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  6. Bomb blast injuries in children: antibiotic management (607)
Important: please update your RDS app to version 4.7.3 Details with newsletter below.

Please update your RDS app to v4.7.3

We asked you in January to update to v4.7.2.  After the deployment planned for 27th February, this new update will be needed to ensure that you are able to download RDS toolkits even when the RDS website is not available. We will wait until as many users as possible have downloaded the new version before switching off the old system for app downloads and moving entirely to the new approach.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. 

To update to the latest release:

 On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Right Decision Service newsletter: February 2025

Welcome to the February 2025 update from the RDS team

1.     Next release of RDS

 

A new release of RDS is planned (subject to outcomes of current testing) for week beginning 24th February. This will deliver:

 

  • Fixes to mitigate the recurring glitches with the RDS admin area and the occasional brief user interface outages which have arisen following implementation of the new distributed technology infrastructure in December 2024.

 

  • Capability to embed content from Google calendar, Google Maps, Daily Motion, Twitter feeds, Microsoft Stream into RDS pages.

 

  • Capability to include simple multiplication in RDS calculators.

 

The release will also incorporate a number of small fixes, including:

  • Exporting of form within Medicines Sick Day Guidance in polypharmacy toolkit
  • Links to redundant content appearing in search in some RDS toolkits
  • Inclusion of accordion headers alongside accordion text in search result snippets.
  • Feedback form on mobile app.
  • Internal links on mobile app version of benzo tapering tool

 

We will let you know when the date and time for the new release are confirmed.

 

2.     New RDS developments

There is now the capability to publish toolkits on the web with left hand side navigation rather than tiles on the homepage. To use this feature, turn on the “Toggle navigation panel” option at the top of the Page settings menu at toolkit homepage level – see below. Please note that publication to downloadable mobile app for this type of navigation is still under development.

The Benzodiazepine tapering tool (https://rightdecisions.scot.nhs.uk/benzotapering) is now available as part of the RDS toolkit for the national benzodiazepine prescribing guidance developed by the Scottish Government Effective Prescribing team. The tool uses this national guidance developed with a wide-ranging multidisciplinary group. This should be used in combination with professional judgement and an understanding of the needs of the individual patient.

3.     Archiving and version control and new RDS Search and Browse interface

Due to the intensive work Tactuum has had to undertake on the new technology infrastructure has pushed back the delivery dates again and some new requirements have come out of the recent user acceptance testing. It now looks likely to be an April release for the search and browse interface. The archiving and version control functionality may be released earlier. We’ll keep you posted.

4.     Statistics

At the end of January, Olivia completed the generation of the latest set of usage statistics for all RDS toolkits. If you would like a copy of the stats for your toolkit, please contact Olivia.graham@nhs.scot .

 

5.     Review of content past its review date

We have now generated reports of all RDS toolkit content that has exceeded its review date by 6 months or more. We will be in touch later this month with toolkit owners and editors to agree the plan for updating or withdrawing out of date content.

 

6.     Toolkits in development

Some important toolkits in development by the RDS team include:

  • National CVD prevention pathways – due for release end of March 2025.
  • National respiratory pathways, optimal cancer diagnostic pathways and cancer prehabilitation pathways from the Centre for Sustainable Delivery. We will shortly start work on the national cancer referral pathways, first version due for release via RDS around end of June 2025.
  • HIS Quality of Care Review toolkit – currently in final stages of quality assurance.

 

The RDS team and other information scientists in HIS have also been producing evidence summaries for the Scottish Government Realistic Medicine team, to inform development of national guidance around Procedures of Limited Clinical Value. This guidance will in due course be translated into an RDS toolkit.

 

7. Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:

  • Friday 28th February 12-1 pm
  • Tuesday 11th March 4-5 pm

 

To book a place, please contact Olivia.graham@nhs.scot, providing your name, organisation, job role, and level of experience with RDS editing (none, a little, moderate, extensive.)

 

To invite colleagues to sign up to receive this newsletter, please signpost them to the registration form  - also available in End-user and Provider sections of the RDS Learning and Support area.   If you have any questions about the content of this newsletter, please contact his.decisionsupport@nhs.scot  If you would prefer not to receive future newsletters, please email Olivia.graham@nhs.scot and ask to be removed from the circulation list.

With kind regards

 

Right Decision Service team

Healthcare Improvement Scotland

 

 

Bomb blast injuries in children: antibiotic management (607)

This guidance is adapted from Public Health England guidance (issued May 2017) and is intended as initial empirical prophylaxis. The advice contained within this guidance is suitable for ALL age groups of patients. Further advice on ongoing antibiotic management may be provided by microbiology/infectious diseases teams if required. In addition to antibiotics, tetanus and blood-borne virus exposure should be considered.

