Initial Assessment

Antimicrobial prescribing: NHS Forth Valley
NHS Forth Valley

Typically done in the Emergency Department, but can also be done in MIU/CAU

All patients presenting with potential rabies exposure need discussed with an infection specialist (ID or microbiology consultant)

Initial Wound Care

Prompt wound care (or mucous membrane for mucosal exposures) substantially reduces the risk of rabies infection

 

  • Clean immediately & thoroughly with soap/detergent and flush with running water for 10–15 minutes.  
  • Povidone-iodine solution or 40–70% alcohol should be applied and the wound covered with a simple dressing. 
  • Primary suture could cause further damage to the wound and may increase the risk of rabies transmission. It should be avoided or postponed. 

 

Patient History

Information required:

  • Name, DOB, CHI number
  • General health status and whether the patient is immunosuppressed
  • Allergies
  • Rabies vaccination status
  • Any post-exposure treatment given whilst abroad (vaccine or immunoglobulin)

Take details on exposure

  • Date of exposure
  • Country of exposure
  • Animal: Species and current health (if known)
  • Site of exposure (in particular, were there severe/multiple bites to the head or neck?)

 

Contact the relevant on call doctor

Once above sections complete: contact the relevant on call doctor to complete the rabies risk assessment:

  • Adults - On call infection doctor 
    • In hours call infections diseases Wifi phone
    • Out of hours phone microbiology on-call via switchboard

 

  • Paediatrics (<16 years) - On call paediatrics via switchboard. The paediatric team may then contact the paediatric infectious diseases team in NHS GGC for consultation (the GGC team will not offer a service HRIG/vaccine administration)