gms | German Medical Science

Objectives/Interrogation: To audit compliance of tetanus prophylaxis in open hand injuries with Public Health England guidelines

Methods: Retrospective audit on 60 patients with open hand injuries referred to the Plastic Surgery department. Two data collection windows of 2 weeks each consisting of 30 patients each. There was a departmental presentation between the two windows to educate and help improve compliance. Parameters included mechanism of injury, tetanus immunisation status and whether tetanus vaccine and/or prophylactic immunoglobulin was administered.

Results and Conclusions: In the first window, 18 patients didn't require a tetanus vaccine booster and 100% (18/18) of patients didn't receive it, 12 patients required a tetanus vaccine booster however only 83% (10/12) received it, 11 patients also required prophylactic tetanus immunoglobulin and it was only administered to 9% (1/11). In the second cycle after the intervention, 9 patients didn't require a tetanus vaccine booster and 100% (9/9) of patients did not receive it, 21 patients required a tetanus vaccine booster however only 71% (15/21) received it, 3 patients also required prophylactic tetanus immunoglobulin and none of them received it 0% (0/3).

Hand injuries are commonly referred to the Plastic Surgery Department. Tetanus is a life-threatening vaccine preventable infection with a total of 4 cases and no deaths reported in England in 2016. Five doses of tetanus vaccine should provide long lasting immunity against tetanus however if the wound is considered 'high risk' prophylactic tetanus immunoglobulin should be administered for immediate protection irrespective of immunisation history. Our audit highlights the poor compliance with prophylactic tetanus immunoglobulin and the importance of educating and raising awareness of the appropriate management guidelines amongst healthcare practitioners in the Plastic Surgery department as well as in the Emergency department and Minor injuries setting. Extrapolating our findings, it is likely that compliance rates are likely be similar across the country and despite this tetanus infections remain extremely rare. Prophylactic tetanus immunoglobulin is costly at £125 compared to a single Revaxis vaccine which costs £6.50 and currently a shortage of it in the NHS for management of tetanus prone wounds has led to an urgent review by Public Health England in 2018 to prioritise its use for susceptible individuals who have sustained high risk injuries and are at greatest risk.