Management of tetanus-prone wounds

The new Immunisation Schedule recommends that 10-yearly tetanus boosters are no longer required up until the age of 50, provided that the primary series of 3 vaccinations plus 2 boosters have been given.

The recommendations for the management of tetanus-prone wounds remain the same.

Types of wounds likely to favour the growth of tetanus organisms include:

compound fractures
deep penetrating wounds
wounds containing foreign bodies (especially wood splinters)
wounds complicated by pyogenic infections
wounds with extensive tissue damage (eg. contusions or burns)
any wound obviously contaminated with soil, dust or horse manure (especially if topical disinfection is delayed more than 4 hours).
Re-implantation of an avulsed tooth is also a tetanus-prone event, as minimal washing and cleaning of the tooth is conducted to increase the likelihood of successful re-implantation.

Wounds must be cleaned, disinfected and treated surgically if appropriate.

History of tetanus vaccination		Type of wound	Tetanus vaccine booster (see below)	Tetanus immunoglobulin
3 or more doses	< 5 years since last dose	All wounds	NO	NO
	5-10 years since last dose	Clean minor wounds	NO	NO
	5-10 years since last dose	All other wounds	YES	NO
	> 10 years since last dose	All wounds	YES	NO
< 3 doses or uncertain		Clean minor wounds	YES	NO
< 3 doses or uncertain		All other wounds	YES	YES

A combination vaccine should be used in order to boost community protection against pertussis:

Please note that CDT and Tetanus Toxoid vaccine are no longer available.

< 8 years old DTPa-IPV (Infanrix-IPV®)
> 8 years old dTpa (Boostrix®)

Can use a diphtheria/ tetanus toxoid vaccine (ADT® ) if pertussis vaccination is contraindicated.