Why you should read this article:

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To understand that accurate risk assessment of patients who present to emergency departments (EDs) with a laceration, wound or bite is vital to identify tetanus prone wounds and administer prophylactic treatment

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To learn why many of the prophylactic tetanus treatments administered in EDs may be unnecessary

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To reflect on why healthcare teams in EDs may be contributing unwittingly to administering avoidable tetanus prophylaxis

Tetanus infection is caused by the Clostridium tetani bacterium, which can enter the body through a wound or puncture in the skin. Patients who present to an emergency department (ED) with a laceration, wound or bite require a risk assessment to determine whether the wound is clean, tetanus prone or high-risk tetanus prone. Those assessed as tetanus prone or high-risk tetanus prone, with an uncertain or inadequate immunisation history, should receive tetanus prophylaxis treatment. However, some patients receive this treatment unnecessarily. This article describes a service evaluation that explored whether practice in one ED was contributing to potentially avoidable tetanus prophylaxis treatment. The article outlines the results of a five-year retrospective database review, which determined that 18% of all tetanus prophylaxis treatments delivered in the ED during that period were unnecessary. The author makes some recommendations to improve practice.