minor wound who are current with tetanus vaccinations generally don’t need a dose.

But watch for severe burns or skin tears…serious wounds with dirt, feces, or saliva…and crush injuries or deep puncture wounds.

In these cases, recommend a tetanus immunization if it has been 5 years or more since the last dose.

Educate that having a booster in the past 10 years may not be enough for severe wounds…since tetanus immunity wanes.

Giving a dose with wound care bumps levels up quickly enough to enhance protection…since it usually takes 3 to 21 days for a tetanus infection to develop.

When in doubt, vaccinate. It’s better to be safe than sorry.

Refer to the ED for more severe wounds…or if patients may have very weak immunity, such as fewer than 3 prior tetanus doses or unknown vaccine history.

Point out that some of these patients will also need a dose of tetanus immune globulin ASAP…to boost protection.