Veterinary Infection Prevention and Control

Linda Caveney, Barbara Jones, Kimberly Ellis, Linda Caveney, Barbara Jones, Kimberly Ellis

• Publisher: Wiley-Blackwell
• Year: 2011
• Print ISBN:
  9780813815343
• eBook ISBN:
  9780470961452
• Edition: 1
• Topic: Medicine
• Subtopic: Veterinary Medicine

Veterinary Infection Prevention and Control is a practical guide to infection surveillance and control in the veterinary setting. Outlining the steps for designing and implementing an infection control plan, the book offers information on both nosocomial infections and zoonotic diseases to aid the veterinary team in ensuring that veterinary practices and hospitals are safe for both the animal patients and their human caregivers. Veterinary Infection Prevention and Control provides guidelines to creating standard operating procedures for effective and efficient infection control in any veterinary practice.

With background information on pathogens, bacteria, and disease transmission, the book focuses on specific infection prevention strategies, including disinfection, sterilization, and isolation.  A companion website provides review questions and the figures from the book in PowerPoint. Veterinary Infection Prevention and Control gives practicing veterinarians, technicians, and practice managers in both small and large animal facilities the tools they need to successfully develop an infection-control program.

1

What Is Infection Control and Biosecurity?

Audrey Ruple, Nathan M. Slovis and Barbara Jones

“First do no harm.” This edict reminds all veterinarians that they must consider the possible harm that might be caused by any intervention. Since as early as 1860, this phrase among veterinarians has been an expression of hope, intention, humility, and recognition that acts with good intentions may have unwanted consequences. The vast majority of patients who have access to medical services today are healed. There are some, however, who suffer unintended consequences of care, such as health care–associated infections (HAI). To ensure that such life threatening–life saving care does not result in HAI, modern health care has developed an extensive system for infection prevention. Regardless of the approaches taken, health care facilities must strive for 100% adherence to the institutions’ infection control strategies. To achieve this caliber of adherence, proper education of the staff will be necessary.

The focus of this chapter is to educate readers to be proactive when it comes to biosecurity attentiveness to safeguard patients, clients, students, co-workers, animal companions, and the community from potential infectious agent(s). Recognizing the need to establish objectives, expectations, and goals for a successful biosecurity program will in turn lead to quality standards of care delivered by a dedicated and educated team.

DEFINITIONS OF DISEASE CONTROL TERMINOLOGY

It is important to establish a common vocabulary as many of these words have other meanings or uses in veterinary practice. The way these words and phrases are defined here is specifically in the context of how they relate to infection control. The definitions are compiled from those by the Centers for Disease Control (CDC), World Health Organization, Food and Agriculture Organization of the United Nations, and the Occupational Health and Safety Administration. Table 1.1 provides the definitions of disease control terminology used in this book.

