title: Audit of tetanus prevention knowledge and practices in accident and emergency departments in England.
abstract: OBJECTIVE
  To assess the knowledge and current tetanus prevention practices of various staff members in accident and emergency (A&E) departments.
  
  
  METHODS
  A structured questionnaire containing 16 questions on tetanus guidance, anti-tetanus practice, vaccination preparations and information on the population served by the department was sent to medical and nursing staff in A&E departments across England.
  
  
  RESULTS
  366 completed questionnaires from 67 hospitals were returned. 48.9% of the questionnaires were completed by the medical staff and 39.9% by the nursing staff at various grades. 75% of respondents said that their department had a local tetanus guideline, but only 29% stated that the tetanus guidelines were always followed. 31.4% of respondents said that injecting drug users were managed as a high-risk group in their department. Many respondents did not follow the national policy; they tended to err on the side of caution when it came to defining and treating tetanus-prone wounds, with 22.1% stating that they would consider any wound tetanus prone. Contrary to current Department of Health guidelines, 46.2% of respondents said that they would give a booster dose if the fifth dose had been given >10 years ago.
  
  
  CONCLUSIONS
  There are clear differences between the recommended guidelines for tetanus prevention and current practice in A&E departments. The changes announced in 2002 do not seem to have been widely implemented. As a result, the apparent success of the national tetanus vaccination programme may be the result of more cautious clinical practice than would be expected from the UK policy. If national recommendations for tetanus are implemented in clinical practice, then the impact on control of the disease should be monitored closely.
authors.affiliation: Immunisation Department, Centre for Infections, Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ, UK. emma.savage@hpa.org.uk
authors.forename: Emma J
authors.initials: EJ
authors.lastname: Savage
authors.forename: Stephen
authors.initials: S
authors.lastname: Nash
authors.forename: Anne
authors.initials: A
authors.lastname: McGuinness
authors.forename: Natasha S
authors.initials: NS
authors.lastname: Crowcroft
mesh_terms: D002983:Clinical Competence / Q000706:statistics & numerical data; D004635:Emergency Medicine / Q000706:statistics & numerical data; D016529:Emergency Nursing / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004739:England; D019983:Guideline Adherence / Q000706:statistics & numerical data; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008485:Medical Audit; D016134:Organizational Policy; D010607:Pharmacy Service, Hospital / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D013742:Tetanus / Q000517:prevention & control*; D013745:Tetanus Toxoid / Q000008:administration & dosage
chemical_list: D013745:Tetanus Toxoid