Appropriate tetanus prophylaxis practices in patients attending Emergency Departments in Italy.

Objective: This study evaluated the physician compliance with tetanus prophylaxis and immunization practices for patients with wounds attending Emergency Departments (EDs) of four randomly selected non-academic acute care public hospitals in Italy.

Methods: All presenting patients (> or = 16 years) within randomly selected week periods were studied. Physician and nurse, who were not involved in care, interviewed each patient regarding: socio-demographics, wound characteristics, and tetanus immunization history; they also collected, through direct observation, data of the physician practices for tetanus prophylaxis and immunization.

Results: A total of 29.8% patients had a wound tetanus-prone and this was more frequently observed in those lower educated, who arrive at the ED with medical referral during daytime and in the weekday, whose injury occurred outdoor, who had not completed the primary vaccination series or has received a booster dose < or =10 years before, and for a wound in abdomen, pelvis, and lower extremity. Overall, 54% of the physicians recorded for each patient information about the characteristics of the wound and the tetanus immunization history and this was more frequently for those patients traumatized outdoor, injured less than 1h before, when the wound was non-tetanus-prone, and less frequently when the wound site was head and neck. Only 1.5% of the physicians correctly adhere to guidelines on tetanus prophylaxis and immunization in wound management and this more frequently adopted for younger patients' and when the physician recorded information about tetanus immunization history.

Conclusion: Health policies and programs should be aimed at improving the quality of health care.