Tetanus-prone wounds

Although any wound may result in tetanus, the likelihood of harbouring tetanus spores and of developing the anaerobic and acidic conditions that promote spore germination is considered to be low in clean wounds (e.g. - clean cuts) (1)

Tetanus prone wound is defined as:

• puncture-type injuries acquired in a contaminated environment and likely therefore to contain tetanus spores e.g. gardening injuries
• wounds containing foreign bodies
• compound fractures
• wounds or burns with systemic sepsis
• certain animal bites and scratches - although smaller bites from domestic pets are generally puncture injuries animal saliva should not contain tetanus spores unless the animal has been routing in soil or lives in an agricultural setting

Note: individual risk assessment is required and this list is not exhaustive e.g. a wound from discarded needle found in a park may a tetanus-prone injury but a needle stick injury in a medical environment is not

High-risk tetanus-prone wounds include:

• Any of the above with either:
  • heavy contamination with material likely to contain tetanus spores e.g. soil, manure
  • wounds or burns that show extensive devitalised tissue
  • wounds or burns that require surgical intervention that is delayed for more than six hours are high risk even if the contamination was not initially heavy

Reference:

• (1) Department of Health (DH). Immunisation against infectious disease. 'The Green Book' Chapter 30 (April 2019)