405. Fear of Exposure among Healthcare Workers (HCWs) after a Sentinel Case of Rabies
Session: Poster Abstract Session: Occupational Health
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • IDWeek Abstract 39795.pdf (510.2 kB)
  • Background:

    Human rabies is an extremely rare infection. Rabies was suspected in our patient based on hospital day 17 serum/tissue results and later confirmed post-mortem. Following diagnosis, staff had fear of contagion from our patient’s outpatient visits and 23-day hospitalization. Although transmission of rabies to HCWs has never been documented, theoretically high risk exposures include direct contact of broken skin and/or mucosa with saliva, tears, oropharyngeal secretions, CSF and neural tissue. Urine/kidney exposure posed an additional concern, as our patient's renal transplant was identified as the infection source. We describe the risk assessment for HCWs at our hospital.

    Methods:

    Our risk assessment included 5 steps:1) identification of exposed HCWs; 2) notification of HCWs for risk assessment by their service chiefs; 3) risk assessment by Infection Control, Infectious Diseases and Occupational Medicine using a tool provided by the Maryland Department of Health and Mental Hygiene; 4) supplemental screening for urine/kidney exposure before final CDC guidance; 5) post-exposure prophylaxis (PEP) when indicated.

    Results:

    A total of 222 persons were possibly exposed: 167 identified via our patient's electronic medical record documentation and 55 through staff discussions. Risk screening was initiated within 2 hours of rabies confirmation and completed for all 222 HCWs. In addition, 94 HCWs reported possible contact with our patient's urine/kidney and had supplemental screening.

    Service

    Rabies Exposure Assessment

    Supplemental for Urine/Kidney Exposure

    Exposure Risk + Given PEP

    Chaplain

    6

    0

    0

    Dietary

    4

    0

    0

    Emergency Room

    6

    3

    0

    Facility Management

    4

    0

    0

    Laboratory

    9

    6

    0

    Medical

    56

    6

    3

    Neurology

    15

    0

    5

    Nursing

    90

    74

    1

    Pharmacy

    2

    0

    0

    Radiology

    15

    5

    0

    Respiratory Therapy

    10

    0

    0

    Social Work

    1

    0

    0

    Surgery

    4

    0

    0

     Nine persons (4.1% of those screened) received PEP with good tolerance. Due to fear of rabies transmission, additional employees without direct patient contact expressed concern and required counseling.

    Conclusion: Rabies exposure represents a major concern for HCWs and requires a rapid response, comprehensive risk screening and counseling of staff, and timely provision of PEP.

    Virginia L. Kan, MD1, Patrick Joyce, MD2, Debra Benator, MD3, Katherine Feldman, DVM, MPH4, Kathleen Agnes, RN, MS5, Janet Gill, RN, BSN, CIC5, Monica Irmler, RN, BSN, CIC5, Arlene Clark, RN5, George Giannakos, NP2, Audrey Gabourel, RN2 and Fred Gordin, MD3, (1)Washington DC VA Medical Center, Washington, DC, (2)Occupational Medicine, VA Medical Center, Washington, DC, (3)Infectious Diseases Section, VA Medical Center, Washington, DC, (4)Maryland Department of Health and Mental Hygiene, Baltimore, MD, (5)Infection Control, VA Medical Center, Washington, DC

    Disclosures:

    V. L. Kan, None

    P. Joyce, None

    D. Benator, None

    K. Feldman, None

    K. Agnes, None

    J. Gill, None

    M. Irmler, None

    A. Clark, None

    G. Giannakos, None

    A. Gabourel, None

    F. Gordin, None

    See more of: Occupational Health
    See more of: Poster Abstract Session

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.