print logo

Go to whole of WA Government Search

You are here » Home » For health professionals » Emergency Department Guidelines » Tetanus prone wounds

Tetanus prone wounds

Disclaimer

These guidelines have been produced to guide clinical decision making for the medical, nursing and allied health staff of Perth Children’s Hospital. They are not strict protocols, and they do not replace the judgement of a senior clinician. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline. 

Read the full CAHS clinical disclaimer

Aim

To guide staff with the assessment and management of tetanus prone wounds.

Background

Tetanus can follow apparently trivial, even unnoticed wounds. However, some wounds tend to favour the growth of tetanus organisms; these include:

  • Compound fractures
  • Deep penetrating wounds
  • Bite wounds
  • Wounds containing foreign bodies (especially wood splinters)
  • Wounds complicated by pyogenic infections
  • Wounds with extensive tissue damage (e.g., burns)
  • Any superficial wound obviously contaminated with soil, dust or animal manure
  • Tooth re-implantation.

Contraindications2

  • Anaphylaxis following a previous dose of any tetanus containing vaccine
  • Anaphylaxis to any component of the tetanus vaccine 

Alternative measures including the use of tetanus immunoglobulin can be considered if a person with a tetanus prone wound has had a severe adverse event following a tetanus vaccine. If there are concerns regarding previous adverse reactions this can be discussed with the on-call immunologist for further advice.

Assessment

Table 1: Guide to Tetanus Prophylaxis in Wound Management3

Vaccination history

 Type of wound  Tetanus vaccine booster Tetanus immunoglobulin
3 or more doses < 5 years since last dose Clean minor wounds No  No
 < 5 years since last dose All other wounds No No*
5-10 years since last dose Clean minor wounds No No
5-10 years since last dose
 All other wounds Yes No*
> 10 years since last dose Clean minor wounds Yes  No
> 10 years since last dose All other wounds Yes No*
< 3 doses or uncertain Uncertain Clean minor wounds Yes No
Uncertain All other wounds Yes Yes

*Patients with humoral immune deficiency and those with HIV (regardless of CD4+ count) are recommended to receive tetanus immunoglobulin if they have a tetanus prone wound, regardless of the time since their last dose of tetanus-containing vaccine.

Management

All wounds should receive appropriate first aid and managed as relevant (see Lacerations (PIC), Bites - Animal and human bites (PIC), Burns, Dental trauma)

Tetanus vaccination1

  • Tetanus toxoid vaccines in Australia are only available in combination with diphtheria and other antigens.
  • If a child has not had 3 or more doses of tetanus vaccine (or if there is uncertainty) and meets the criteria outlined in Table 1 above:
    • A patient < 10 years of age should be given diphtheria-tetanus-acellular pertussis combination vaccine (DTPa) (e.g. Tripacel®), intramuscularly (IM) at a dose of 0.5 mL
    • For infants < 6 weeks of age refer to the Infectious Diseases Department (internal WA Health only) for advice.
    • A patient ≥ 10 years of age should be given diphtheria-tetanus-acellular pertussis combination vaccine (reduced antigen formulation) (dTpa) (e.g. Boostrix® or Adacel®), IM at a dose of 0.5 mL.
  • If a patient is given a tetanus vaccination and is not up to date with DTPa/dTpa vaccines according to the Australian Immunisation register (AIR), they should be given a copy of their AIR Immunisation history statement (which includes the vaccines overdue) and be advised to complete these immunisations with a community immunisation provider or at the PCH Stan Perron Immunisation centre (Level 1 clinic D, week days).

Tetanus Immunoglobulin (TIG)3

  • TIG is used for passive protection of people who have not had three or more doses of tetanus vaccine or where there is any uncertainty regarding immunisation status who have a tetanus prone wound.
  • The dose (irrespective of age and weight) is:
    • 250 international units if ≤ 24 hours since injury
    • 500 international units if >24 hours since injury
  • Administer by slow IM injection, using a 23 gauge needle because of its viscosity.
  • TIG is not needed for clean minor cuts, even if the person has no history of tetanus vaccination.
  • A tetanus vaccine must be given as well as the TIG in the opposite limb. This combination provides both active and passive protection. Arrangements should be made for catch up vaccines if required.
  • At PCH, TIG is available from the Transfusion Medicine Unit. To order, contact the transfusion medicine scientist and provide patient details and clinical history.
  • Refer to the Transfusion Medicine Protocols for further information.

Nursing

Vaccines should be given, as follows:

  • Refer to the Australian Immunisation Handbook – vaccination procedures.
  • As per the Immunisations procedure (above); verbal or written consent is required from the parent/legal guardian prior to administering vaccinations and this must be documented in the patient’s medical record.
  • Vaccines are prescribed on the once only section of the paediatric Hospital Medication Chart (pHMC) by the doctor and given by either a doctor or nurse according to CAHS medication policies and procedures. Vaccines are prescribed using brand names e.g., Boostrix® / Adacel®, Tripacel®.
  • Recipients of vaccines should remain under close observation for at least 15 minutes to ensure they do not experience an immediate adverse event.
  • Immediately notify medical staff of adverse events following immunisations.
  • It is mandatory to report adverse events to the Western Australian Vaccine Safety Surveillance system.
  • Document adverse event in the patient’s medical record as per the CAHS Allergy and Adverse Drug Reaction Management Policy (internal WA Health only)

Record vaccine/s given in the following documentation

  • Australian Immunisation Register (AIR) online. At PCH refer to the Immunisations procedure regarding the process.
  • Personal health record book or provide a WA Childhood Vaccination Record Card.
  • Patient medical notes.

Further immunisation advice can be obtained by contacting one of the following PCH staff:

Bibliography

  1. Australian Centre for Disease Control. Australian Immunisation Handbook 10th Edition. Australian Government Department of Health and Ageing. 2020. [Internet]. [Cited 26 May 2026. Available from: The Australian Immunisation Handbook
  2. Australian Centre for Disease Control. Australian Immunisation Handbook 10th Edition. Australian Department of Health and Ageing. Tetanus. 2019. [Internet]. [Cited 26 May 2026]. Available from: Tetanus | The Australian Immunisation Handbook
  3. Australian Centre for Disease Control. Australian Immunisation Handbook 10th Edition – Table. Guide to tetanus prophylaxis in wound management. 2023. Australian Government Department of Health and Ageing. [Internet]. [Cited 26 May 2026]. Available from: Table. Guide to tetanus prophylaxis in wound management | The Australian Immunisation Handbook


Endorsed by:  Director, Emergency Department  Date:  May 2026


 Review date:   May 2029


This document can be made available in alternative formats on request for a person with a disability.

Related CAHS internal policies, procedures and guidelines

Useful resources

Back to top
Home  |   Privacy  |   Copyright  |   Disclaimer  |   About us  |   Ministers' website  |   Contact us