175 Bite Wounds 86 Definition A break in the skin from the teeth of an animal, human, snake, or spider resulting in abra- sions, punctures, scratches, or lacerated wounds. Of major concern in all bite wounds is local infection caused by bacteria, viruses, rickettsia, spirochetes, fungi, and toxins. In addition, cellullitis and sepsis are potential complications of bite wounds. Characteristics Bite wounds may exhibit superficial skin breaks with no bleeding, puncture-type wounds (from sharp pointed teeth), major lacerations, or crush injuries. A bite from a non-poisonous snake can cause infection or allergic reaction in some people. Bite marks from most spiders are small and not easily seen common symptoms include pain, small puncture wound, red- ness, itching, and swelling that lasts several days. Depending on the severity of the bite, dog bites may cause crush-type wounds because of the rounded teeth and strong jaws of the animal. Depending on the extent and location of the bite, damage may occur to bones, ves- sels, tendons, muscles, and nerves. A potential bite outcome is rabies, an almost invariably fatal, acute viral encephalomyelitis, which may be transmitted to humans by infected saliva or other secretions from an animal. Policy Evaluate employee in the occupational health unit and provide treatment or refer for med- ical care as appropriate. Always assess the employee’s immunization status for tetanus when a bite occurs. If the bite was caused by a domestic or wild animal, immediately report the bite to local health authorities and animal control (rabies vaccine may be needed). Assess if employee is allergic to snake bites. Poisonous snake bites are medical emergencies. Objectives Clinical Assessments and Interventions Referral for Medical Action ● Deep or puncture-type wounds. ● Bites on the face, hand, or foot. ● Bites with extensive injury. ● Increased redness, drainage, or if flu-like symptoms, including fever and swollen glands, occur. ● Bites from suspected/unknown rabid animal. If rabies is sus- pected, contact local health de- partment for information on the risk of rabies for each species of animal in a particular area. ● Bites that involve potential HBV or HIV exposure. ● Bites from all poisonous spiders, like brown recluse or black widow. ● Snake bite. Determine extent and severity of the bite. ● Assess the extent and nature of the bite wound (animal, human, spider, snake) and the body part involved. ● Obtain history of the bite and any self- treatment. If the injury was caused by an animal, inquire about type of animal and its status (health, rabies vaccination if known, behavior), type and location of bite event, circumstances surrounding the bite incident (provoked or defensive bite versus unprovoked), time elapsed since the bite, and whereabouts of the animal. If the ani- mal is known to the employee, obtain name and phone number of owner. ● If the employee has received a human bite, try to determine whether the biter is HIV or hepatitis B infected, or if the biter is from a high-risk group for infection transmission. Guideline continues on next page