An audit of the post-exposure management of rabies in Addenbrooke’s Hospital, Cambridge

Rabies is a clinically significant disease, caused by a neurotropic virus that is transmitted in the saliva of infected animals. The incubation period is exceptionally variable, followed by viral encephalitis, and almost always death. Overall rabies infection kills approximately 50 000 to 70 000 people/year. Control of the disease can be achieved by eliminating the animal reservoir or effective pre-exposure and post-exposure prophylaxis (PEP). Effective human rabies vaccines exist for pre-exposure immunization. These are normally recommended for people in high-risk occupations and travellers to rabies-affected areas. Although rabies is no longer endemic in the UK, it remains a significant problem in returning travellers. There are approximately 2000 PEP courses issued/year, 85–90 % for returning travellers and approximately 10–15 % for bat exposure in the UK. In this audit, we have evaluated the quality of the rabies PEP management in Addenbrooke’s Hospital, Cambridge over 3 years. The objectives of the audit were the correct risk assessment of the patient, timely prescription of PEP, as well as effective communication between clinical teams and record keeping. The standards were drawn from previously published literature. Although the standards relating to patient safety were met and exceeded, some drawbacks in communication and record keeping, as well as some non-auditable issues were identified. Additionally, a review of annual case numbers and peak periods of PEP referrals was used to identify key staff training periods. A shared experience with other issuing centres across the country could be used to optimise the approach to this highly clinically significant issue.