Infection control in veterinary clinics

Each year there are around 2 million infections that are acquired in health care settings in the United States, and approximately 90 000 deaths result from those infections. The cost is over $4.5 billion. Not surprisingly, infection control is a concept that is being widely promoted. The hand washing stations in hospitals are a very prominent indication of the importance being placed on infection control in human hospital settings. Alcohol-based rubs for hand antisepsis are promoted in drug stores and other locations and exhortations to wash our hands come at us from all directions.

Increasing concerns about zoonoses and antimicrobial resistance are bringing public health and private veterinary practice together. An emphasis on prevention will pay rich dividends for the safety of our patients and staff and the broader community.

The medical community has a particular responsibility in infection control in hospitals — this community includes veterinarians. The Canadian Committee on Antibiotic Resistance has recently published a document entitled “Infection Prevention and Control Best Practices for Small Animal Veterinary Clinics,” which is endorsed by the Canadian Veterinary Medical Association and the Centre for Public Health and Zoonoses, University of Guelph. The document, prepared by Maureen Anderson, Jenny Montgomery, Scott Weese and John Prescott, is accessible through the Web sites of both organizations that endorse the publication.

The document starts with a 1-page, 10-point summary, which highlights the goal of protecting patients, owners, veterinary personnel and the community; the need for a formal infection control program that includes surveillance; routine practices that include hand hygiene, risk reduction, risk assessment and education; specific measures related to surgery; isolation facilities; proper wound care; the special case of animals from shelters; the importance of making personnel safety a priority; and education regarding zoonotic and infectious disease risks and prevention. A detailed summary is provided towards the end of the booklet.

This succinct guide is modified from practices that have been developed for human hospitals, as this field is poorly developed in veterinary medicine. However, concern for safety and for achieving best practice, increased awareness of zoonotic diseases, and the “increasingly litigious nature of society” are driving accelerated development of infection control in veterinary clinics. The booklet notes that human and animal pathogens are present in veterinary clinics and that these clinics may play a role in the dissemination of infectious agents, including antimicrobial resistant bacteria. The authors advise that every veterinary clinic should have a documented infection control program.

There is an excellent well-illustrated section on transmission of microorganisms. Infection control measures that are discussed include clinic design, protocols for hand hygiene, immunization, managing infectious disease outbreaks, care of animals with zoonotic organisms, and personal protective equipment. The authors consider that an infection control practitioner (a veterinary technician or a veterinarian) is needed to lead the establishment, implementation, and monitoring of the infection control program. There are discussions of gloves, gowns, face protection, respiratory protection, and footwear.

There is a Table that identifies the need for gloves, gown, mask and other personal protective equipment for each of 53 disease agents, 37 of which are zoonotic. Another table shows the personal protective equipment required for each of 23 routine procedures. A table in the appendix provides a check list for an infectious disease audit. This document is valuable for the implementation of infection control procedures in small animal veterinary clinics.

Statements that are emphasized include “Every veterinary clinic should have an isolation area for caring for and housing animals with potentially contagious infectious diseases” and “It should be clinic policy not to feed raw meat to hospitalized animals.”

Human hospitals have been struggling to have simple hand washing carried out appropriately by hospital personnel. A typical complaint is that “despite much time, effort and cost, there is a growing frustration within infection control that training programs do not appear to have a lasting effect on behavior or produce consistently good hand hygiene compliers” (1). Significantly reducing transmission of infections in small animal veterinary clinics, as in human hospitals, will require “clear goals, a committed leadership, access to resources, a best-practice mindset, effective people management, and ongoing vigilance” (2).

Are veterinarians doing any better than their physician colleagues? Last year a special report in the Journal of the American Veterinary Medical Association presented the results of a survey on infection control practices and zoonotic disease risks among veterinarians in the United States (3). Occasional eating or drinking in animal handling areas was a common practice, especially among small animal practitioners. About half the small animal practitioners and less than a third of the large animal or equine practitioners reported always washing their hands before eating, drinking or smoking. The frequency of hand washing between contacts with patients was even lower.

Increasing concerns about zoonoses and antimicrobial resistance are bringing public health and private veterinary practice together. An emphasis on prevention will pay rich dividends for the safety of our patients and staff and the broader community.