Clinical Practice Guidelines

Management of tetanus-prone wounds


  • Statewide logo

    This guideline has been adapted for statewide use with the support of the Victorian Paediatric Clinical Network

  • See also

    Key Points

    • All wounds, other than clean minor wounds, should be considered tetanus-prone
    • Children < 10 years old should be immunised with DTPa or a DTPa-combination vaccine depending on their immunisation status
    • Children ≥ 10 years old should be immunised with dTpa
    • Tetanus immunoglobulin is only required for children > 10 years old with a tetanus-prone wound and incomplete or uncertain tetanus immunisation

    Background

    • 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.

    Assessment

    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 avulsed tooth (minimal washing and cleaning of tooth is conducted to increase the likelihood of successful re-implantation).

    Management

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

    Guide to tetanus prophylaxis in wound management

    History of tetanus vaccination Time since last dose Type of wound Tetanus-containing vaccine* Tetanus immunoglobulin* (TIG)
    ≥3 doses <5 years Clean minor wounds No No
    ≥3 doses <5 years All other wounds No No
    ≥3 doses 5–10 years Clean minor wounds No No
    ≥3 doses 5–10 years All other wounds Yes No
    ≥3 doses >10 years Clean minor wounds Yes No
    ≥3 doses >10 years All other wounds Yes No
    <3 doses or uncertain >10 years Clean minor wounds Yes No
    <3 doses or uncertain >10 years All other wounds Yes Yes

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

    • < 10 years old: DTPa or DTPa combinations
    • ≥ 10 years old: dTpa (Boostrix®)

    • Diphtheria/tetanus toxoid vaccine (ADT®) can be used if pertussis vaccination is contraindicated. (CDT and Tetanus Toxoid vaccine are no longer available.)
    • The recommended dose for TIG is 250 IU im, as soon as practicable after the injury. If more than 24 hours have elapsed, 500 IU should be given. Because of its viscosity, TIG should be given slowly using a 23 gauge needle.
    • Children with a significant humoral immune deficiency require TIG for tetanus-prone wounds.

    Last revised on July 2016