Originally published in The Ottawa Citizen April 29, 2003

Original Title: The big gaping maw

As warmer weather approaches, children will be spending more time playing outdoors. So will dogs.

Although there are dog leash laws in Ottawa and the majority of dog owners are responsible, dog bites remain the most common animal bite seen in our hospitals. The Canada Safety Council estimates there are 460,000 dog bites in Canada every year, almost half of them involving children.

The Canadian Hospitals Injury Reporting and Prevention Program states animal bite injuries account for one per cent of all emergency room visits, with dogs accounting for 85 per cent of all these wounds.

Boys five to nine years old sustain the most dog bites –they account for 28.5 per cent of all bitten people. And almost one-third of the time, bites occur between 4 p.m. and 8 p.m. during summertime.

The victim usually knows the dog. Eighty-five per cent of all dog and cat bites come from the family’s or a neighbour’s pet. Thirty-four per cent of attacks occur at the victim’s home and 30 per cent at a friend’s house. Provoking the animal accounts for half of all bite attacks.

Our children are more susceptible to serious injury because they are lower to the ground. Head, face and neck bites account for 70 per cent of the cases. Forty per cent of all bites in children are facial.

Over half of all attacks were minor requiring little treatment. A third needed medical follow-up after leaving the emergency department and one in 20 required admission to hospital.

The wound care for dog and cat bites vary. Dog bites cause lacerations, punctures and crush injuries. Cat bites commonly puncture the skin. Cat bite punctures have a high risk of bacterial infection; three to 18 per cent of dog bites become infected versus 28 to 80 per cent of cat bites.

There are several initial steps to care for a dog or cat bite. First, use soap and water and gently wash the wound.

Use a clean towel when applying direct pressure to stop the bleeding of the injured part. Apply a sterile bandage to the wound.

To reduce swelling and prevent infection, try to keep the injured part raised above the level of the heart.

Consult your doctor no later than eight to twelve hours after the bite injury for an evaluation. It may require oral antibiotic therapy. Report the incident.

Cat bites (not scratches) warrant a visit to your doctor because of their high risk of infection. Deep or gaping lacerations, bites to the hand, foot or head or any signs of infection like swelling, worsening pain, a spreading area of redness, fever or oozing of pus from the wound require immediate attention. Seek medical advice and treatment if the bleeding does not stop despite 15 minutes of direct firm pressure or if you suspect nerve damage, broken bones or a severe soft tissue crush injury.

People with underlying medical conditions that compromise their body’s wound healing capability such as cancer, lung disease, diabetes, liver disease or hepatitis, AIDs or other conditions that weaken the ability to fight infection should consider every bite as serious and warranting medical attention.

Your doctor’s approach to any bite injury is to ascertain the risk of infection, clean and remove any damaged tissue (debride the wound) if necessary and to determine whether to stitch it closed or leave it open to heal. The doctor will explore the wound to determine if there is damage to deeper structure like nerves and tendons.

Deep penetrating cat bites through joint spaces, bones or tendons, bites to the face, hands, feet and genitalia and wounds requiring surgical repair usually need an oral antibiotic to prevent infection.

Antibiotic ointments like Fucidin and Bactroban work well for dog and cat bite wounds with low risk of infection. Get a tetanus vaccine booster if your last one was more than five years ago. It is best to schedule a follow-up visit one to two days after the initial assessment.

If the injury is severe, the wound fails to heal or the infection spreads despite oral antibiotics, you will likely require hospitalization. In these cases, intravenous antibiotics and an assessment from a plastic surgeon is usually in order.

Rabies shots are rarely required for dog and cat bites. The decision to vaccinate against rabies is a concern of the public health department and the medical officer of health.

Preventing animal bites continues to be an area in need of improvement. Young children need constant supervision in the presence of any pet. Animals that are eating, fighting amongst themselves or appear sick should be left alone.

When choosing a dog, pick a family-friendly dog. Veterinarians, professional dog breeders or dog trainers are an excellent resource.

© Dr. Barry Dworkin 2003