Red Book: Table 2.18. Prophylactic Management of Human or Animal Bite Wounds to Prevent Infection

Table 2.18. Prophylactic Management of Human or Animal Bite Wounds to Prevent Infection

Table 2-18

Category of Management	Management
Cleansing	Sponge away visible dirt. Irrigate with a copious volume of sterile saline solution by high-pressure syringe irrigation.^a
	Do not irrigate puncture wounds. Standard Precautions should be used.
Wound culture	No for fresh wounds, unless signs of infection exist.
	Yes for wounds more than 8-12 h old and wounds that appear infected.^b
Radiographs	Indicated for penetrating injuries overlying bones or joints, for suspected fracture, or to assess foreign body inoculation.
Débridement	Remove devitalized tissue.
Operative débridement and exploration	Yes if one of the following: • Extensive wounds (devitalized tissue) • Involvement of the metacarpophalangeal joint (closed fist injury) • Cranial bites by large animal
Wound closure	Yes for selected fresh, nonpuncture bite wounds (see text)
Assess tetanus immunization status^c	Yes
Assess risk of rabies from animal bites^d	Yes
Assess risk of hepatitis B virus infection from human bites^e	Yes
Assess risk of human immunodeficiency virus from human bites	Yes
Initiate antimicrobial therapy^g	Yes for: • Moderate or severe bite wounds, especially if edema or crush injury is present • Puncture wounds, especially if penetration of bone, tendon sheath, or joint has occurred • Facial bites • Hand and foot bites • Genital area bites • Wounds in immunocompromised and asplenic people • Wounds with signs of infection
Follow-up	Inspect wound for signs of infection within 48 h

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Table 2.18. Prophylactic Management of Human or Animal Bite Wounds to Prevent Infection

Last updated: October 20, 2009

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