What is the proper procedure for managing a raccoon bite?

Management of Raccoon Bite Wounds

Raccoon bites require immediate wound cleansing followed by rabies post-exposure prophylaxis with both rabies immune globulin and vaccination, as raccoons are regarded as rabid unless proven negative by laboratory testing. 1

Immediate Wound Management

1. Thorough wound cleansing (critical first step):

   • Wash and flush all bite wounds for approximately 15 minutes with soap and water 2, 1
   • Apply povidone-iodine solution or other virucidal agent to the wound 2
   • Remove any superficial debris 2
   • Avoid immediate wound closure/suturing as infected wounds should not be closed 2

2. Tetanus prophylaxis:

   • Administer tetanus toxoid (0.5 mL intramuscularly) if vaccination status is outdated or unknown 2, 1

Rabies Post-Exposure Prophylaxis

Raccoons are considered high-risk rabies vectors, particularly in the eastern United States 2.

For previously unvaccinated persons:

1. Rabies Immune Globulin (RIG):

   • Administer 20 IU/kg body weight 2
   • Infiltrate as much as possible around and into the wound area
   • Inject remaining volume intramuscularly at a site distant from vaccine administration
   • Must be given at the beginning of prophylaxis (day 0), but can be given up to day 7 if initially missed 2

2. Rabies Vaccine:

   • Administer 5 doses of human diploid cell vaccine (HDCV) or purified chick embryo cell vaccine (PCECV) 2, 1
   • Schedule: days 0,3,7,14, and 28 2
   • Administer intramuscularly in the deltoid (adults) or anterolateral thigh (children)

For previously vaccinated persons:

• Only vaccine is required (no RIG)
• 2 doses on days 0 and 3 2

Antibiotic Prophylaxis

• Consider broad-spectrum antibiotics for bite wounds, especially for:
  • Hand wounds
  • Puncture wounds
  • "Dirty" wounds of any type 3
• Antibiotics help prevent bacterial infection from oral flora of the animal 4

Follow-up and Monitoring

• Follow up within 24 hours either by phone or office visit 2
• Monitor for signs of infection (increased pain, swelling, redness, purulent drainage)
• Complete the full course of rabies vaccination
• If the raccoon is captured, it should be euthanized and tested for rabies 2, 1
• Discontinue vaccination if laboratory testing confirms the animal is negative for rabies 1

Important Caveats

• Never delay rabies prophylaxis while waiting for animal testing results when dealing with wild animals like raccoons 1
• The unprovoked/provoked nature of the attack may influence risk assessment, but for raccoons, assume rabies risk regardless 2
• Even if the bite appears minor, rabies prophylaxis is still indicated for raccoon bites 2
• Rabies can have incubation periods exceeding 1 year, so prophylaxis should be initiated regardless of time elapsed since exposure 2

Remember that raccoons are among the primary wildlife reservoirs for rabies in the United States, particularly in the eastern states, making prompt and complete post-exposure prophylaxis essential for preventing this almost universally fatal disease.