It is important to recognize that important characteristics of such events may include:

  • Blast injuries involving embedded metalwork (e.g. nuts, bolts)
  • Large numbers of victims may originate from outside of the incident area

Tetanus immunisation

ALL bomb blast victims with injuries must have their tetanus immunisation status checked and treated according to the extant advice on management of patients with tetanus prone wounds in the ‘Green Book’ Tetanus: the Green Book, chapter 30 - GOV.UK (www.gov.uk)

Hepatitis B vaccination

ALL patients who sustained injuries that breached the skin must have their immunisation status checked and treated according to the extant advice on Hepatitis B prophylaxis in the ‘Green book’ Hepatitis B: the Green Book, chapter 18 – GOV.UK (www.gov.uk).

Patients who are discharged from inpatient care before completion of an accelerated hepatitis B vaccination course should receive the remaining doses of vaccine either at out-patient follow up, or by arrangement with the relevant immunisation provider.

ALL patients should be tested at 3 months to determine their hepatitis B vaccine response and at 3 months and 6 months to determine their hepatitis C and HIV status.

Post exposure prophylaxis for HIV

HIV PEP is not usually required. Discuss with the Infectious Disease Consultant on-call if uncertain (via RHC switchboard).

Emergency Department Paediatric Antibiotic Management of Bomb Blast Injuries

Injury

Antibiotic prophylaxis  (see appendix 1 for doses)

Soft tissue injury

 

(NO foreign body in situ)

IV co amoxiclav  

Penicillin allergy: IV Clindamycin and gentamicin 

Continue IV treatment until first surgical debridement/washout 

Then switch to PO Co-amoxiclav

Penicillin allergy: PO Clindamycin and Ciprofloxacin 

Duration: 5-7 days (minimum) post-surgical debridement/washout

Soft tissue injury

(Foreign body in situ)

IV Co amoxiclav 

Penicillin allergy: IV Clindamycin and Gentamicin

Continue IV treatment until first surgical debridement/washout and removal of foreign body

Then switch to PO Co-amoxiclav 

Penicillin allergy: PO Clindamycin and Ciprofloxacin

Duration: 7 days (minimum – consider up to 14 days) post-surgical debridement/washout and removal of foreign body

Seek advice from microbiology/Infectious Disease teams re duration if foreign body remains in situ.

Open Fractures

Or

‘Through and through’ fractures

Or

Intra-articular injuries

IV Co-amoxiclav 

Penicillin allergy: IV Clindamycin and Gentamicin

Continue IV antibiotics until soft tissue closure OR for a maximum of 72 hours.

Then switch to PO Co-amoxiclav

Penicillin allergy: PO Clindamycin and Ciprofloxacin

Prolonged oral therapy may be required after this, please seek advice from the microbiology/Infectious Diseases teams.

Penetrating CNS injury

IV Ceftriaxone (high dose) PLUS IV Metronidazole

Penicillin allergy: IV Ciprofloxacin and IV Metronidazole

Suggest discuss with an infection specialist, consider addition of vancomycin

Then switch to PO Ciprofloxacin and Metronidazole when able to swallow, absorb and clinically stable/showing signs of improvement.

Duration: 2 weeks if foreign body removed

6 weeks if foreign body still in situ

Please seek advice on oral antibiotics and total duration of treatment with the microbiology/infectious diseases team

Open skull fracture from penetrating trauma

IV Ceftriaxone (high dose) until closure then discuss duration of IV therapy and oral switch with microbiology/Infectious Disease teams.

CSF leak post skull fracture

No antibiotics required

Give Pneumovax

Penetrating eye injury

PO/IV Ciprofloxacin AND PO/IV Clindamycin (use IV route if oral route compromised)

AND 

Topical Chloramphenicol, 0.5% drops every 2 hours and 1% eye ointment at night

Assess daily for PO route.

Then change to PO Co-amoxiclav

Penicillin allergy: PO Clindamycin and Ciprofloxacin

Duration: 2 weeks if foreign body removed

Seek advice from microbiology/infectious diseases teams re duration if foreign body remains in situ.

Internal ear injury

Keep clean and dry. Urgent referral to ENT for examination and removal of debris/clots and instillation of antibiotic ear drops if required.

Penetrating abdominal injury or chest trauma

IV Co-amoxiclav

Penicillin allergy: Clindamycin and Gentamicin

Add IV Fluconazole if any spillage of gastrointestinal contents or perforation (review regularly with microbiology/Infectious Diseases teams)

Review daily for IVOS - Switch to PO Co-amoxiclav

Penicillin allergy: PO Clindamycin and Ciprofloxacin

Duration: Minimum 7 days following surgery

Seek advice from microbiology/infectious diseases teams re duration if foreign body remains in situ

Editorial Information

Last reviewed: 14/01/2025

Next review date: 30/11/2028

Author(s): Katherine Longbottom.

Version: 4

Author email(s): katherine.longbottom2@nhs.scot.

Approved By: Antimicrobial Utilisation Committee

Document Id: 607

References

Public Health England. Antibiotic Prophylaxis Guidance for Bomb Blast Victims. V 1.0, 2017.  

UK Health Security Agency. Hepatitis B: The Green Book, Chapter 18, Updated August 2024.  

UK Health Security Agency.  Tetanus: The Green Book, Chapter 30, Updated June 2022.