Tetanus-prone wounds

Thorough cleaning of wounds is essential.

A tetanus-prone wound includes:

• puncture-type injuries acquired in a contaminated environment and likely therefore to contain tetanus spores e.g. gardening injuries, needles in the community
• wounds containing foreign bodies such as wound splinters  
• 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 rooting in soil or lives in an agriculture setting. See also Bites, human + animal

A high risk tetanus-prone wound is defined as a wound/burn with any one of the above criteria plus:

• 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.

Confirm the patient’s vaccine status. For further information about the NHS national vaccination schedule see Complete routine immunisation schedule from 1 January 2025 - GOV.UK

Some groups of patients are considered as “Not immunised or immunisation status unknown or uncertain”. These include:

• Injecting drug users where there is any doubt to their immunisation status. This group may be at high risk from tetanus-contaminated illicit drugs. 
• Patients who are immunosuppressed, even if fully vaccinated in the past.

For those whose immunisation status is uncertain, and individuals born before 1961 (they may have not been immunised in infancy), a full course of immunisation is required.