Frequency and Factors Associated with Adult Immunization in Patients Visiting Family Medicine Clinics at a Tertiary Care Hospital, Karachi

Assessing the impact of the 2018 tetanus guidelines on knowledge and practices of emergency physicians in trauma patients: a national survey study

Background

Tetanus remains a significant public health issue in China, with the approach of anti-tetanus prophylaxis in the emergency department resulting in both overuse, particularly of human tetanus immune globulin (TIG), and underuse with the tetanus vaccine. This is largely due to the absence of updated guidelines on tetanus prophylaxis before 2018. Our study aimed to evaluate the effects of the 2018 Chinese tetanus guidelines on the knowledge and practices of emergency physicians about tetanus prevention in trauma patients.

Methods

From November 2019 to April 2020, we conducted a web-based survey involving 499 emergency physicians. The survey included a questionnaire covering knowledge, attitudes, and practices related to tetanus. We assessed the influence of the 2018 tetanus guidelines on the knowledge and practices of emergency physicians related to tetanus prevention for patients with trauma using multiple regression analysis.

Results

The survey results showed that only 45.3% of the participants had received formal training on tetanus immunization, despite 53.3% reporting the availability of tetanus vaccines at their institutions. Physicians typically prescribed tetanus antitoxin or human TIG instead of tetanus toxoid (TT) to treat injuries, regardless of the patient's TT vaccination history. Among the respondents, those who were aware of the 2018 tetanus guidelines had higher mean scores on the general knowledge, risk knowledge, and treatment knowledge scales, with increases of 6%, 13%, and 9%, respectively, compared to those who were unaware of the guidelines. Awareness of the 2018 tetanus guidelines was associated with a high level of knowledge, as indicated by the general knowledge score, recommendation knowledge score, and total knowledge score, after adjusting for the effects of all variables on the knowledge, attitudes, and practices of the participants. A high level of education was also associated with a high level of knowledge indicated by the recommendation knowledge score and total knowledge score.

Conclusions

Our study highlights a substantial gap in the attitudes, knowledge, and practices of emergency physicians in China regarding tetanus immunization. The results suggest an urgent need to promote the Chinese Expert Consensus Guidelines on tetanus to improve emergency physicians' knowledge and competence in tetanus prophylaxis. The findings underscore the importance of enhancing physicians' awareness of the latest guidelines to ensure appropriate and effective treatment for patients with tetanus-prone injuries.

Insufficient knowledge and inappropriate practices of emergency doctors towards tetanus prevention in trauma patients: a pilot survey

China has a shocking number of tetanus cases in the world, but little research has investigated doctors’ knowledge of and practices in tetanus prophylaxis, especially tetanus vaccination. To this end, we conducted a pilot study on 197 emergency doctors using a mixed method of web-based (163; 82.8%) and paper-based (34; 17.2%) surveys. There was no difference between the two groups except for the percentage of doctors receiving a tetanus booster in the past 10 years and the responses to question 11. Surprisingly, only 28.9% of doctors had received formal training on tetanus immunization and only 21.3% had themselves received a tetanus vaccine booster in the past 10 years. Furthermore, only 14.2% of the respondents confirmed the availability of the tetanus vaccine in their respective institutions. Finally, the correct rates and Tetanus-immune-globulin (TIG)-only option rates for questions 11–15 were unsatisfactory. Our results showed that most emergency doctors’ knowledge and practices strayed from the recommendations of Advisory Committee on Immunization Practices (ACIP): 1) TIG alone for most trauma patients instead of vaccine was an overused treatment approach. 2) Most of the emergency doctors lacked formal training on and knowledge of tetanus vaccination. 3) Even the emergency doctors themselves were not properly vaccinated. 4) The tetanus vaccine was only available in a small number of the respondents’ institutions. The findings of this study suggest an urgent need to improve this dire situation.