Appendix 2: Examples of pathways in use

1. New exposure presentation to primary care

Patient contacts GP surgery/Ayrshire Urgent Care Service (AUCS) reporting a bat exposure.
GP takes history and contacts Infection Specialist via NHS A&A switchboard for risk assessment.
Infection Specialist supports a risk assessment and decides Rabies PEP is required and informs GP.
Patient provided with Patient Information Leaflet detailing recommended course.
GP refers patient to Combined Assessment Unit (CAU), Rapid Assessment and Care (RAC) to get first vaccination.
Patient attends CAU for first vaccination.
Infection Specialist emails Immunisation Coordination Team, copying in the Health Protection Team (HPT), to advise patient commenced on PEP and provides recommended vaccination schedule.
Immunisation coordination team contact the patient with appointments for subsequent vaccinations.
During vaccination course, patient has questions about rabies – these are directed to the HPT in the first instance.

Patient attends ED on a Saturday out of hours (OOH) following a holiday in Turkey. Whilst in Turkey, the patient was bitten on the arm by a dog, immediately attended healthcare and was commenced on rabies PEP.
ED contacts Infection Specialist via NHS A&A switchboard to discuss and verify the treatment plan that was commenced in Turkey.
Vaccination is required that day and is administered in ED. The next vaccination is required on a Bank Holiday Tuesday.
The ED refer the patient to Combined Assessment Unit (CAU) for Tuesday and provide a patient information leaflet.
The patient attends CAU on the Tuesday to receive the vaccination.
Infection Specialist emails Immunisation Coordination Team, copying in the Health Protection Team (HPT), to advise patient commenced on PEP and provides recommended vaccination schedule. Also advises that dose due to be given in CAU.
Immunisation coordination team contact the patient with appointments for subsequent vaccinations.
During vaccination course, patient has questions about rabies – these are directed to the HPT in the first instance.

Patient aged 11 attends ED reporting a bat exposure on a Sunday out of hours (OOH).
ED clinician contacts Infection Specialist via NHS A&A Switchboard. Infection Specialist supports a risk assessment and advises Rabies PEP is required. The local paediatric team is alerted and this is discussed with Glasgow Paediatrics Infectious Diseases as required.
ED provides 1st vaccine and patient information leaflet.
The next vaccination is required on a bank holiday. The ED clinician contacts the local paediatric team to advise of history, and request vaccination within ward 1A/C.
Infection Specialist emails Immunisation Coordination Team, copying in the Health Protection Team (HPT), to advise patient commenced on PEP and provides recommended vaccination schedule. Advises dose due to be given in Ward 1A/C.
Immunisation coordination team contact the patient with appointments for subsequent vaccinations.
During vaccination course, patient has questions about rabies – these are directed to the HPT in the first instance.

Unvaccinated individual with high risk exposure attends ED.
Wound care is provided and ED contacts the Infection Specialist via NHS A&A switchboard to carry out a risk assessment.
Infection Specialist advises Rabies post-exposure prophylaxis (PEP) and immunoglobulin is required.
ED contacts on call Pharmacy, who contacts central supplies for immunoglobulin. First vaccine and immunoglobulin is administered in ED.
Infection Specialist emails Immunisation Coordination Team, copying in the Health Protection Team (HPT), to advise patient commenced on PEP and provides recommended vaccination schedule.
Immunisation coordination team contact the patient with appointments for subsequent vaccinations.
During vaccination course, patient has questions about rabies – these are directed to the HPT in the first instance.