Bat in the Hospital: The Rabies Scenario Every Infection Preventionist Should Be Ready For.

A bat is flying through your health care building with staff and patients present. After the initial panic, a well-meaning staff member swats the bat to the floor, killing it, scoops it into a bag, and drops it in the trash. Most people would call that the end of the story. As an infection preventionist (IP), you hear this, and you know your job is about to get complicated. What are your next steps? Do you have standard work (a written, repeatable procedure) or any plan at all for this scenario at your facility?

It Happens More Often Than You Think

A bat loose in a hospital sounds like a freak event, but it is far more common than most administrators or IPs realize. As development pushes bats out of their natural habitat, they look for new places to roost, and hospitals make appealing real estate: tall enough to deter predators, thermally stable for raising young, and ringed by lighting that draws a steady insect supply. One 3-year review at a single tertiary care center documented 67 separate bat incidents.¹ For the IP, the question isn’t whether a bat will ever turn up in your building; it’s whether you’ll have a plan when it does.

Why a Loose Bat Is an Infection Prevention Problem

The concern is rabies. Bats are the leading cause of human rabies deaths in the US; at least 7 in 10 people who die of domestically acquired rabies were infected by bats.² A longer view tells the same story: Among the 42 U.S.-acquired human rabies cases reported from 2000 through 2024, bats were the source in 35 (about 83%).³ Rabies attacks the central nervous system and causes severe brain inflammation. It is preventable: Per the World Health Organization, the incubation period can range from less than 1 week to 3 months, occasionally longer.⁴ Post-exposure prophylaxis (PEP), a combination of rabies vaccine and rabies immune globulin, is highly effective, but only if it begins before symptoms appear. Once symptoms start, rabies is almost always fatal.⁴

What makes bats uniquely dangerous in a care setting is how easily exposure can go unnoticed. Bat teeth are tiny, and a bite or scratch can be microscopic, sometimes leaving no visible mark at all.⁵ Contact can happen during a fumbled capture, and swatting a frightened bat can spray saliva or brain tissue. The recent record is sobering. In the fall of 2021, 3 people in 3 states died of rabies within 5 weeks; none received PEP, 2 had simply released the bat, and 1 had picked it up with their bare hands.⁶ Two more bat-associated deaths followed in 2024. In several of these cases, the victims either didn’t realize a bat could transmit rabies or never recognized they had been exposed at all.³

Now move that into a hospital. A bat found in a room with a sleeping, sedated, or cognitively impaired patient (or an unattended child) involves someone who cannot reliably tell you whether contact occurred. When direct contact can’t be ruled out, the conservative course is to treat the exposure as possible and offer PEP.

One Bat, 128 Patients

Consider a recently published account from a 68-bed progressive care unit. Over 6 days, a bat was sighted 3 times on the same unit before it was finally captured—and by then it had been killed in a way that left it untestable.⁷ Because rabies couldn’t be ruled out, the facility had to treat the full 9-day window as a potential exposure event: 128 patients and 3 employees were identified as potentially exposed. The response required a multidisciplinary incident command structure, a mass-vaccination clinic, a dedicated patient hotline, standardized call scripts and certified letters, and PEP procured and delivered at no cost to those affected.⁷

One lost bat can trigger a weeks-long, facility-wide undertaking. The team didn’t do anything wrong; the point is that doing it right is an enormous workload, far easier to manage with a written plan than by improvising on the fly.

First, Don’t Make It Worse: Handling the Bat

Before any public health machinery kicks in, frontline staff have one critical job: avoid contaminating themselves and the evidence. Rabies testing requires an intact brain. A bat that is crushed, thrown in the trash, or frozen can become untestable, and without a negative result, everyone potentially exposed may be required to undergo a PEP series. The basics are simple enough to fit on a laminated card by the nurses’ station (Figure).

A Coordinated Response, Step by Step

The card above covers the frontline reflex; what follows is the infection prevention–led response that begins once the area is secure. With trained staff and a plan in place, the response looks like this.

