INSTRUCTIONS FOR CLINIC AND EMERGENCY DEPARTMENT STAFF

Bite, Scratch, or Contaminated Needle Stick, Scalpel or Cage Injury

1. Assess the adequacy of wound cleansing
2. Evaluate the need for debridement and prophylactic antibiotics, e.g., Augmentin, to prevent bacterial infection.
3. Collect a viral culture from the wound. (Use Bartels Viral Transport Media and sterile cotton or polyester "Dacron" swabs.)
4. Collect baseline blood specimen for antibody titers to B virus. (The paired serum will be collected in two weeks at the clinic designated by the company to handle the B virus prevention program.)
5. Counsel the patient on symptoms to watch for and precautions to take at home while awaiting results of cultures and blood tests. (Normally, viral cultures are reported as negative in one week and serology results should be reported in two to three weeks. Until then the CDC guidelines recommend that, "It is prudent for persons who have had high-risk exposures to avoid activities involving the exchange of body fluids (including saliva) until tests of sera . . . have shown no evidence of seroconversion."
6. Ensure proper storage of specimens prior to shipment. (If held longer than two hours, viral serum specimens should be frozen. See Sample Collection and Handling.)
7. Notify the patient’s company to pick up the specimens so that they can be shipped to NIH B Virus Resource Laboratory, preferably within one to two days.
8. Virology and blood samples from the involved monkey will be the responsibility of the company veterinarian.

Splash to Eyes

This should rarely occur because employees should be wearing face shields or safety glasses with side shields. If the employee is exposed to contaminated secretions, then, following the immediate cleansing of the eye for 15 minutes, a culture from the eye and serology studies should be done as outlined above.

Symptoms that Could Be Related to a B Virus Infection

For an employee who reports symptoms that could be related to a B virus infection, the protocol depends upon the exposure history. If the worker gives no history of exposure and the signs or symptoms are not specific to a herpesvirus infection, e.g., a flu-like illness, then the physician should consider simply observing the patient. Further assurance could be obtained by drawing blood for serology studies. Check with the B Virus Laboratory to see if they recommend doing studies on a "stat" basis.

If the risk of infection appears to be higher, either because of the history of a recent exposure or because of symptoms specific for a B virus infection, then hospitalization and intravenous antiviral therapy should be considered. When setting up the prevention program, a local hospital-based physician, knowledgeable in the treatment of B virus, should be designated as the consultant for the clinic. There are also physicians available for consultation by phone.

 

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