Bites from mammals, such as dogs, cats, monkeys, bats and humans, are common and can cause infections. There are 4.5 million people bitten by dogs every year, with 885,000 seeking medical care, and cat bites make up to 50 per cent of animal-bite injuries across the world (World Health Organisation, 2018). Bacteria can cause skin infection or complications to the whole body, such as sepsis or tetanus. Depending on the local context, first aid providers may also need to consider the risk of rabies.
Guidelines
Good practice points
- People should avoid approaching stray or wild animals and take extra care to keep their hands from getting bitten.
- Bleeding from an animal bite should be treated as per the guidelines for Severe bleeding.
- Depending on availability, the first aid provider should clean the wound with either potable (clean) water, saline, or soap and water. Ideally, human and animal bite wounds should be cleaned with potable water and soap to minimise the risk of bacterial and rabies infections.
- The person should seek further medical care as soon as possible if vaccination or skin closure is required.
- If available, a pressurised water source should be used to clean the bite area (e.g., from a tap, squirting device or water bottle).
- If warmth or pain develops around the bite area, this is an indication of infection and the person should seek medical advice immediately. The bite area should be monitored as infection can happen in the hours or days after the bite occurs.
Chain of survival behaviours
Prevent and prepare
- Avoid approaching stray or wild animals.
- If there is a prevalence of rabies in the area, people should follow the advice of local health authorities.
- Be aware of specific diseases transmitted by animals in your area (rabies, anthrax, hantavirus, bovine, encephalopathy, etc.).
- Always supervise babies and children around animals.
Early recognition
- The person has visible teeth marks on their skin.
- The person tells you they were bitten by an animal or human.
First aid steps
- If the wound is bleeding, apply pressure to the wound to stop the bleeding. Follow the steps for Severe bleeding. Once the bleeding has stopped, complete the rest of the steps listed here.
- Clean the bite wound with potable (clean) water as quickly as possible, using a pressurised water source. If no or insufficient water is available, use a disinfectant.
- Dry the area around the wound and apply a sterile dressing.
Access help
- Seek further medical care as soon as possible if skin closure is required.
- If the injured person has not been vaccinated against tetanus, seek further medical care.
- If rabies is prevalent in the area and the injured person has not been vaccinated against it, seek further medical care.
- Monitor for signs of infection. If warmth or pain develops around the bite area, seek medical advice.
Recovery
- Change the dressing on the bite area as necessary.
- Seek psychological support if necessary.
Education considerations
Context considerations
- In areas where animal bites are common, include this topic to raise awareness. Learners should know the preventative actions, potential effects of, and treatment for animal bites. Emphasise caution when in areas with stray or wild animals.
- When relevant, demonstrate the signs of a rabid dog and how to behave in the presence of one.
- Depending on the availability of resources, the first aid provider should clean the wound with either potable water, saline or soap and water.
Facilitation tips and tools
- Practise how to clean the wound as this may increase learners’ confidence to do it themselves.
- Emphasise the importance of long-term wound care to prevent infection.
- Online or printed visuals of bite wounds, including ones that are and are not infected, may help learners to identify this type of wound in the future.
- Suggest local psychological support resources to help people affected by bite incidents involving aggressive animals or humans.
- Educational materials should reflect discussions with local public health authorities regarding the need for vaccinations.
Scientific foundation
Systematic reviews
The Centre for Evidence-Based Practice (CEBaP) performed four independent searches in 2019. No relevant studies on the use of wound irrigation for human or cat bites could be identified. For the use of wound irrigation for dog bites, one retrospective cohort study showed limited evidence in favour of wound irrigation. It was shown that irrigation of a dog bite with saline resulted in a significant decrease of wound infection, compared to no irrigation. Evidence is of very low certainty (downgraded for risk of bias and indirectness) and results cannot be considered precise due to the low number of events.
Non-systematic review
Potable (clean) water, saline and soap and water solutions are irrigants that benefit an animal bite. There are no direct comparisons between these different interventions. The literature reviewed in the section for Cuts and grazes also supports irrigation as a method to prevent infection.
Despite multiple recommendations in literature reviews and common clinical practices, there is no evidence for the use of povidone-iodine to treat an animal bite.
References
Systematic reviews
Centre for Evidence-Based Practice. (2019). Evidence summary: Dog bite – Wound irrigation (first aid). Belgian Red Cross-Flanders. Available from: https://www.cebap.org/knowledge-dissemination/first-aid-evidence-summaries/
Centre for Evidence-Based Practice. (2019). Evidence summary: Human bite – Wound irrigation (first aid). Belgian Red Cross-Flanders. Available from: https://www.cebap.org/knowledge-dissemination/first-aid-evidence-summaries/
Centre for Evidence-Based Practice. (2019). Evidence summary: Cat scratch or bite – Wound irrigation (first aid). Belgian Red Cross-Flanders. Available from: https://www.cebap.org/knowledge-dissemination/first-aid-evidence-summaries/
Centre for Evidence-Based Practice. (2019). Evidence summary: Rabies. Belgian Red Cross-Flanders. Available from: https://www.cebap.org/knowledge-dissemination/first-aid-evidence-summaries/
Non-systematic review
World Health Organisation. (2018). Fact sheet: Animal bites. Retrieved from https://www.who.int/news-room/fact-sheets/detail/animal-bites
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Published: 15 February 2021
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