Clinical Practice Guidelines

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
    All other wounds YES NO
    > 10 years since last dose All wounds YES NO
    < 3 doses or uncertain Clean minor wounds YES NO
    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.