Education is key to help protect patients from animal bites

Issue: January 2015

NEW YORK — Educating patients on animal interaction and pet selection is one way physicians can contribute to the prevention of animal bites, according to a presenter at the 2014 Infectious Diseases in Children Symposium.

Animal bites account for 1% of ED visits and often come from household pets, according to Margaret C. Fisher, MD, medical director of the Unterberg Children's Hospital at Monmouth Medical Center. Approximately 90% of animal bites are from dogs, and 3% to 15% are from cats.

Margaret C. Fisher

Children aged 5 to 9 years are most at risk for bite injuries, according to statistics posted on the CDC website, with injuries occurring predominantly on the hands and arms. Among children aged 4 years or younger, a majority of bite injuries were to the head/neck region.

Treatment measures to address bites

“Risk for infection is pretty high,” Fisher said during her presentation. “For dogs, risk for infection is up to 20% and for cats risk of infection is up to 80%.”

Along with infection, animal bites can cause tissue and bone damage, psychological stress, skin and soft tissue and skeletal infections, clenched fist injury and nail biting injury.

To decrease risk for infection and prevent injury, Fisher reviewed steps physicians should take when caring for patients with animal bites.

When a patient presents with an animal bite, physicians should immediately clean the affected area thoroughly with soap and water, anesthetize the area and remove damaged tissue. When considering if the wound should be closed, physicians should be mindful that the presence of sutures significantly increases the risk for infection. If the wound is clean, however, closing it poses little risk for adverse outcomes.

“If you are going to use a drug, you need to name the bug before you pick the drug,” Fisher advised regarding antibiotic use. “However, if the patient doesn’t come to you within 24 hours and there is no sign of infection, you probably don’t need to administer an antibiotic.”

Also, Fisher noted, when “naming the bug,” consider the type of animal, as different animals carry different bacteria in their mouths.

Preventive vaccinations for animal bites

Immunizations also must be considered when managing patients with animal bites. If a patient has received less than 3 prior doses of tetanus vaccine or if tetanus vaccination status is unknown, vaccination should be administered. If a patient has received 3 or more doses of tetanus vaccine previously, tetanus vaccination is not necessary, according to Fisher.

When determining whether rabies prophylaxis is needed, bats, skunks and other wildlife should be considered rabid, indicating the need for prophylaxis. Livestock, rodents and rabbits should be determined rabid on a case-by-case basis.

The first symptom of rabies is tingling at the bite site, according to Fisher. Rabies can cause hydrophobia, encephalitis, paralysis and death.

Rabies vaccination requires four doses, administered on days 0, 3, 7 and 14.

Patient education and prevention

To prevent animal bites, Fisher encouraged physicians to educate their patients. Approach animals cautiously, do not touch pets while they are eating, avoid wild animals, and do not tease or provoke any animal, she recommended.

Patients also should be counseled on the type of pets they choose. Exotic and wild animals do not make good pets, Fisher noted, and amphibians and reptiles have been increasingly associated with infection, particularly salmonella. Children who are immunocompromised may have further pet restrictions.

“Most animal bites are by dogs or cats that the child actually knows,” Fisher said. “Remember to include education about pets and approach to animals in general information given during well-visits.”

For more information:

Fisher M. “Animal bites: Suturing, antibiotics, and rabies considerations.” Presented at: IDC NY 2014; Nov. 22-23; New York.

Disclosure: Fisher reports no relevant financial disclosures.