Management of unscheduled tetanus prophylaxis in Emergency Departments: Point-of-Care implementation as a rapid tool for the evaluation of anti-tetanus antibodies

Background and aim: Each analytical activity, including those carried out in Point of Care (POCT) must be, at law, under the control of Laboratory Medicine. Before the implementation of the rapid tetanus quick stick (TQS) test for the evaluation of the specific tetanus immunisation, a multi-disciplinary and multi-professional group was created. The aim of this study was to evaluate the ability of Emergency Department (ED) staff to manage and correctly understand the result of TQS test in POCT.
Materials and Methods: This analysis took into consideration 152 patients admitted to ED with traumatic wounds; information on the state of tetanus immunisation at their arrival wasn’t recorded. Blood sample analysis was performed twice. The Laboratory confirmed a 100% concordance between their results and ELISA test (standard criterion). Study design consisted of 2 phases: the first one (50 test) to preliminarily evaluate if any corrective action or improvement of procedures is required, and the second one (102 tests) to confirm the quality of corrective actions.
Results: The concordance of results between TQS test in Laboratory and POCT test in ED was 80% in the first phase and 95% in the second one.
Conclusions: The use of the rapid TQS test is a valuable tool; however, to avoid serious mistakes of interpretation, periodic checks on the quality of the results must be arranged.