Download After Hours Standing Orders for Antiviral Prophylaxis

After Hours Standing Orders for Antiviral Prophylaxis
Exposures to Herpes B and SIV/SHIV/HIV
After an NHP related injury/exposure, notify the shift supervisor and START scrubbing
with soap and water (bite, scratch, laceration or needle stick) or flushing with water
(mucosal exposure) IMMEDIATLY for 15 minutes (SOP HH-7)
1)
2)
Contact one of the following individuals:
Jenny Short
cell
530-400-3379
Sarah Davis
cell
530-574-4557
Greg Hodge
cell
530-304-5585
Jaleh Janatpour
cell
916-716-5884
home 530-756-6300
The exposed employee MUST contact the occupational health physician
24hr phone number (530) 797-6691
3)
To the occupation health physician state the specific circumstances of the injury
and the health status of the animal, including involvement in any research
studies such as SIV, other infectious agents, and recent medications given to the
involved animal.
4)
Do not delay immediate scrubbing or flushing of the exposure site a full 15
minutes per SOP# HH-7. THIS IS EXTREMELY CRITICAL TO THE OUTCOME!
5)
Contact the on-call veterinarian, as posted in 1402, to obtain animal samples as
soon as possible per SOP HH-09.
6)
If directed to do so by the physician follow Dr. Belcourt’s Standing Orders to
provide the appropriate antiviral medication(s) that are kept secured in a lock
box in the Research Services Office. If antivirals are indicated, provide to the
injured employee the entire intact bottle(s) of appropriate medication(s),
documenting as follows.
7)
Document implementation of standing orders in the “Antiviral Drug Log Binder”
(a blue 3-ring binder) which is maintained in the Research Services Office.
8)
Remove the Rx # sticker from the bottle being provided to the injured employee
and place the sticker onto a blank form. There are separate forms for the
“Standing Order for Valacyclovir following potential Herpes B exposure” and the
“Standing order for Combivir for post exposure prophylaxis potential
HIV/SIV/SHIV exposure” in the binder. Complete the required forms per the
Revised 9/6/2016, Greg Hodge
physician orders, including the CNPRC after hours NHP related injury log (in
the front of the binder.
9)
If providing on site antiviral medications to the injured employee per Standing
Orders, also provide to the injured employee a copy of the relevant patient
information for Valtrex (Valacyclovir) and/or Combivir, as applicable. Copies
are in the binder.
10)
Complete the “CNPRC After Hours NHP Related Injury Log” in the binder,
documenting that the employee was provided with the specific antiviral meds or
that the employee has declined the meds at this time. Include the name of the
physician spoken to.
11)
Instruct the employee to report to Occupational Health by calling 530-752-6051
the very next business day to schedule an appointment.
12)
In an emergency involving more severe injury the employee may need to be
transported to Sutter Davis Emergency Room, located off Covell Blvd. at 2000
Sutter Place. Call 9-1-1 (campus phone) or campus emergency 530-752-1234 for
any emergency or serious injury.
13)
For employees who are being sent to Sutter, if possible provide a copy of “To
Sutter Emergency Room Physician and Triage Staff.” This is a summary of Herpes
B and NHP exposure information. Copies are in the binder.
14)
If it is a serious injury follow emergency procedures to call 9-1-1. Also contact one
or more of the following individuals:
Jenny Short
Kari Christe, DVM
Jeff Roberts, DVM
Home 530-756-6300
Home 916-419-3964
Cell 530-908-2475
Cell 530-400-3379
Pager 530-750-8013
Valacyclovir (Valtrex) Antiviral Prophylaxis guidelines for potential Herpes B Virus
exposures
B virus exposure includes macaque bites, macaque scratches or contact to the mucous
membranes or non-intact skin with macaque body fluids/ secretions, particularly ocular,
oral or genital secretions or nervous system tissue, and also direct contact with material
contaminated by macaques (such as cages surfaces, sharps, instruments or equipment).
The usual dosage of valacyclovir (Valtrex) is 1 gm, 1 tablet 3 times daily until further
consultation with the Occupational Health Physician.
Evaluation of the exposure is according to following guidelines per the B Virus Working
Group recommendations¹: (Follow occupational health physician’s orders)
Valacyclovir Prophylaxis recommended for:
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Skin exposure (with loss of skin integrity) or mucosal exposure (with or without
injury) to a high risk source (such as a macaque that is ill, immunocompromised, or
known to be shredding virus or that has lesions compatible with B virus disease).
Inadequately cleaned skin exposure (with loss of skin integrity) or mucosal
exposures (with or without injury).
Laceration of the head, neck or torso.
Deep puncture bite.
Needle stick associated with tissue or fluid from the nervous system, lesions
suspicious for B virus, eyelids or mucosa.
Puncture or laceration after exposure to objects (a) contaminated either with fluid
from monkey oral or genital lesions or with nervous system tissues, or (b) known to
contain B virus.
Valacyclovir Prophylaxis considered for:
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Mucosal splash that has been adequately cleaned.
Laceration, bite (with loss of skin integrity), that has been adequately cleaned.
Needle stick involving blood from an ill or immunocompromised macaque.
Puncture or laceration occurring after exposure to objects (a) contaminated with
body fluid (other than that from a lesion – see Valtrex recommended above), or (b)
potentially infected cell culture.
Valacyclovir Prophylaxis NOT recommended for:
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Skin exposure in which the skin integrity remains intact.
Exposure associated with non-macaque species of nonhuman primates.
Lamivudine / Zidovudine (Combivir) per standing Order for SIV/HIV/SHIV Exposure
Currently Combivir is recommended for;
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A bite or scratch from an SIV or SHIV infected nonhuman primate.
Splash to eyes, nose, mouth, mucous membranes or non-intact skin with body fluids
from an SIV or SHIV infected nonhuman primate or from SIV, HIV or SHIV infected
nonhuman primate tissue, fluid or culture.
Laceration, puncture wound or scratch from a contaminated object such as a scalpel
cut during a necropsy procedure on SIV or SHIV infected nonhuman primate.
Injury Follow-up Procedures
Follow SOP HH-9 for immediate collection of animal samples for Herpes B testing. After
following the procedures described above, it is important for the injured employee to report
to the Research Services Manager of Operations in room 1904 (530) 752-0438 AND to
Occupational Health Services the very next work day. Occupational Health Services is
located at Cowell Hall, California Ave. on campus; phone 530-752-6051. Normally the
employee should contact the Research Services Manager of Operations who will call
Occupational Health to verify that an Occupational Health Physician is available to see the
employee. Refer to SOP HH-7 and SOP HH-9 for complete procedures.
Important Emergency Procedures
If the injury is severe or profusely bleeding, call 9-1-1 from a campus phone or (530) 7521234 or (530) 753-1230 from a cell phone or report to Sutter Health Emergency Room as
appropriate. For serious primate related injuries, provide emergency medical professionals
with afterhours home contact phone numbers as above. Time permitting provide the “To
Sutter Emergency Room Physician and Triage Staff” document and the references below to
the first responders.
References
National B virus Resource Lab, Georgia State University Viral Immunology Lab, Emergency
Phone for Dr. Julia Hilliard, Director Office 404-413-6560 Cell 404-556-9451
http://www2.gsu.edu/~wwwvir/
Recommendations for Prevention of and Therapy for Exposure to B Virus (Cercopithecine
Herpesvirus 1) Cohen, Jeffrey I, et al and the B Virus Working Group, Clinical Infectious
Disease 2002:35: 1191-1203
http://www.cdc.gov/ncidod/diseasesbvirus.pdf