Bite wounds

The following information about bite wounds is taken from 3D Regional HealthPathways, accessed April 2020:

Assessment

1. Assess the wound according to the general wound care pathway.
2. 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.
3. Ask about any anxiety related to the injury and consider whether the patient is at risk of further injuries from the same source.
4. Investigations:
   • 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.

Management

1. If suspected HIV, or hepatitis B or C exposure, seek acute infectious diseases advice. See also blood or body fluid exposures.
2. If suspected rabies exposure, seek acute infectious diseases advice.
3. 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.
4. If symptoms or signs of infection:
   • If localised wound infection:
       ♦ treat with oral antibiotics.
       ♦ see wound infections.
   • If spreading or systemic infection, see cellulitis.
5. Provide analgesia, if required. 
6. 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.
7. Consider the need for prophylactic antibiotics.
8. Manage any anxiety, as these patients are at risk of flashbacks, nightmares, and post-traumatic stress syndrome.
9. 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.
10. Complete an ACC form.

Learn more

Infected bite wounds The Pink Book, NZ
Animal bite DermNet, NZ
Human bite DermNet, NZ
Dog and cat bites Patient Info, UK
Human bites Patient Info, UK

References

1. Bite wounds 3D Regional HealthPathways, NZ, 2020