This page provides clinical guidance on bite wounds for health professionals.
The following information about bite wounds is taken from 3D Regional HealthPathways, accessed April 2020:
- Assess the wound according to the general wound care pathway.
- Consider risk factors for infection:
• If the bite occurred while overseas, consider rabies virus.
• If a human bite, consider blood-borne viruses e.g., hepatitis B and C, HIV.
• Wound infection risk factors.
- Ask about any anxiety related to the injury and consider whether the patient is at risk of further injuries from the same source.
• If there are clinical signs of infection, take a wound swab, or collect pus aspirate. Provide appropriate clinical details – these are very important as they alert the laboratory to specifically look for unusual organisms.
• Consider arranging X‑ray for clenched fist injuries, crush injuries, possible fractures, or foreign body.
- If suspected HIV, or hepatitis B or C exposure, seek acute infectious diseases advice. See also blood or body fluid exposures.
- If suspected rabies exposure, seek acute infectious diseases advice.
- Decide whether there are any indications for specialist management or discussion:
• If the bite involves the face or upper limb distal to the elbow, request acute plastic surgery assessment.
• If suspected joint or bone involvement other than the face or upper limb distal to the elbow, request acute orthopaedic assessment.
• Otherwise, request assessment based on whether the wound is likely to require soft tissue debridement, reconstruction, or a skin graft:
♦ If the wound is likely to require significant soft tissue debridement, reconstruction, or a skin graft, request acute plastic surgery assessment, or
♦ If not, request acute orthopaedic assessment or acute general surgery assessment as appropriate.
• If unsure, seek plastic surgery, orthopaedic, or general surgery advice as appropriate.
- If symptoms or signs of infection:
• If localised wound infection:
♦ treat with oral antibiotics.
♦ see wound infections.
• If spreading or systemic infection, see cellulitis.
- Provide analgesia, if required.
- Manage the wound:
• Irrigate the wound thoroughly using sterile saline or potable water. Consider using a topical wound cleansing solution – see wound management products.
• Consider risks and benefits of primary closure, or delayed primary closure.
• Dress with an antimicrobial dressing – see wound management products.
• Provide tetanus-prone wound management, if necessary.
- Consider the need for prophylactic antibiotics.
- Manage any anxiety, as these patients are at risk of flashbacks, nightmares, and post-traumatic stress syndrome.
- Ensure the patient is not at risk of further injury from the same source. If there are concerns about non-accidental injury, see Assault or Abuse.
- Complete an ACC form.
- Bite wounds 3D Regional HealthPathways, NZ, 2020