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Animal Bites Nursing Guide

Content reviewed by Ann Dietrich, MD, FAAP, FACEP.

Animal bite etiology and epidemiology 

Animal bites, primarily from domestic animals, are a common cause of emergency department (ED) visits. Dog and cat bites account for over 95% of all bite injuries treated in EDs (Holzer et al., 2019). In the U.S., dog bites lead to approximately 340,000 ED visits annually, with children and adolescents aged 5 to 15 being the most frequent victims (CDC, 2018).  

While wild animal bites are less common, bites from any animal pose a risk of serious complications, particularly if they involve deeper tissue or if the victim is immunocompromised. 

Types of injuries 

  • Dog bites: Often result in crushing-type wounds due to the strong jaw pressure, which can cause significant tissue damage. 
  • Cat bites: Typically cause puncture wounds that can drive bacteria deep into tissues, increasing the risk of infection. 

Common bacterial infections 

Animal bites can introduce various bacterial strains, including: 

  • Pasteurella 
  • Staphylococcus 
  • Streptococcus 
  • Bacteroides 
  • Clostridium 
  • Enterobacter 
  • Neisseria 
  • Moraxella 
  • Haemophilus 
  • Fusobacterium 

Animal bite Complications 

Complications arising from animal bites include: 

  • Infection: Common and potentially severe. 
  • Meningitis: If the infection spreads to the central nervous system. 
  • Nerve damage: From deep or crushing wounds. 
  • Osteomyelitis: Bone infection. 
  • Rabies: A viral infection that is almost always fatal if not treated promptly. 
  • Sepsis: A life-threatening response to infection. 
  • Septic arthritis: Infection within a joint. 

Diagnosis 

Diagnosis of animal bites typically involves: 

  • Wound culture: To identify the causative bacteria in infected wounds. 
  • Blood tests: 
    • Erythrocyte Sedimentation Rate (ESR) 
    • C-reactive Protein (CRP) 
    • White Blood Count (WBC) 
  • Imaging: 
    • X-rays to assess bone involvement. 
    • Cervical films in children if shaken injury is suspected. 
  • Other studies: Blood cultures or a sepsis workup may be needed depending on the patient’s condition. 

Animal bite management 

Initial treatment 

  • Wound care: Includes debridement, irrigation, and inspection for foreign bodies or underlying structural involvement. 
  • Suturing: Should be done cautiously; often delayed or avoided in highly contaminated wounds. 
  • Prophylaxis: 
    • Tetanus: Vaccine administration is necessary if the patient’s immunization status is unknown or outdated. 
    • Rabies: Post-exposure prophylaxis and immunoglobulin are necessary if the biting animal is suspected to be rabid. 

Antibiotics 

Antibiotics are essential in managing animal bites to prevent or treat infection. Common choices include: 

  • Amoxicillin/clavulanate (Augmentin®) 
  • Amoxicillin (Trimox®, Amoxil®) 
  • Cephalexin (Keflex®) 
  • Sulfamethoxazole/trimethoprim (Bactrim®) 
  • Clindamycin (Cleocin®) 
  • Ciprofloxacin (Cipro®) 
  • Azithromycin (Zithromax®) 
  • Doxycycline (Vibramycin®) 
  • Metronidazole (Flagyl®) 

Surgical intervention 

  • Severe injuries: May require surgical debridement, especially if there is significant tissue loss or involvement of critical areas such as the face or hands. 
  • Plastic surgery: Consultation may be necessary for cosmetic or functional repair. 

Animal bite nursing care plan 

Assessment 

  • Incident details: Circumstances, time of the event, and any pre-hospital treatment. 
  • Animal information: Type, current location, health status, and vaccination history. 
  • Wound evaluation: Check for bone involvement, foreign bodies, joint space involvement, and neurological status. 
  • General condition: Assess for signs of systemic infection, such as fever, and check vital signs. 

Animal bite nursing diagnoses 

  • Anxiety 
  • Alteration in tissue perfusion 
  • Impaired skin integrity 
  • Pain 
  • Risk for infection 
  • Ineffective breathing (related to asphyxia in severe cases) 

Interventions 

  • Wound care: Clean and irrigate the wound as directed. 
  • Prophylaxis: Administer tetanus and rabies vaccines as indicated. 
  • Monitoring: Regularly monitor vital signs and assess for signs of infection or worsening condition. 
  • Emotional support: Provide reassurance and support, particularly for children and their parents. 
  • Education: Educate the patient and family on signs of infection, the importance of follow-up care, and preventive measures. 

Expected outcomes 

  • Infection prevention: The patient remains free from infection. 
  • Increased awareness: The patient understands the signs and symptoms of infection and the importance of following medical advice. 
  • Risk reduction: The patient recognizes and avoids behaviors that increase the risk of animal bites. 

Individual/caregiver education 

  • Signs of infection: Redness, swelling, warmth, or pus around the wound; fever; or increased pain. 
  • Animal behavior: Recognizing warning signs in animals to prevent bites. 
  • Antibiotic compliance: Importance of completing the full course of prescribed antibiotics. 
  • Follow-up care: Understanding the need for follow-up appointments, especially if symptoms worsen. 
  • Animal safety: Proper care and handling of pets to prevent bites. 
  • Vaccination: Importance of keeping tetanus vaccinations up to date. 

ICD-10 Code for Animal Bites 

  • W54.0XXA – Bitten by dog, initial encounter 
  • W55.01XA – Bitten by cat, initial encounter

FAQs

Additional Information

Content Release Date 

4/1/2022

Content Expiration

12/31/2027

References 

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