What to do if you are bitten by a dog? Beijing CDC reminds you: Early wound treatment is very important

People's Daily Online, Beijing, September 9 (Reporter Sun Hongli) Dog bites are the most common type of animal injuries. In addition to non-specific infections, they can also cause special infections such as rabies, tetanus, and gas gangrene. According to the "Common Animal Injury Diagnosis and Treatment Guidelines (2021 Edition)" issued by the National Health Commission, correct early wound treatment, preventive antibiotics for contaminated wounds, and prevention of rabies, tetanus and other diseases according to needs and immunization history are the basic principles for treating dog bites.

In autumn, dog bites and other injuries enter a high incidence period. The Beijing Center for Disease Control and Prevention reminds that wound treatment is not only conducive to the recovery of important anatomical structures and functions, but also an important measure to prevent wound infection, tetanus and rabies. Clinicians must pay enough attention to wound treatment to avoid unnecessary complications.

The Beijing Center for Disease Control and Prevention said that there is evidence that even without the use of rabies passive immunization agents, more than 99% of patients can survive through effective wound cleaning, immediate rabies vaccination and completion of post-exposure prophylaxis procedures.

Dog bite wound treatment

Actively bleeding wounds should be controlled with direct pressure and a neurovascular assessment should be performed distal to the wound. Wounds deep to vital structures should be treated as severe penetrating injuries.

Wound irrigation and cleaning

Use soapy water (or other weak alkaline cleaning agents) and running water at a certain pressure to clean all bites alternately for about 15 minutes, then use sterile gauze or cotton wool to absorb any residual liquid in the wound. If the pain is severe during cleaning, local anesthesia can be given. If conditions permit, use professional cleaning equipment to flush the inside of the wound to ensure effective flushing. Finally, rinse the wound with saline to avoid residual soapy water or other cleaning agents in the wound.

Disinfection

After thorough rinsing, apply or clean the inside of the wound with dilute iodine or other medical preparations that have the ability to inactivate viruses to inactivate the rabies virus remaining in the wound.

Debridement and expansion

Dog bite wounds, especially lacerations, are cleaned to remove necrotic tissue and, if necessary, dilated. Puncture wounds can be dilated as necessary to ensure the effectiveness of the cleansing. The method of wound closure varies to a certain extent depending on the type of bite. Scratches and simple puncture wounds do not require primary closure. For simple lacerations, clinicians can adopt primary wound closure. If aesthetics are required, such as facial lacerations, clinicians can also choose primary repair for such wounds.

Proper wound care is essential for improving outcomes and reducing the risk of infection in patients undergoing primary wound closure. When suturing bite wounds, adequate irrigation, debridement, avoidance of deep sutures (if possible), antibiotic prophylaxis, and close follow-up are required.

Delayed Closure

Wounds older than 6 hours and wounds in patients prone to infection (such as those with impaired immunity, asplenia or splenic dysfunction, venous congestion, and adult diabetes) are not recommended for primary wound closure. In early treatment, wound cleaning and devitalized tissue debridement are performed, bite wounds are left open for drainage, and dressings are changed regularly. Delayed closure can be performed after 72 hours of injury depending on the wound condition.

Preventing tetanus

Dog bite wounds are contaminated wounds with a high chance of tetanus infection. Tetanus prevention should be carried out according to Appendix 1 "Guidelines for the Use of Post-Traumatic Tetanus Vaccines and Passive Immunization Preparations" in the "Guidelines for the Diagnosis and Treatment of Non-Neonatal Tetanus (2019 Edition)".

Preventing rabies

Dog bites are the main route of rabies infection and may lead to infection and disease. Rabies prevention should be carried out according to the current standards and guidelines for rabies exposure prevention and treatment.