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Question regarding Tetanus Prophylaxis


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I have a question regarding when to administer tetanus immune globulin and am wondering if anyone has any insight on this. According to the guidelines, a person should get TIG if they have any wound that is not considered clean and minor if they have had less than 3 doses to tetanus vaccine (or if they do not know their immunization status). My question is in regards to what is considered a "clean and minor" wound. I realize anything that is contaminated with dirt/feces/saliva is considered dirty, but I am specifically wondering about splinters and minor burns. The reason I am asking this is because I work in an Occ Med clinic  where workers come in with minor issues (such as splinter removals) and some are not immunized. TIG is very expensive and the only way for them to get it in my area is to go to the ED for it. I am just wondering if it is overkill to send someone to the ED for TIG for something as minor as a splinter if they're not up to date on tetanus. And in regards to burns, is any partial thickness burn, no matter how small, considered tetanus prone and therefore warrants TIG in some cases? 

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  • 2 weeks later...

I had a similar question on this. We don't give Ig in our office. We'd have to send them to ER to get that.  I had an adult patient who had a finger would from a stable gun.  His Tdap was over 5 years ago andI just gave him a Td to be safe.

 

But here's what I got from a colleague 

 

booster + Ig after 10 years (*more than 10 years last dose)
 
only booster if between > 5-10 years
 

Ig also for severely immunocompromised

 

I also heard if the wound is very dirty and tdap is unknown, just send them to ER for Ig.

I think if it's just a splinter or mild burn, it's safe to not have them go to ER just for an Ig.

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