Wounds that are contaminated with soil, debris, feces, or saliva are at increased risk for tetanus. Puncture wounds or wounds that contain devitalized tissue are at increased risk of infection with C tetani. This includes wounds that result from cruch injury, frostbite, burns, or avulsion. All wounds should be adequately cleaned, foreing material removed, and debrided if necrotic or devitalized tissue is present or if residual foreign matter is present. The decision to use tetanus toxoid-containing vaccine or human tetanus immune globulin depends on the type of injury and the tetanus immunization status of the patient. tetanus immune globulin should be used in children with fewer than three previous tetanus toxoid immunizations. who have tetanus-prone wounds, and should be administered to HIV-infected Children with Tetanus-prone wounds, regardless of their immunization history. When tetanus immune globulin is indicated for wound prophylaxis 250 units are given intramuscularly. If tetanus immunization is incomplete, a dose of age-appropriate vaccine should be given. When both are indicated, tetanus toxoid and tetanus immune globulin shound be administered concurrently at different sites using different syringes. Prophylactic antimicrobials are useful if the child is unimmunized and tetanus immune globulin is not available.