Table 1.1 Definitions of Disease Control Terminology

Alcohol-based hand rubs	An alcohol-containing preparation designed for application to the hands for reducing the number of viable microorganisms on the hands. In the United States, such preparations usually contain 60–95% ethanol or isopropanol.
Antimicrobial soap	Soap or detergent containing an antiseptic agent.
Antiseptic agent	Antimicrobial substances that are applied to the skin to reduce the number of microbial flora. Such substances may include alcohols, chlorhexidine, chlorine, iodine, chloroxylenol, quaternary ammonium compounds, and triclosan.
Antiseptic handwash (or HCW handwash)	FDA product category. An antiseptic-containing preparation designed for frequent use; it reduces the number of microorganisms on intact skin to an initial baseline level after adequate washing, rinsing, and drying; it is broad-spectrum, fast-acting, and, if possible, persistent.
Antiseptic hand rub	Applying an antiseptic hand rub product to all surfaces of the hands to reduce the number of microorganisms present.
Biosecurity	All the cumulative measures that can or should be taken to keep disease from occurring and prevent the transmission of disease. The policies and hygienic practices designed to prevent incidents of infectious disease.
Colonization	Presence of a microorganism on or in a host, with growth and multiplication of the organism but without interaction between host and microorganism; i.e., no clinical signs and no immune response.
Clinical infection	An infection by a microorganism that can be identified through clinical signs and laboratory tests.
Detergent	Detergents (e.g., surfactants) are compounds that possess a cleaning action. They are composed of both hydrophilic and lipophilic parts and generally are divided into three groups: anionic, cationic, and nonionic detergents. Although products used for handwashing or antiseptic handwash in health care settings represent various types of detergents, the term “soap” is used to refer to such detergents in this guideline.
Disinfectant	A chemical agent that can be applied to inanimate objects (surgical equipment, floor, hand surfaces, etc.) that causes the destruction or inhibition of microorganisms, but not necessarily their spores, or some viruses.
Hand antisepsis	Refers to either antiseptic handwash or antiseptic hand rub.
Hand hygiene	A general term that applies to handwashing, antiseptic handwash, antiseptic hand rub or surgical hand antisepsis, or the use of disposable exam gloves.
Handwashing	Washing hands with plain soap and water.
Health care worker	HCW
Infection	The entry and development or multiplication of a microorganism; however, infection does not always cause disease. There are several types of infection: colonization, subclinical, latent, and clinical.
Isolation	An area within the veterinary practice or animal facility that is used to separate animals with a contagious disease from other animals.
Latent infection	An infection that is inactive and is causing no clinical signs, though it continues to be capable of producing clinical signs.
Multiple drug–resistant organism (MDRO)	Microorganisms, predominantly bacteria, that are resistant to one or more classes of antimicrobial agents. Although the names of certain MDROs describe resistance to only one agent, e.g., MRSA, these pathogens are frequently resistant to multiple antimicrobial agents.
Nosocomial infection	An infection produced by a pathogenic agent that was neither present nor incubating at the time the patient was admitted to the veterinary hospital and/or animal facility.
Persistent activity	Persistent activity is defined as the prolonged or extended antimicrobial activity that prevents or inhibits the proliferation or survival of microorganisms after application of the product. This activity may be demonstrated by sampling a site several minutes or hours after application of the product. This property also has been referred to as residual activity. Both substantive and nonsubstantive active ingredients can show a persistent effect if they substantially lower the number of bacteria during the wash period.
Personal protective equipment (PPE)	Specialized clothing or equipment worn by personnel for protection from infectious material.
Plain soap	Plain soap refers to detergents that do not contain antimicrobial agents or contain low concentrations of antimicrobial agents that are effective solely as preservatives.
Reservoir	Any person, animal, arthropod, plant, or place (soil, water) in which an infectious agent normally lives and multiplies. It is the natural habitat of the infectious agent and on which it depends on for survival.
Sanitizer	An agent that reduces the number of microorganisms to safe levels as judged by public health requirements. According to the protocol for the official sanitizer test, a sanitizer is a chemical that kills 99.999% of the specific test bacteria in 30 sections under the test conditions.
Sterilization	A validated process used to render a product free of all forms of viable microorganisms. For any sterilization process, the presence of microorganisms on an individual item can be expressed in terms of probability; although this probability can be reduced to a very low number, it can never be reduced to zero.
Subclinical infection	An infection with no detectable clinical signs, but that is capable of producing clinical signs. Certain subclinical infections can be detected by an immune response.
Surgical hand antisepsis	FDA product category. Antiseptic handwash or antiseptic hand rub used preoperatively by surgical personnel that substantially reduces the number of microorganisms on intact skin; it is broad-spectrum, fast-acting, and persistent.
Surveillance	Ongoing systematic collection, collation, analysis, and interpretation of data and the dissemination of information to those who need to know in order that action may be taken. The data chosen to be collected depends on the needs of the individuals, practices, institutions, or facilities; for example, specific Salmonella isolates in a tertiary equine hospital to monitor for nosocomial infections.
Transmission	Any mechanism by which an infectious agent is spread from a source or reservoir to an individual.
Waterless antiseptic agent	An antiseptic agent that does not require use of exogenous water. After applying such an agent, the hands are rubbed together until the agent has dried.
Zoonosis	Any infectious disease that can be naturally transmitted from vertebrate animals to humans.

EPIDEMIOLOGIC LEVELS OF DISEASE CONTROL ACTIVITIES

Disease control activities against infectious agents occur at four levels: individual, institutional, community, and global.

The first level, the individual, is predominantly the domain of the primary provider. A variety of prevention strategies can be targeted to individuals through their primary provider, normally a veterinarian providing wellness and general health services. One example is the use of chemoprophylaxis (antibiotics) to help prevent surgery-site infections.

The second level is that of the institution, which is the domain of the infection-control practitioner or the organization health official. This level would include veterinary hospitals, pet boarding facilities, human health care facilities, nursing homes, other human residential facilities, and schools. Programs to prevent the spread of fecal, respiratory, and blood-borne pathogens to health care workers or patients are examples of control strategies targeted at the institutional level.

The third level is targeted to the community (in general) and is predominately the domain of public health agencies (local, state, and national levels). The removal of dead animal carcasses after a hurricane is an example of a control measure targeted for the community.

The fourth level is related to global strategies. For a number of important pathogens, it has become evident that global control strategies are critical to disease occurrence within the United States. Examples of this a...

Table of contents

• Cover
• Title Page
• Copyright
• Contributors
• Foreword
• Acknowledgments
• Introduction
• 1: What Is Infection Control and Biosecurity?
• 2: Microbiology Review
• 3: “Links in the Chain” of Disease Transmission
• 4: Zoonotic Diseases
• 5: Disease Prevention Strategies
• 6: Guidelines for Effective Cleaning and Disinfection
• 7: Chemical Disinfectants
• 8: “Best Practice” Procedures Prior to Sterilization of Medical Equipment
• 9: Packaging, Preparation for Sterilization, and Sterile Storage of Medical Equipment
• 10: High-Temperature Sterilization
• 11: Low-Temperature Sterilization
• 12: Processing of Complex Medical Equipment and Specialty Processing
• 13: Surgical Textiles, Linens, and Laundry
• 14: Infection Control: The Surgical Environment and Ancillary Areas
• Appendix A: Medical Term Reference Information
• Appendix B: Common Concentrate Dilutions
• Appendix C: Table of Disease Transmission and Disinfection Guidelines
• Appendix D: Donning and Removal of a Surgical Gown
• Index