If a patient steps on a nail and is unsure about their last tetanus status, which vaccine should you administer?

In the situation where a patient steps on a nail and is unsure of their last tetanus vaccination status, administering the Tdap vaccine is the appropriate choice. The Tdap vaccine not only protects against tetanus but also includes protection against diphtheria and pertussis.

For adults, if it is uncertain when the last tetanus booster was given, the general recommendation is to receive a Tdap as the primary booster, especially since many adults may not have had this vaccine in recent years. The Tdap vaccine can provide adequate immunization against tetanus, especially given that tetanus can develop from wounds contaminated with dirt, feces, or saliva, such as when stepping on a nail.

In contrast, Td is typically used for booster doses for tetanus and diphtheria every ten years after the initial Tdap administration. However, if the patient’s last vaccination is not clear or outdated, starting with the Tdap can ensure that the patient is adequately protected against all three diseases. This proactive approach is crucial in acute care settings where infection risk is elevated.

Therefore, administering the Tdap vaccine addresses both the need for tetanus protection and updates the patient's immunization regarding pertussis and diphtheria.