Point-of-care tetanus immunoassay : an audit of unscheduled tetanus prophylaxis

Abstract

Tetanus is a life threatening non-communicable infection caused by the anaerobic bacillus tetanus clostridium which enters the body through a wound. The World Health Organisation (2006) aim to eradicate tetanus incidence globally is supported by the implementation of national vaccination programmes. The United Kingdom population receive tetanus prophylaxis through a robust vaccination infrastructure and unscheduled tetanus prophylaxis when patients present to emergency departments following penetrating injury. However, individual patient recall of tetanus immune status is problematic. The decision to prescribe tetanus prophylaxis is dependent on accurate assessment of a tetanus-prone wound and current tetanus immunity status so one solution is the use of tetanus immunoassay. This paper presents an analysis of expenditure on unscheduled tetanus prophylaxis in two emergency departments at one NHS Foundation Trust in the North of England. Consideration is given to potential benefits of single step point-of-care tetanus immunoassay using one drop of the patient’s blood. Cost-savings were limited however critical to the discussion is the impact of tetanus immunoassay on patient choice. Any prospective change to an A&E departments’ tetanus prophylaxis practise must guarantee no less a level of seroprotection than necessary and preferably should enhance individual patients’ safety, comfort and choice.