Download Rabies Protocol

PLEASE NOTE: This on-line, read-only version of the Policy & Procedure is the OFFICIAL copy. 08/04/17, 2:47 AM
CAREGROUP OCCUPATIONAL HEALTH NETWORK
SUBJECT: RABIES PROTOCOL
EFFECTIVE DATE:
July 2001
PURPOSE:
To provide procedures for the care and prophylaxis treatment of individuals with
mechanical trauma to skin and or underlying tissue from a bite or exposure to saliva
in a wound or mucus membrane from an animal with either known or high risk of
rabies.
POLICY:
Clients with known risk of workplace acquired rabies will be advised to immunize
workers pre-exposure. Post-exposure treatment will include wound care, risk
assessment, active and passive immunoprophylaxis as appropriate, and referrals for
cosmetic or musculo-skeletal recovery as needed.
RESPONSIBILITY:
All clinical staff.
PROCEDURES:
1.
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12.
Cleanse and copiously irrigate wound with saline.
Remove foreign bodies and debride wound as necessary.
Consider x-ray if suspect foreign body or bony injury.
Obtain wound cultures for bites older than 8 hours.
Do not suture wounds older than 8 hours.
Initiate antibiotic treatment.
Assess tetanus status and follow Tetanus Protocol.
Assess Hepatitis B and HIV status of human source and follow BBFE Protocol.
Assess risk of rabies (See Below) and follow the Rabies Protocol (See Below)
Teach wound care and signs and symptoms of infection.
Arrange Follow-up/Referrals. Consider Plastics referral for cosmetic
disfigurement.
13. Contact the Department of Public Health for assistance and reporting @
617-522-3700 x 420 or the Boston Department of Health & Hospitals
Communicable Disease Control 617-534-5916.
SPECIAL:
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Domestic animals must be observed for 10 days for signs of rabies. Wild animals
should be captured and a brain tissue analysis performed to determine rabies status.
If the wild animal or bat can not be captured, patients should receive the rabies
prophylaxis. Small rodents and immunized domestic animals have minimal risk of
rabies. Rabies is increasing in frequency in the raccoon and squirrel population. The
Animal Control Officer is available at 617-635-5348.
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PLEASE NOTE: This on-line, read-only version of the Policy & Procedure is the OFFICIAL copy. 08/04/17, 2:47 AM
FORMS:
Boston Department of Health & Hospitals (BDHH) Form for Reporting Animal Bites
and Initation of Rabies Postexposure Prophylaxis (**BDHH will take the
information by phone or faxing this form.)
Risk Assessment
Animal
Dogs and Cats
Evaluation of Animal
Healthy and available for 10 days
observation.
PEP Recommendations
No prophylaxis unless animal
develops signs of rabies.
Signs of rabies during the 10 day
observation period, known rabid
or suspected rabid.
Begin prophylaxis immediately.
Unknown or escaped.
Begin prophylaxis immediately.
Regard as rabid. Rabies from bats
can not be excluded even if there
is no sign of a bite.
Begin prophylaxis immediately.
Livestock, rodents, lagomorphs.
Consider geographic
considerations.
Consult Department of Public
Health. Almost never require
treatment.
Fish, birds, reptiles and fish.
None
No prophylaxis. These animals do
not get rabies.
Skunks, raccoons, oposums, bats,
foxes, ferrets, woodchucks, and
most other carnivores.
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PLEASE NOTE: This on-line, read-only version of the Policy & Procedure is the OFFICIAL copy. 08/04/17, 2:47 AM
Rabies Protocol
Vaccination Status
Not Previously Vaccinated
Previously Vaccinated
AUTHOR:
APPROVAL:
Treatment
Local Wound Cleansing
Regimen
Soap and Water
Remove Debrie
Irrigate
Human Rabies Immune Globulin
(HRIG or RIG)
HRIG 20 IU/Kg body weight.
Up to one half of the dose should
be infiltrated around the wound(s)
and the rest given IM in the
gluteal area. (Average adult dose
1400 IU)
Rabies Vaccine: Human Diploid
Cell Vaccine (HDCV) or Rabies
Vaccine Absorbed RVA) or
Purified Chick Embryo Cell
Vaccine (PCEC).
Local Wound Cleansing
HDCV or RVA 1.0 cc, IM to the
deltoid area only on days: 0, 3,
7,14, and 28.
Rabies Vaccine
HDCV or RVA 1.0 cc IM to the
deltoid area only on days: 0 and
3.
Soap and Water
Remove Debrie
Irrigate
Kathleen Doughty MHA, BSN, RN
CGOHN Clinical Practice Committee, September 2001
REFERENCES:
CDC. MMWR 1999; No. RR-1. Recommendations of the Advisory Committee on Immunization PracticesHuman Rabies Prevention. United States 1999.
Uphold, Constance R. and Graham, Mary Virginia. Clinical Guidelines in Adult Health, Second Edition.
Barmarrae Books, Inc. University of Florida, Gainesville, Florida: 1999.
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