Biosecurity Assessments in Private Practice

1. Introduction

Course objectives are:

1. List key components of an effective infection prevention program.
2. Identify components of an effective surveillance program for your setting.
3. Describe how to motivate people in using hand hygiene effectively.
4. Describe what is involved in isolation protocols for your setting.
5. Describe some important concepts to include when educating clients that have Salmonella, Streptococcus equi, and Clostridium difficle/perfringens on their farms.
6. Describe how to inform the community that you offer biosecurity services for their farm/facilities.
7. Describe how to charge for your services.

2. Materials and Methods

The equine community has always recognized veterinarians as a resource for “spreading knowledge and preventing infection.” The community’s perception is that we are infection preventionists who have the knowledge about the pathophysiology of infectious disease, so we must also have the knowledge of infection prevention, control, and epidemiology. Right? Veterinarians now have expanded roles when it comes to biosecurity and biocontainment. The community seeks our expertise for leadership and as educators and mentors.

Our intellectual knowledge does not come for free and therefore we must feel comfortable charging for services that we once gave out for free. Therefore, we should adequately charge for travel, time spent performing the evaluation, and time spent writing a report. This paper will describe how our practice incorporates a biosecurity and biocontainment program into a practice builder and revenue.

The application of biosecurity and biocontainment procedures is important not only in healthcare facilities but also for equine breeding facilities, training facilities, and other facilities that house horse populations.¹ A biosecurity assessment should be approached in like manner as a physical exam. The basic objective is to identify deficiencies in the facility design, standard operating procedures, training, and the animal housing/movement. Before you arrive to the facility, you must have the owner(s)/ employee(s) dedicated to the evaluation. Just going through the motions of having an evaluation performed to comply with the Occupational Safety and Health Administration (OSHA) may get you nowhere. During your visit, you would want to talk to managers and personnel to get a feel of how the standard operating procedures are followed. Ask questions such as: What happens to abortions? How are animals with diarrhea and new arrivals managed? Ask these questions to several of the personnel to determine if they are consistent with their answers. Emphasize before you visit the facility that they should change nothing before your arrival. Observe activities and take plenty of photographs. Take notes so that when you leave the facility you will be able to easily recall your findings. Unfortunately, most of the time, when we get called out for a biosecurity assessment, it is because of an outbreak situation. Ideally, an assessment should be performed under “normal circumstances.”

One of the targeted elements for disease prevention is to prevent the transmission of the infectious agent. We know from previous studies that >20% of foals by 6 months of age will have infectious diarrhea (The National Animal Health Monitoring System Equine 1998 Study). The goal of the biocontainment procedures is to prevent the transmission of that infectious agent to other foals. The transmission of infectious agents requires three elements: a source (or reservoir) of the infectious agent(s), a susceptible host with a portal of entry receptive to the agent, and a mode of transmission for the agent. Identification of areas or processes where transmission of pathogens is likely to occur (control points) and implementation of measures aimed at minimizing the possibility of such transmission, while allowing for reasonable flow and function within the veterinary hospital or animal facility, are important components of biosecurity.² During the assessment and development of the prevention and control activities targeted to infectious diseases, the weakest link in the chain of infection (agent, transmission, host) must be considered for each specific pathogen. In some situations, control of the agent in a specific reservoir may be the best way to reduce disease occurrence. Chlorination of water is an example of destroying an agent in its reservoir or eliminating a possible mode of transmission (see Figs. 1 through 6).
 

Strategies aimed at the level of transmission must be tailored to the type of transmission involved. An example of a control activity targeted to airborne transmission is the isolation of the animal to a facility where there is no shared airspace or is located on the premises where no other animals are currently housed. The control of vector-borne transmission can be targeted toward destroying the vector and toward the use of repellents such as in the case of vesicular stomatitis outbreaks. 

In many instances, the best mechanism to prevent disease occurrence is through modification of the host, such as developing or boosting immunity through active immunization. Other control activities targeted to the host may include improving the nutritional status of a neglected animal or providing chemoprophylaxis (antibiotics) against a variety of agents. Every effort should be made to minimize the contact between animals with a history or clinical signs suggestive of infectious contagious disease or those with confirmed contagious disease and the remainder of the patients or animals at a boarding facility.¹

In developing control programs, the feasibility of a policy also must be assessed. Feasibility or practicality of the policy is dependent not only on the sociodemographic factors but also the operating needs of the facility. For instance, there may be equine facilities that buy and sell horses on a routine basis and will accept the risk of contagious disease outbreaks, such as Streptococcus equi, as the norm, instead of isolating newly arrived horses for a period of time required.

Cost and the availability of resources also must be considered when developing control strategies. Implementing and maintaining even the most basic biosecurity program requires trained personnel and an adequately staffed facility with appropriate supervision. Outbreak investigations have indicated an association between infections and understaffing; the association was consistently linked with poor adherence to hand hygiene.^3–5 The understaffing of human nurses can facilitate the spread of methicillin-resistant Staphylococcus aureus in intensive-care settings through relaxed attention to basic control measures.⁴

A surveillance component to your infection control program is essential to gauge the effectiveness of your biosecurity policies. Data collected through the surveillance process will provide information regarding your current protocols and will provide early warning regarding potential contagious disease threats. The type of surveillance program that your facility will use must be determined on the basis of several factors, including cost, efficiency, and the number of high-risk cases routinely housed in your facility.  [...]