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Bites - human and animal - Management
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How should I assess a bite?
- Document how and when the bite occurred.
- Examine the bite, and document its location, appearance, and any damage to underlying structures (e.g. arteries, nerves, tendons, or joints).
- Determine whether the person is at increased risk of the wound becoming infected, either due to the nature of the bite or due to a medical condition (e.g. diabetes, immunosuppressed status).
- Assess whether the wound is infected. The following may be present: redness, swelling, serosanguinous or purulent discharge, pain, localized cellulitis, lymphadenopathy, or fever.
- Determine tetanus status.
- For human bites: assess whether there is a risk of acquiring a blood-borne viral infection (e.g. hepatitis B or C, or HIV).
- In most cases, the status of the biter will not be known, and it is often not practical to obtain a blood sample for testing. There is a higher risk of acquiring a blood-borne virus if:
- The biter is known to be HIV positive, hepatitis B surface antigen (HBsAg) positive, or hepatitis C positive.
- The biter is likely to be a high-risk person, such as an intravenous drug user.
- Assess the status of the person who has been bitten:
- Ask if they are known to be HIV positive, hepatitis B surface antigen (HBsAg) positive, or hepatitis C positive.
- Check their vaccination status for hepatitis B.
- It is essential to obtain an X-ray in people with the following:
- Clenched fist injuries, to exclude the presence of teeth or dental fragments, and to rule out bone damage.
- Crush injuries, suspected fractures, bites where a foreign body is a possibility.
- For animal bites: assess the risk of acquiring rabies, and discuss the need for post-exposure prophylaxis urgently with the Virus Reference Department of the Health Protection Agency (telephone 020 8327 6017).
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