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Initial assessment, investigation and wound care

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

  • initial clinical assessment includes:
    • documenting the timing and nature of the bite and the animal (including if result of human) involved, any immunosuppression, and any known antibacterial allergies
    • if the bite is particularly severe
      • before a detailed clinical assessment, a patient may require urgent first aid treatment (e.g. to control bleeding)
    • examine wound and adjacent structures for infection; foreign bodies (e.g. broken teeth, especially in deep or crush wounds); damage to blood vessels, nerves, tendons, joints or bones; and lymphadenopathy
      • diagrams and masurements and diagrams may be helpful, particularly to document the extent of cellulitis in established infections
  • identification of infective organisms:
    • swabs should be obtained from potentially contaminated or clinically infected bite wounds
    • blood cultures should also be taken for microbial culture under aerobic and anaerobic conditions if the patient is systemically unwell
      • prolonged culture for up to 7 days may be required to allow for the growth of certain anaerobic Porphyromonas spp (formerly classified within the Bacteroides spp) - therefore it is important to inform the laboratory of the nature of the injury and what sort of mammal bit the patient
      • additional culture for mycobacteria and fungi may be required when wounds are contaminated by soil, vegetative debris or water from ponds, lakes or aquaria; or if the patient is immunosuppressed, including by HIV infection; or if the patient has a wound that does not respond to antibacterial therapy
      • after a human bite, sequential serum samples may be required from the patient to check for hepatitis or HIV seroconversion
  • initial wound care:
    • should include immediate irrigation with normal saline (or running drinking water if saline is not available)
    • hydrogen peroxide solution or povidone iodine are also sometimes used - however these are not recommended for large or deep wounds
    • if a person has an infected, inflamed or oedematous wound on the limbs, a human bite to the hand, or a cat-bite puncture wound over or near a joint (especially on the hands), the respective limb(s) should be elevated

Note1: if the bite is from a macaque monkey, and so could have transmitted simian herpes virus, then advice should be sought from a clinical virologist or from the Health Protection Agency.

Reference:

  1. Drug and Therapeutics Bulletin (2004);42:65-72.

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The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

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