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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 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. 2. 3. 4. 5. 6. 8. 9. 10. 11. 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: D:\81921635.doc 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. Page 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. D:\81921635.doc Page 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. D:\81921635.doc Page