This survey shows that the overall prevention ability of posttraumatic tetanus in Ningxia is insufficient, which is reflected in the low ability of medical personnel to master the correct prevention methods of tetanus and the low rate of standardized treatment of tetanus, which has nothing to do with the working years of the respondents, the grade of the hospital where they work, and their professional and technical titles, which is consistent with the research results of Li Jieying[7]. It is suggested that the lack of tetanus prevention and treatment ability is a widespread problem in Ningxia, and it is urgent to attract the attention of medical industry and health authorities.
In this questionnaire, occupation is one of the factors affecting the correct cognition of tetanus prevention. This is mainly due to the fact that in the traditional medical relationship, doctors, as the prescriptor of drug treatment and medical orders, occupy a dominant position in medical activities, and nurses often passively implement medical orders, so nurses have a low awareness of the prevention norms of tetanus[8]. As the first person responsible for receiving trauma patients, doctors made decisions on the severity of the patient's trauma, the degree of post-injury pollution, and the collection of patient's medical history data. The doctors directly determined the prevention methods of tetanus for this patient. With the continuous development and standardization of the medical industry, the requirements for nurses are constantly increasing. As the implementer of medical orders, nurses should give full play to their subjective initiative, actively participate in relevant academic activities, constantly update their knowledge, and play an important role in reviewing medical orders before implementation, raising questions about irregular handling, and health education for patients with posttraumatic tetanus. In order to standardize the prevention and treatment of posttraumatic tetanus and improve medical treatment.
As one of the influencing factors for tetanus, the possible reason is that in China, the first treatment department for trauma patients is mainly the emergency department, so the medical staff in the emergency department have to see more and deal with more than those in other departments, so the master rate of standard prevention of tetanus is higher. The most common sources of tetanus include surgical: trauma, surgery, burns, etc., but also include medical conditions such as: Chronic ulcers, chronic suppurative otitis media, etc., and the risk of tetanus after animal bites is very high, especially in mammals[1, 9]. Therefore, the training and education of tetanus prevention and treatment should not be limited to surgeons, emergency doctors, burn doctors, etc., but should also include physicians in the training to strengthen the training of tetanus prevention and treatment.
Tetanus is a specific infectious disease that can be prevented by vaccines, and timely and standardized wound debridement can significantly reduce the adverse prognosis of tetanus[10]. Relevant literature reported that about 87.8% of patients with posttraumatic tetanus did not go to the hospital for wound treatment after injury[11]. The research results of Dai Cheng[12] showed that the mortality rate of patients who underwent standard wound debridement was significantly lower than that of those who did not. A common feature can also be found in many reports of tetanus: the wounds after contamination were not treated with timely standard debridement [13–17]. Therefore, standardized wound management is very necessary. The results of this questionnaire show that the trained medical personnel have a higher degree of correct understanding of tetanus prevention and can reduce the unreasonable use of TAT[18]. Therefore, relevant units should further increase training efforts and investment, and add the standard prevention and treatment rate of tetanus into the daily assessment mechanism. In order to reduce the waste of medical resources, medical workers should be encouraged to practice in a standardized manner.
The hospital where the author works is a third class A hospital. In the daily diagnosis and treatment work, the author found that the low rate of prevention and disposal of broken wind norms in addition to the factors of the medical staff themselves, but also the problems of the patients and the hospital itself, the vaccination cycle is long, but the hospital that can vaccinate is less qualified, so vaccination needs to pay in addition to money costs, as well as time and commuting costs. Many patients refuse tetanus vaccines because they believe they only need short-term protection and will not face exposure for decades to come. Therefore, in addition to strengthening the professional ability of medical personnel, it is necessary to strengthen the popularization of science among citizens, so that the people can understand what kind of wounds need tetanus prevention, how to choose the appropriate tetanus prevention, and improve the overall protection awareness of the masses, so as to promote the prevention and treatment of tetanus. The abuse of TAT, TIG and other passive immune agents can increase the waste of medical resources and increase the risk of adverse reactions[19].
Through the analysis of the case data of trauma patients treated in the General Hospital of Ningxia Medical University, it was found that almost no patients were asked about their vaccination history before tetanus preventive treatment, which means that almost all tetanus preventive vaccination is determined by medical workers according to medical experience whether patients need to give tetanus active or passive immunization. According to statistical data, only 11.75% of patients were given active tetanus immunization, while more than 50% were given passive tetanus immunization, regardless of the nature of their wounds and immunization history. Among the patients who were given TAT for passive immunization, the positive rate of TAT skin test was as high as 16%, which means that medical risks coexist on the basis of huge waste of medical resources, which is consistent with the conclusions of many previous studies[20–23].
In the analysis of patients who were treated in the General Hospital of Ningxia Medical University in need of tetanus prevention after trauma, by comparing the animal injury group with the non-animal injury group, and the posttraumatic tetanus normative prevention group with the non-normative prevention group, it was found that the patients who underwent posttraumatic tetanus normative prevention had the following characteristics: The age was younger, the injury type was animal bite or scratch, the wound nature was contaminated wound, and the injury site was face and limb. The possible reason is that most of the animal injuries were to young people, and the injury site was mainly face and limb. This is consistent with the findings of other studies[24–26], and may be because pet owners tend to be younger, and younger people today are more concerned about their health and do not want to expose themselves to risk. Therefore, the absorption rate of adsorbent tetanus vaccine is higher in younger age groups.