Infection Prevention and Control Best Practices: For Small Animal Veterinary Clinics

Hand hygiene, including:

• Handwashing

• Use of alcohol-based hand sanitizers

Risk reduction strategies, particularly those related to:

• Use of personal protective equipment (PPE)

• Cleaning and disinfection

• Laundry

• Waste management

Risk assessment of animals and personnel with regard to:

• Disease transmission

• Disease susceptibility

Education

• Veterinary personnel

• Animal owners

• Public

Hand hygiene is the single most important way to prevent infections in the healthcare setting. Intact skin is the first line of defense against bacteria. Hand hygiene of some kind should be performed:

• Before and after contact with a patient (especially before performing invasive procedures)

• Before and after contact with items in the patient’s environment

• After any contact with or any activity involving the body fluids of a patient

• Before putting on and especially after taking off gloves

Personal protective equipment (PPE) is used to protect veterinary personnel and to reduce the risk of pathogen transmission by clothing to patients, owners, veterinary personnel and the public.

• Street clothes should always be covered by protective outerwear, such as a lab coat, when working in the clinic.

• Protective outerwear, including scrubs, should not be worn outside the clinic.

• Lab coats and gowns worn when handling patients with potentially infectious diseases should be laundered after each use.

Gloves should be worn when contact with blood, body fluids, secretions, excretions and mucous membranes is possible, as well as when cleaning environmental surfaces and when doing laundry if gross contamination of items is present.

• Gloved hands should not be used to touch surfaces that will be touched by people with nongloved hands

• Gloves should be removed promptly after use and hand hygiene performed immediately.

• Gloves are NOT a substitute for proper hand hygiene.

Cleaning involves the removal of visible organic matter with soap or detergent, whereas disinfection involves the application of a chemical or other procedure in order to kill the remaining microorganisms.

• Cleaning must always be done before a disinfectant is used.

• Gloves should be worn when cleaning and disinfecting, and hands should be washed after finishing any cleaning activity.

• Selection of a disinfectant for a particular purpose should take into account the product’s spectrum of activity, susceptibility to inactivation by organic matter, potential pathogens in the environment, compatibility with soaps and detergents, toxicity for personnel and animals, contact time required, residual activity, corrosiveness, environmental effects and cost.

Linens used in veterinary clinics should be laundered together using detergent, and dried in a hot air dryer to promote killing of microorganisms.

• Laundry from potentially infectious cases should be treated separately from other laundry, including use of bleach in the wash cycle

• Linens contaminated with gross organic material must be pre-cleaned by hand to remove such material prior to laundering.

• Laundry should not be considered clean until it has also been dried.

All personnel in the surgical area should wear designated surgical scrubs, a surgery cap or hair bonnet, and a nose-and-mouth mask when surgery is underway.

• Scrubs worn in surgery should not be worn when handling or treating other patients, and should be covered with a lab coat outside of the surgical suite

Peri-operative antimicrobials are indicated in clean-contaminated, contaminated and dirty procedures. The need for antimicrobial prophylaxis in clean procedures is unclear.

• If peri-operative antimicrobials are used, they should be administered so that therapeutic levels are present at the surgical site at the time of first incision. Starting antimicrobial therapy after surgery is no more effective than not using antimicrobials at all.

Contact with a surgical incision post-operatively, particularly with bare hands, should be avoided.

• Bandage changes should be performed using aseptic technique.

• Pet owners and handlers should be instructed on how to manage an animal with an incision, and the signs for which to look that may indicate the development of a SSI.

All personnel entering an isolation area, regardless of whether they plan on having direct contact with the animal, must wear appropriate personal protective clothing.

• Designated personal protective equipment must remain in the isolation room.

Animals from shelters and similar facilities should be considered high risk from an infectious disease standpoint. All animals from such facilities should be examined immediately upon arrival without coming in contact with other animals in the waiting/reception area. Animals from these facilities should be housed separately from other patients, if possible.

• For elective procedures (e.g. spay, neuter), all animals should be appropriately vaccinated for their age and treated for relevant intestinal parasites and ectoparasites. Animals with clinical signs compatible with an infectious disease should not be admitted for elective procedures.

If anyone is bitten or scratched by an animal:

• Immediately wash the wound thoroughly with plenty of soap and water.

• Report the incident to the local public health unit (due to risk of rabies exposure).

• Seek medical attention for bite wounds in certain locations on the body, and for any bite wound in certain persons, such as immunocompromised individuals.

Infection control issues should be considered when designing new clinics or when undertaking renovation or expansion of existing clinics.

• Designated staff areas should be set aside for eating, drinking and breaks. These activities should not occur in any area where animals or diagnostic specimens may be present.