Occupational Health and Safety in the Care and Use of Nonhuman Primates (2003) / Chapter Skim
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9. Postexposure Medical Treatment in Nonhuman-Primate Facilities
9. Postexposure Medical Treatment in Nonhuman-Primate Facilities
Pages 135-146
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From page 135... ...
It is critical that the designated medical providers be informed and appropriately updated regarding the nature of the health risks. That might require joint participation of research personnel, animal care staff, environmental health and safety staff, and occupational health services staff in continuing education regarding use of specific agents and safety train135
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From page 136... ...
The individual responsible for the occupational health program should develop a close working relationship with the local emergency department to ensure that (1) emergency medical staff are familiar with the specific hazards posed by nonhuman primates and (2)
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From page 137... ...
In the handling of nonhuman primates, it is reasonable to adopt universal precautions and thereby minimize exposure risk regardless of the presence or level of infection (CDC-NIH 1999~. When employee injuries occur, information on the viral status of the animal and any infectious experimental agents should be communicated to the patient's health professional.
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From page 138... ...
Occupational exposure to SIV has occurred through mucosal splashes, contamination of cuts or skin abrasions, and needle stick injuries (Essex 1994; Khabbaz and others 1994; Sotir and others 1997~. The assumption that SIV infection can be transmitted by routes similar to those in occupational exposure to HIV has led the CDC to recommend that occupational exposures to SIV and hybrid strains of HIV-SIV be managed according to PHS postexposure prophylaxis guidelines for HIV (CDC 2001c)
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From page 139... ...
Although B virus infection occurs uncommonly after nonhuman-primate exposures, the illness is often fatal when left untreated, and so substantial care must be taken in assessing and following up on such contact (Holmes and others 1995~. There should be follow-up monitoring of potential B virus exposure including tracking of any unexplained influenza-like illness lasting more than 48 hours in personnel working with nonhuman primates or their tissues, to allow for appropriate treatment advice by an occupational health physician.
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From page 140... ...
Nonhuman-primate facility directors and occupational health care providers should consider the use of a wallet card or other simple guide to remind employees about first aid and provide emergency contact information. Good general guidelines for medical management of animal-bite wounds management are available (Smith and others 2000~.
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From page 141... ...
The physical examination should include collection of vital signs and inspection of the wound or contaminated mucous membrane. This examination should be documented and should include information regarding the location, length, estimated depth, and shape of the wound, potential for nerve or tendon damage, vascular integrity, and presence of foreign body or contamination.
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From page 142... ...
Contact animal-care staff or infection-control staff to review health status of the colony, including consideration of infectious diseases (medication use, known experimental retrovirus infections, B virus serology status, and so on)
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From page 143... ...
reviewed the subject of bacterial infection following nonhuman-primate bites and has advised that the diagnosis and treatment of simian bites should be similar to those of human bites. A rational approach to preventing bacterial infection would include empiric postbite antibiotic prophylaxis for all but the most superficial wounds.
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From page 144... ...
; head, neck, or torso laceration; deep puncture bite; needle stick associated with tissue or fluid from central nervous system; lesions suspicious for B virus on the animal's eyelids or mucosa; puncture or laceration after exposure to an object likely to be contaminated with fluid from oral or genital lesions, central nervous system tissues, or tissue known to contain virus; postcleaning culture positive for B virus; and immunocompromised status. · Postexposure prophylaxis for B virus is considered in the following situations: mucosal or eye splash even if adequately cleaned; laceration with loss of skin integrity; needle stick with blood from ill or immunocompromised macaque; puncture or laceration after exposure to an object contaminated with body fluid (other than from a lesion)
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From page 145... ...
also offer a detailed discussion of postexposure prophylaxis in pregnant women and those with renal insufficiency. Physicians should check for updates on the preferred treatment regimen following B virus exposure on the CDC and B virus laboratory web sites, since this report cannot stay up-to-date.
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From page 146... ...
However, a recent report of a human infection caused by a recombinant-vaccinia rabies virus (Rupprecht and others 2001) has raised concerns about the adequacy of health and safety recommendations for animal handlers who may be caring for nonhuman primates infected with vaccinia virus.
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