title: Development of a clinical path for the emergency care of hand bite injuries without signs of infection.
abstract: The care of bite injuries has not currently reached a consensus, including in our department. The goal of this study was to evaluate our current care of bite injuries by an assessment of professional practices (APP), then formulate and validate a flowchart to standardize our practices.
  
  
  
  During a first round of file reviewing, 30 files were randomly selected and then evaluated using a 15 item auditing form (group 1). A flowchart was then designed to standardize the care of hand bite injuries and released in our department. Six months later, 30 new files were randomly selected and evaluated using the same auditing form (group 2).
  
  
  
  When comparing the results of the 15 items before and after the release of the flowchart, 7 items reached 100% in group 2. The wounds were described more precisely, signs of severity were systematically researched and the antibiotic treatment was standardized. Two items decreased but did not reach 0%: systematic prescription of bacteriologic swabs and X-rays. Using these results the flowchart was improved.
  
  
  
  Our results showed an improvement of the care of hand bites for 11 items, including 5 that were statistically significant. This flowchart enabled to standardize our practices and could be used in other emergency departments.
authors.affiliation: Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 10 Avenue Baumann, 67400 Illkirch, France.
authors.forename: A
authors.initials: A
authors.lastname: Koutsomanis
authors.affiliation: Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 10 Avenue Baumann, 67400 Illkirch, France.
authors.forename: J J
authors.initials: JJ
authors.lastname: Hidalgo Diaz
authors.affiliation: Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 10 Avenue Baumann, 67400 Illkirch, France.
authors.forename: P
authors.initials: P
authors.lastname: Vernet
authors.affiliation: Pôle de Santé publique, Secteur méthodologie et biostatistiques, Hôpitaux Universitaires de Strasbourg, France.
authors.forename: F
authors.initials: F
authors.lastname: Séverac
authors.affiliation: Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 10 Avenue Baumann, 67400 Illkirch, France. Electronic address: Philippe.liverneaux@chru-strasbourg.fr.
authors.forename: P
authors.initials: P
authors.lastname: Liverneaux
authors.affiliation: Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 10 Avenue Baumann, 67400 Illkirch, France.
authors.forename: S
authors.initials: S
authors.lastname: Facca
mesh_terms: D000328:Adult; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001733:Bites and Stings / Q000628:therapy*; D002985:Clinical Protocols; D004636:Emergency Service, Hospital; D005260:Female; D006230:Hand Injuries / Q000628:therapy*; D006801:Humans; D065186:Interrupted Time Series Analysis; D008297:Male; D008485:Medical Audit; D008499:Medical Records / Q000592:standards; D008875:Middle Aged
chemical_list: D000900:Anti-Bacterial Agents
keywords: Assessment of professional practices; Bite injuries; Hand; Prophylactic antibiotic treatment