How to assess and treat human and animal bites – and when to use antimicrobials
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How to assess and treat human and animal bites – and when to use antimicrobials

Erin Dean Health journalist

Essential information

Human and animal bites are an infection risk and are seen relatively frequently in emergency departments (EDs) and primary care. Dog and human bites are the bites most commonly seen in EDs and can cause significant tissue damage.

Nursing Standard. 36, 5, 59-59. doi: 10.7748/ns.36.5.59.s26

Published: 05 May 2021

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Picture credit: iStock

What’s new?

The National Institute for Health and Care Excellence (NICE) has published guidance on treating and assessing human and animal bites. It sets out when antibiotic prophylaxis is needed and which to prescribe. Different approaches are required depending on the source of the bite.

Assessment

Assess the type and severity of the bite, including what caused it, the site and depth of the wound and if it is infected. Assess the risk of tetanus, rabies or a blood-borne viral infection and take appropriate action. Manage the wound with irrigation and debridement as necessary. For bites from exotic pets or animals with which you are unfamiliar, consider seeking specialist advice from a microbiologist.

Risk factors

Children are the most represented group in dog bite injuries, with the highest incidence in mid-to-late childhood, according to the World Health Organization. Risk of injury to the head and neck from dog bites is greater in children than adults, adding to the potential severity and the death rate.

Most human bites occur during physical fights that involve punching, according to the NHS.

High-risk areas for bites to become infected include the hands, feet, face, genitals and skin overlying cartilaginous structures or an area of poor circulation, NICE says. High risk also applies to those more likely to develop a serious wound infection because of a comorbidity, such as diabetes, immunosuppression or asplenia.

How you can help your patient

  • » Antibiotics should be offered if a bite has drawn blood and considered if a human or cat bite has broken the skin but not drawn blood.

  • » Antibiotics should be considered if a dog bite has caused considerable deep tissue damage, or if the wound is visibly contaminated (for example, with dirt or a tooth), is in a high-risk area, or the patient is at high risk of infection.

  • » Antibiotics should be offered if there are signs or symptoms of infection, such as discharge, inflammation, fever or an unpleasant smell.

  • » Take a swab for microbiological testing if there is discharge (purulent or non-purulent).

  • » Refer the patient to hospital if there are signs of serious illness, such as severe cellulitis, abscess, osteomyelitis, necrotising fasciitis or sepsis, or a penetrating wound involving bones, joints, tendons or vascular structures. Consider referral if they have an infection after taking prophylactic antibiotics, are systemically unwell, cannot take oral antibiotics or the infection does not respond to antibiotics.

  • » Reassess the bite if signs of infection develop or worsen rapidly or significantly at any time, do not improve within 24-48 hours of starting treatment, or the person becomes systemically unwell or has severe, disproportionate pain.

  • » Be aware of potential safeguarding issues in vulnerable adults and children.

Expert comment

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Carole Young lead tissue viability specialist nurse, Cambridge University Hospitals NHS Trust

‘Bites are a common problem that lead people to seek healthcare.

‘The NICE guidance provides useful, straightforward advice on when antibiotics are needed and which should be given. The type of wound can vary a lot, depending on what has done the biting, and it can be extremely serious.

‘Dogs tend to cause the most complex wounds, with shearing and pulling of tissues, and often cause a more irregular wound. Human bites are quite different, and create puncture wounds, and there is quite a high risk of someone leaving a tooth behind in the wound.

‘Assessments need to be holistic, taking into account comorbidities that could put someone at higher risk of infection, and it is really important to find out what did the biting, when it happened and how long has passed since it happened.’

Find out more

National Institute for Health and Care Excellence: Human and animal bites: antimicrobial prescribing guideline

World Health Organization: Animal bites: advice

NHS: Advice on animal and human bites

More essential clinical updates rcni.com/clinical-update

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