15 40 Definition Highly fatal disease caused by the organism Clostridium tetani, a gram-positive, spore- forming, anaerobic bacillus found in soil, human and animal excrement, and household dust. The bacillus enters the circulatory system through an open wound, which can be tiny but usually is a deep puncture or cut, and excretes a toxin that greatly increases the irritabil- ity of the central nervous system. The incubation period lasts from 2 days to 2 weeks and possibly longer. Characteristics Stiffness of the jaw, difficulty swallowing, stiff neck, restlessness, irritability, headache, fever, and convulsions are apparent. Progresses to severe muscle spasms and seizures and (without treatment) to eventual respiratory arrest. Policy Tetanus immunization status must be assessed when caring for an employee with any wound. Maintain current standing orders before administering a tetanus booster. Routine booster dose of vaccine is recommended every 10 years. Objectives Clinical Assessments and Interventions Referral for Medical Action Tetanus Prophylaxis ● No standing order for tetanus tox- oid. ● Tetanus immunoglobulin if not adequately immunized. ● Signs of wound infection. ● Signs of tetany. ● Hypersensitivity to tetanus toxoid. Follow-up Actions ● Observe injection site for reac- tion. ● Assess employee wound for infec- tion and refer if needed. ● Provide employee with wound care as necessary. ● Educate employee regarding im- portance of tetanus booster. ● Record immunization in em- ployee health folder. Prevent tetanus infection. ● Assess injury and treat employee per Guideline 80, Abrasion and Laceration, page 163. ● Administer tetanus toxoid injection per standing order as soon as possible after an injury, preferably within 24 hours. ● As with administration of any medication, verify allergy history. ● Provide maximal protection—a series of three toxoid injections* followed by peri- odic boosters per standing order (refer to schedule on following page). *The initial series of three toxoid injections are considered the primary series and are recommended as part of childhood vaccination. Most adults in the United States have received the series however, a percentage of older adults remain not having received the primary series. Also, immigrants from Third World countries may not have received the three primary vaccinations. A primary series is the first two doses at least 4 weeks apart and the third dose 6–12 months after the second.