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Animal Bites Treatment (102.145)

Animal Bites Treatment (102.145) - Policies, Clinical, UWMF Clinical, UWMF-wide, Clinical Policies and Procedures, Wound and Skin

102.145

UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE

TITLE: ANIMAL BITES TREATMENT

Effective Date: January 2007 Approval: See Authorization
Supersedes Protocol: May, 2004 Contact: Clinical Staff Education

Reviewed May, 2008 July, 2008 May 2009 February 2012 May 2013


PURPOSE:

To provide guidelines for the assessment, treatment, documentation and reporting of animal bites at the University of
Wisconsin Medical Foundation (UWMF) or Department of Family Medicine (DFM) clinics.

DEFINITION:
When an exposure has occurred, the likelihood of rabies infection varies with the nature and extent of that exposure.
Under most circumstances, two categories of exposure -- bite and nonbite -- should be considered.
Bite- Any penetration of the skin by teeth constitutes a bite exposure. All bites, regardless of body site, represent a
potential risk of rabies transmission, but that risk varies with the species of biting animal, the anatomic site of the bite, and
the severity of the wound.
Nonbite- The contamination of open wounds, abrasions, mucous membranes, or theoretically, scratches (potentially
contaminated with infectious material from a rabid animal) constitutes a nonbite exposure. Nonbite exposures from
terrestrial animals rarely cause rabies. However, occasional reports of rabies transmission by nonbite exposures suggest
that such exposures should be evaluated for possible postexposure prophylaxis administration.
Rabies is transmitted only when the virus is introduced into a bite wound, open cuts in skin, or onto mucous membranes
such as the mouth or eyes. The most common wild reservoirs of rabies are raccoons, skunks, bats, foxes, and coyotes.

POLICY:
 The clinical staff will utilize the following procedural guidelines to assess, treat, document and report animal bites
of patients.
 If the patient has not already done so, the provider or clinical staff will report the animal bite to the proper
authorities/agency.
 Medical and clinical staff should utilize the Rabies Algorithm (link -
http://www.dhs.wisconsin.gov/communicable/Rabies/RabiesAlgorithm/Index.htm) to determine if additional
treatment is needed; ie rabies vaccine and immunoglobulin.
 If rabies vaccine and immunoglobulin are indicated, refer to the UWMF Rabies Vaccine policy.

SUPPLIES:
 Wound care supplies - Virucidal agent such as Hebiclens or povidone-iodine solution, sterile water or saline,
wound irrigating equipment (as necessary), antibiotic ointment/cream, gauze, gloves.
 Provider’s order and patient record

PROCEDURE:

1. Check provider’s order and clarify any inconsistencies.

2. Wash hands and gather equipment.

3. Identify the patient: include date of birth and verify allergies. (including povidone-iodine)


4. Explain procedure to the patient.

5. Provide good light and provide privacy by closing curtains or door.

6. Apply gloves.

7. Wash the wound thoroughly with soap and sterile saline or water. If necessary, irrigate wound with large
amounts of sterile saline or water solution under high pressure. If provider orders virucidal agent, such as
Hibiclens or Povidone Iodine, it should be diluted in the sterile saline or water solution as directed.

8. Apply antibiotic ointment/cream to wound to prevent infection and cover it with a clean bandage.

9. Documentation:
a.) Progress Notes section of HealthLink
 Utilize the .nnbite smartphrase
 In addition, include the following: completion of Rabies Algorithm and outcome, how patient
tolerated procedure, discharge instructions/follow-up care and any additional patient education.

10. Reporting Animal Bites: If the patient has not already done so, animal bites must be reported.
a.) An Accounting of Disclosure Form (link: http://apps.uconnect.wisc.edu/emailforms/form.jsp?ef=121)
must be completed by the staff reporting the bite to the appropriate agency.


REVISED BY: LaVay Morrison RN, BSN, Clinical Staff Educator, 2013
REVIEWED BY: Sandy Schumacher, RHIT, Dir. of Health Information Services, 2013
Deb Craig, RN, Manager Urgent Care, 2013
WRITTEN BY: Ronnie Peterson, R.N., M.S., Manager of Clinical Support
ger of Clinical Support Manager of Clinical Support
REFERENCES:
1. Animal Bite Reporting and Rabies Prevention. (2011). Public Health Madison & Dane County. Retrieved
October 5, 2011 from http://www.publichealthmdc.com/enviromental/animal/bite.cfm
2. Wisconsin Department of Health Services: Rabies Prevention Flowchart (2012). Retrieved April 8, 2013
from http://www.dhs.wisconsin.gov/communicable/Rabies/RabiesAlgorithm/Index.htm closure s
3. 019 Accounting of Disclosure Policy and Guideline policy, UWMF, April 2003


AUTHORIZED BY: Richard Welnick, MD, Medical Director, Ambulatory Clinic Operations, UWMF
Sandra A. Kamnetz M.D., Vice Chair, Department of Family Medicine


__________________________________________________________________________________________
Medical Director, UWMF Date

__________________________________________________________________________________________
Vice Chair, Department of Family Medicine Date