A chain is only as strong as its weakest link. This is also true regarding hygiene in veterinary hospitals, somebody once said. A veterinary hospital is a complex work field and a balanced range of protocols is necessary. Quite often the weakest link is you. Something done unaware can transfer a disease. To be aware of the risks is the start of a mental and physical training to prevent zoonosis and nosocomial infections. A zoonosis means a disease that passes from an animal to a human and/or vice versa. A nosocomial disease is one that is not present when a patient enters a hospital. It is hospital acquired.

So, the goal of good hygiene protocols is multiple: to prevent spreading of a disease from one of your patients to you; to prevent a weak patient getting even more ill from something you carry with you; to prevent one patient catching something from another patient directly, via you or the hospital environment. Also, you do not want to take some disease home to your own animals or your family. Think about rabies, Bartonella henselae, infections from bite wounds, leptospirosis, dermatomycosis, worm infections, MRSP, MRSA, tetanus, parvovirus, Coxiella Burnetii, psittacosis, Giardia, kennel cough, feline herpes virus, and a lot more. To prevent transmission you obviously need to know how these diseases are transferred. And this is as diverse as the diseases themselves. Transfers can happen through a scratch, via bodily fluids, through aerosol transmission or via skin contact. Some are spread via fomites, objects that are contaminated for different lengths of time. A study examining the white coats of 100 medical students found bacterial contamination on all coats. Other studies suggest you should clean your stethoscope, cell phone, computer keyboards, and touchscreens better. Bedding and environmental surfaces, as well as medical devices such as blood pressure cuffs, can serve as fomites. Some bacteria form a biofilm that gives them a good degree of protection against antimicrobial agents. These biofilms are found on medical devices such as central venous catheters, indwelling urinary catheters, and endotracheal tubes. Often colonization occurs within 3 days of placement. This is just one of the reasons why the longer the stay in hospital the greater the risk of a nosocomial infection. The severity of the underlying disease state plays a role in infection and mortality, and also the use of antibiotics prior to and during hospitalization, as well as the use of corticosteroids and chemotherapy. That is why our patients in the ICU are at greater risk. Prophylactic intravenous catheter changes every 3 days do not decrease the incidence of catheter-related colonization or bacteraemia in humans. It is advised to inspect and clean the catheter site regularly. The same policy applies to urinary catheters, especially in female dogs and cats. A closed collection system is not only better at reducing the risk of an ascending urinary tract infection, but it also decreases the risk of spreading a possible infection from the urine, e.g., leptospirosis.

Most important in infection control is still hand hygiene. Hand-washing reduces bacterial numbers by 50%, the proper use of alcohol-based disinfectants is even more effective with a reduction of bacterial numbers by 88%. Take care when smearing the disinfectant and be patient while it dries. Nail polish does not seem to increase bacterial counts. But your nails should be kept short, no longer than 2 mm. Some hospitals adopt a “bare below the elbows” policy to avoid rings, wrist watches, or long sleeves to serve as fomites.

Some of the hygiene protocols should be observed with every patient. Studies examining animals for methicillin-resistant staphylococci found that animals may have an infection, or be colonized at one point and might clear the organism on their own, or only be contaminated. So, there could be more to it than meets the eye. Caring for a possibly contagious patient starts before the patient enters the clinic. Do you have a designated examination room for these patients? Can you minimise the route of this patient through your facility? Can you minimise the staff involved? Can you minimise the stuff that might get contaminated?

Once a specific contagious disease is determined a barrier nursing plan should be chosen. Whether you need eye protection, a gown, or a mouth mask depends on the expected route of transmission. Which kind or gloves are advised? If chemotherapy is involved you might have special orange medical grade gloves in your hospital. If not, make sure to use nitrile ones as they give better protection against chemicals than latex gloves. Barrier nursing has an important role in reducing zoonosis and nosocomial infections. But a gloved hand can still spread a disease throughout the hospital. Make sure that you shed your gloves and gowns inside out and leave them in the isolation area. Train your body and mind to be aware of possible transmissions. When you first started in theatre did it not cost quite some concentration to keep sterility? Get everything you need - and not more - together before you cross into isolation. Try to plan treatments carefully, if possible, at the end of shifts, not in the middle of that one hour in which owners call for an update, not during an understaffed lunch hour. Try to make some time for TLC as well as other treatments. Gloved cuddles are better than none and speaking in a friendly way should always be possible.

Last, but not least, a straightforward waste management and an easy to follow environmental disinfection protocol is what you need for the final part of the treatment of a contagious patient.

References

1.  Hardy JM, Owen TJ, et al. The effect of nail characteristics on surface bacterial counts of surgical personnel before and after scrubbing. Vet Surg. 2017;46(7):952–961.

2.  Treakle AM, Thorn KA, et al. Bacterial contamination of health care workers’ white coats. Am J Infect Control. 2009;37(2):101–105.

3.  Ogeer-Gyles JS, et al. Nosocomial infections and antimicrobial resistance in critical care medicine. J Vet Emerg Crit Care. 2006;16(1):1–18.

4.  Cohn LA, Middleton JR. A veterinary perspective on methicillin-resistant staphylococci. J Vet Emerg Crit Care. 2010;20(1):31–45.