Misuse of tetanus immunoprophylaxis in wound care

We prospectively studied medical personnel compliance with antitetanus prophylaxis in 211 patients with wounds in three emergency departments. The guidelines were incorrectly followed in 13.4% of the patients, with 88.9% of the mistakes resulting from overimmunization. The most common mistake was the practice of giving tetanus and diphtheria toxoid (Td) to a patient with a clean wound who had complete primary immunization and a booster within ten years. This mistake accounted for 63% of the mistakes. The next most common, accounting for 18.5%, was the practice of giving Td and tetanus immune globulin to the never-immunized patient who had sustained a clean wound. Overimmunization increases the possibility of adverse reactions, and undertreatment places the patient at risk for tetanus.