A Farm Worker with a Dirty Wound

A 24-year-old man from Russia presents with a wound on his left forearm sustained whilst working on a farm the day before yesterday. The wound has been cleaned under a tap but still contains some debris and dirt. You clean the wound carefully and prescribe antibiotics. He has never received a prior tetanus vaccination.

1. What constitutes a tetanus prone wound?

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Tetanus prone wounds include:

  • Puncture wounds
  • Wounds over 6 hours old
  • Dirty wounds
  • Wounds with significant devitalized tissue
  • Avulsions
  • Open fractures
  • Gunshot wounds
  • Crush injuries
  • Burns

2. Which tetanus prone wounds require tetanus immunoglobulin?

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Tetanus prone wounds only require tetanus immunoglobulin (TIG) if there is an unknown history of tetanus prophylaxis, less than 3 doses of tetanus toxoid have been given in the past or it is over 5 years since the last dose.

The preventative dose of tetanus immunoglobulin is 250 IU in most cases, unless over 24 hours have passed since the injury or the wound is heavily contaminated, then 500 IU should be given.

3. How would you manage this patient’s tetanus risk?

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In this case the patient has a contaminated, tetanus prone wound that is over 24 hours old. He should therefore receive the higher dose of tetanus immunoglobulin and the vaccination. His GP should be also contacted to arrange the remainder of course as indicated.

For further information about tetanus prophylaxis please refer to the following reference: Green Book Tetanus Overview