RCH logo

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  

    Lacerations 
    Australian Immunisation Handbook 
    Victoria State Government Immunisation information

    Key points

    1. All wounds, other than clean minor wounds, should be considered tetanus-prone
    2. Tetanus immunoglobulin (TIG) is required for children with a tetanus-prone wound AND who are unimmunised, have had an incomplete primary tetanus immunisation course or an uncertain tetanus immunisation history
    3. Children with a significant immunodeficiency require TIG regardless of immunisation history
    4. Children within in the 9–13 year age group need to be considered for a tetanus booster as the last scheduled tetanus containing vaccine is at 4 yrs of age, placing them at least 5 years post booster 

    Background

    • The primary course of tetanus immunisation is at 2, 4 and 6 months of age on the standard schedule 
    • The current 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 

    Assessment

    Identify if wound is tetanus-prone

    • Compound fractures
    • Bite wounds
    • Deep penetrating wounds
    • Wounds containing foreign bodies (especially wound 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)

    Take an immunisation history, discussing the need for catch-up immunisations where appropriate.

    Management

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

    Guide to tetanus prophylaxis in wound management

    History of Tetanus Immunisation                       Clean Minor Wounds Other Wounds
    Tetanus vaccine* Tetanus immunoglobulin** Tetanus vaccine* Tetanus immunoglobulin**
    ≥3 doses Only if due for routine booster NO Yes if >5 years since last booster NO
    <3 doses or uncertain or unimmunised YES NO YES YES

    * Vaccine to be used according to age group:

    • <10 years old: DTPa or DTPa combinations (ie Infanrix or Infanrix IPV)
    • ≥10 years old: dTpa (ie Boostrix® or Adacel) 

    ** The recommended dose for TIG is 250 IU IM, give 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.

    NB Children with a significant humoral immune deficiency require TIG for tetanus-prone wounds. Discuss with senior doctor or immunology team.

    Immunisation Side effects

    • Common:
      • Infants and young children: mild fever, grizzly, unsettled, unhappy or sleepy
      • Older children: pain, redness and swelling at the injection site
    • Very rare: anaphylaxis

    Consider transfer when

    Child requiring care beyond the comfort level of the hospital 

    For emergency advice and paediatric or neonatal ICU transfers, call the Paediatric Infant Perinatal Emergency Retrieval (PIPER) Service: 1300 137 650.

    Last Updated January 2019