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Tetanus Prophylaxis Audit

Tetanus Prophylaxis Audit. T. Sahami, M. Javed, N. Wilson Jones. Tetanus. Infection caused by clostridium tetani Spores found in house dust, soil and faecal matter. Establishes within wound and releases exotoxin – tetanospasmin.

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Tetanus Prophylaxis Audit

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  1. Tetanus Prophylaxis Audit • T. Sahami, M. Javed, N. Wilson Jones

  2. Tetanus • Infection caused by clostridium tetani • Spores found in house dust, soil and faecal matter. • Establishes within wound and releases exotoxin – tetanospasmin. • Irreversibly binds to neurones preventing inhibition of motor reflex responses.

  3. Tetanus • Incubation period 7-8 days • Symptoms :- • Trismus • Neck stiffness • Dysphagia • Abdominal muscle rigidity • Muscular spasms

  4. Vaccination schedule

  5. Tetanus immunisation guidelines

  6. Tetanus Prone Wounds • Wounds or burns >6 hours old requiring surgical intervention • Wounds or burns with significant devitalized tissue • Puncture wounds • Wounds in contact with soil/manure • Compound fractures • Wounds associated with systemic sepsis

  7. High Risk Wounds • Heavy contamination with material likely to contain tetanus spores • Extensive devitalised tissue

  8. The Audit Proforma

  9. Audit Results • 25 patient notes reviewed against national guidelines for tetanus prophylaxis • 36% mismanaged according to clinical guidelines • 8% given Tetanus vaccinations without sufficient indication • 28% were given inadequate tetanus prophylaxis

  10. Audit Results

  11. Audit Results • Of the patients given inadequate prophylaxis, 20% were given Revaxis alone, which should have been given in conjunction with Human Tetanus Immunoglobulin (HTIG) • 4% with a high risk wound received Revaxis when they should have received only the HTIG. • A further 4% with a high risk wound received no prophylaxis despite an indication for HTIG

  12. 4/5ths of the inappropriate managements were initiated by referring hospitals, illustrating the need for further education on current prophylactic guidelines in the management of tetanus prone injuries.

  13. Implementing change • Education of burns and plastics SHO’s during induction. • Posters with guidelines in order to prompt prophylaxis. • Education to hospitals within our locality particularly A&E departments. • Modification of current admission proforma to allow correct classification of tetanus status.

  14. Tetanus immunisation guidelines

  15. Summary • Majority of pt’s will be fully immunised or up-to-date and will only require prophylaxis if High risk wound – HTIG (not Revaxis) • If pt has not completed primary immunisations or is not up-to date – give HTIG and Revaxis • If any doubt about immunisation status – Give both HTIG and Revaxis

  16. The end • Any questions?

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