St Andrew's ambulatory care strategy for animal & human bite injuries & localised infections

Abstract

Background: Infected animal bites and localised infections are traditionally managed by inpatient admission, intravenous antibiotics, and localised washout +/- debridement. Our hand trauma protocol was modified to accommodate the challenges faced in delivering this pathway during the COVID-19 pandemic.

Objective: To evaluate the outcomes of two management pathways, ambulatory (2020) vs inpatient (2019), at a single tertiary referral centre.

Method: Data were prospectively collected (March - July 2020), and compared to data held for the previous year (March - July 2019). Only referrals for animal or human bites and infections were included (adult and paediatric patients); particular focus was placed on patient antibiotic administration, subsequent management and clinical progress.

Results: There were 254 patient referrals and 200 operations between March - July 2019 (2019 group, n = 166) and March - July 2020 (2020 group, n = 88). A higher proportion of patients had ambulatory care management in the 2020 versus 2019 group (76.1 %, 67/88 vs. 42.8 %, 71/166; p < 0.001). A lower proportion of patients received intravenous antibiotics in the 2020 versus 2019 group (25.0 %, 22/88 vs. 54.2 %, 90/166; p < 0.001). The proportion of operatively managed patients were similar in the 2019 and 2020 groups (76.5 %, 127/166 vs. 72.7 %, 64/88; p = 0.51). There was no significant difference in complications (9 %, 15/166, vs. 4.5 %, 4/88; p = 0.195), or re-admission rates (3.6 % %, 6/166 vs. 2.3 %, 2/88; p = 0.56) in the 2019 versus 2020 groups.

Conclusion: An ambulatory care treatment pathway for carefully selected patients with non-severely infected animal bites and localised infections, has comparable outcomes to routine admission for intravenous antibiotics and surgery.

Level of evidence: III.

Keywords: Ambulatory care; Animal bite; Hand infection; Hospitalisation; Plastic; Surgery.