The guidelines provided by the New York State Workers Compensation Board offer fundamental principles for managing human bites, animal bites, and associated lacerations. These directives are intended to assist healthcare professionals in identifying appropriate therapeutic approaches within the context of a comprehensive assessment.
Healthcare professionals with expertise in managing human bites, animal bites, and associated lacerations can rely on the guidance outlined by the Workers Compensation Board to make well-informed decisions about the most suitable therapeutic methods for their patients.
It is important to emphasize that these guidelines are not intended to replace clinical judgment or professional expertise. The final decision regarding the management of human bites, animal bites, and associated lacerations should involve collaboration between the patient and their healthcare provider.
Human Bites, Animal Bites and Associated Lacerations
Types of Bites and Professions at Risk
Bites can stem from both human and animal sources, with certain professions facing higher susceptibility. These include veterinarians, animal handlers, law enforcement officers, and others who interact closely with animals. Human bites are prevalent among caregivers, educators, and in scenarios involving workplace violence.
Concerns and Diseases Associated with Bites
Aside from causing tissue damage, animal bites pose a significant risk of infection, with additional concerns about diseases such as rabies, cat scratch fever, and exposure to blood-borne pathogens. Factors such as the location and depth of the wound, as well as the time before treatment, can influence infection rates.
Guidelines for Physical Examination
Thoroughly documenting the circumstances of the bite, including the type of animal involved and the location, helps inform treatment decisions. It’s crucial to assess the individual’s immunization status for tetanus and rabies and administer prophylaxis as necessary. A comprehensive medical history, including any underlying conditions, guides appropriate treatment.
Diagnostic Approaches
Routine wound culture and sensitivity testing for both animal and human bites are not recommended, as they have limited predictive value for infection or subsequent treatment efficacy.
Medications
NSAIDs for Pain Management
- Use for Animal or Human Bites Pain: It’s recommended to utilize Non-Steroidal Anti-inflammatory Drugs (NSAIDs) for managing pain stemming from acute, subacute, or chronic bites from animals or humans.
- Indications: NSAIDs are suggested for treating pain associated with conditions like acute wrist sprain. Over-the-counter options should be considered first.
- Frequency/Duration: Patients can use NSAIDs on an as-needed basis. Discontinuation may occur upon symptom resolution, lack of efficacy, or the emergence of adverse effects.
NSAIDs for Patients at Risk of Gastrointestinal Bleeding
- Recommendation: NSAIDs should be accompanied by cytoprotective drugs like misoprostol, sucralfate, histamine Type 2 receptor blockers, or proton pump inhibitors for patients prone to gastrointestinal bleeding.
- Indications: High-risk patients, such as those with a history of gastrointestinal bleeding, the elderly, diabetics, and smokers, should receive cytoprotective medications alongside NSAIDs.
- Frequency/Dose/Duration: Proton pump inhibitors, misoprostol, sucralfate, and H2 blockers are recommended. Dosage and frequency should align with manufacturer guidelines.
NSAIDs for Patients at Risk of Cardiovascular Adverse Effects
- Recommendation: Patients with cardiovascular disease or multiple risk factors should discuss the risks and benefits of NSAID therapy. Acetaminophen or aspirin is recommended as the first-line therapy for minimizing cardiovascular adverse effects.
- Preferred NSAIDs: Non-selective NSAIDs are preferred over COX-2 specific drugs. When low-dose aspirin is part of cardiovascular disease prevention, NSAIDs should be taken at least 30 minutes after or 8 hours before aspirin.
Acetaminophen for Pain Management
- Recommendation: Acetaminophen is recommended for managing pain from animal and human bites, especially in patients with NSAID contraindications.
- Indications: All patients with bite-related pain can use acetaminophen, including those with acute, subacute, chronic, or post-operative pain.
- Dose/Frequency: Follow manufacturer recommendations; use as needed. Caution should be exercised not to exceed four grams per day due to potential hepatic toxicity.
- Discontinuation: Cease usage upon pain resolution, adverse effects, or intolerance.
Opioids
- Not Recommended: Opioids are not advised for treating pain from animal or human bites.
Initial Care
Blood Borne Pathogen Protocol for Human Bites
- Recommendation: Evaluate and treat exposures that could potentially transmit viral blood borne pathogens according to standard protocols.
- Rationale: Traumatic bite lacerations, which could pose a high risk of transmitting viral blood borne pathogens such as HIV, HBV, or HCV, should be considered for testing and prophylaxis. Timely administration of prophylactic antivirals substantially reduces the risk of transmission from HIV-contaminated blood.
Prophylactic Antibiotics for Dog Bite Wounds
- Recommendation: Administer prophylactic antibiotics for all dog bite wounds.
- Indication: Applicable to all dog bites.
- Dose/Frequency: Various antibiotics have shown efficacy in quality studies, including penicillin VK, cloxacillin, dicloxacillin, erythromycin, co-trimoxazole, cephalexin, and amoxicillin/clavulanate. Strong Gram-positive coverage is essential.
Prophylactic Antibiotics for Treatment of Human Bite Wounds
- Recommendation: Prophylactic antibiotics are recommended for treating human bite wounds.
- Rationale: Due to the higher reported incidence of wound infections associated with human bites, prophylactic treatment is deemed appropriate. Broad-spectrum oral antibiotics are suggested to cover typical staphylococcal and streptococcal species.
Prophylactic Antibiotics for Treatment of Cat Bite Wounds
- Recommendation: Administer prophylactic antibiotics for cat bite wounds.
- Rationale: Reported infection incidence rates from cat bites range from 20 to 40%, with potentially significant complications. Broad-spectrum antibiotics that cover Pasteurella multocida, the most common pathogen contracted from cat bites, may be necessary.