Control and contain the situation: Staff alert security or facilities to help calmly clear the area of staff and visitors. Administrators may need to contact animal control if the bat cannot be safely captured. Do not use a towel or linens to capture the bat; use a hard container or box. Secure the container and leave the bat inside so public health can collect it for testing. Do not freeze the bat; public health recommends refrigeration. A live bat will be humanely euthanized by public health, and the brain must remain intact for testing.

Perform an exposure assessment: Infection prevention should compile a list of staff, patients, and visitors who may have had contact and assess each for direct contact with the bat’s saliva or nervous tissue. If contact can be confidently ruled out, the risk of rabies exposure is generally low; if it cannot, err on the side of treating it as an exposure.

Internal notification and team activation: Draft an SBAR (Situation, Background, Assessment, Recommendation) and distribute it to administrative leaders, risk management, regulatory and compliance, the managers of affected employees, infection prevention, and public relations. Risk management will want clear, detailed documentation of the situation and follow-up. If a bite has been confirmed or cannot be excluded, convene a multidisciplinary incident command team to coordinate the response.

External notification to public health: The IP coordinates with public health to assess the risk to staff and patients and whether prophylaxis is warranted. Including for the unaware-patient scenarios described earlier, where direct contact cannot be excluded.

Patient notification: An exposure notification to the patient and their primary care physician is warranted if exposure cannot be ruled out. Provide clear information pitched to the patient’s health literacy about the risks. Track the patient, whether they choose prophylaxis or not, to determine the outcome of the exposure.

Staff notification: Infection prevention and occupational health work together to notify affected staff, clearly educate them about the risks and how to access treatment, and track outcomes.

Document everything: Record who was potentially exposed; the date, time, and location of the incident; the disposition of the animal; and every notification attempt and PEP decision. A simple tracking spreadsheet is invaluable when an investigation stretches across dozens of people and several weeks.

Assess the building: Facilities should evaluate points of entry; bats can slip through openings as small as ¼ inch.⁵ Check for other bats or a colony, and contact a qualified, licensed wildlife-exclusion specialist if additional bats are found. A colony also means accumulating guano, which can harbor Histoplasma capsulatum, the fungus that causes histoplasmosis; disturbing droppings during construction, renovation, or heating, ventilation, and air conditioning work can aerosolize spores that threaten immunocompromised patients.⁸

Build the plan before you need it

The key takeaway is to have a written plan for these exposure scenarios, so your response is consistent every time. Educate staff to avoid contact with bats and to escalate any bat exposure (patient or staff) to infection prevention. Vector control may be the newest line item on your plate, but with a plan in the drawer, you won’t be improvising when the next one comes flapping down the corridor.

Resources

• CDC, Preventing Rabies from Bats
• CDC, About Rabies

References

1. Alsuhaibani M, Kobayashi T, McPherson C, et al. Bat intrusions at a tertiary care center in Iowa, 2018-2020. Infect Control Hosp Epidemiol. 2022;43(12):1948-1950.

2. About rabies. CDC. Accessed June 2, 2026. https://www.cdc.gov/rabies/about/index.html

3. Human rabies deaths—Minnesota and California, 2024. MMWR Morb Mortal Wkly Rep. 2026;75(2):28-31. Accessed June 2, 2026. https://www.cdc.gov/mmwr/volumes/75/wr/mm7502a4.htm

4. Rabies. World Health Organization. Published June 5, 2024. Accessed June 2, 2026. https://www.who.int/news-room/fact-sheets/detail/rabies

5. Preventing rabies from bats. CDC. Published July 1, 2025. Accessed June 2, 2026. https://www.cdc.gov/rabies/prevention/bats.html

6. Notes from the field: human rabies—Idaho, Illinois, and Texas, 2021. MMWR Morb Mortal Wkly Rep. 2022;71(1):1-2.

7. Newsom R, Gilpin N, Marko D, Sackett-Hodge LM, Bercea P. Coordinated response to bat intrusion: managing potential rabies exposure in a healthcare facility. Am J Infect Control. 2025;53(suppl): S12. Abstract EP 06.

8. Histoplasmosis: elimination and engineering controls. National Institute for Occupational Safety and Health. CDC. Accessed June 2, 2026. https://www.cdc.gov/niosh/histoplasmosis/prevention/elimination-and-engineering-controls.html