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How to Prepare a Biosecurity Program for an Equine Veterinary Hospital
G.A. Perkins, J. Bartol
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1. Introduction
Biosecurity is essential for veterinary practices and maintaining trust and clientele. Whenever horses are transported and comingled with new animals, treated with antibiotics, eating an altered diet, or undergoing other stressors, there is a chance for a perfect storm where there is possible shedding and increased susceptibility to a contagious infectious agent. There is always a risk of acquiring an infectious disease in an equine hospital, whether it is Salmonella spp., an infection at the intravenous catheter site with a multidrug resistant (MDR) bacteria, or influenza. A biosecurity program needs to be in place to reduce these risks and is becoming a necessary part of standard-of-care expectations of our equine clients. The goals of a biosecurity program at a veterinary practice are to reduce the risk of nosocomial infections in hospitalized horses and to protect human health.1–4
2. Materials and Methods
The development of a biosecurity program begins with someone who is in charge and accountable. In most veterinary practices it would be best to have a veterinarian and a technician involved in the oversight of a biosecurity program. However, the entire practice needs to be engaged in proper biosecurity practices, as the program is only as good as the weakest link. If the veterinarians are practicing good biosecurity and lead by example, then the rest of the staff will follow suit. The training of personnel and keeping everyone informed of the protocols is a continuous activity. Preparing written biosecurity protocols using everyone’s input helps educate and inform the practice as a whole and is a very healthy process for the group. Once the documents are finalized, they should be easily accessible to everyone and referenced when needed. Having these documents in an easy-to-read format and providing it to visitors, such as visiting student externs before they arrive, sets the stage for a practice that cares about biosecurity and helps protect your clientele.
Formalizing a biosecurity program begins with putting protocols into place, then monitoring patients and assessing for problems, and training personnel. Continuous updating of the program is essential to its success.
Assessment and Critical Evaluation of Existing Protocols and Structure
If you are designing a new facility or wanting to formalize an infectious disease program at your practice, these are the broad topics that you will want to investigate.
- Facility layout
- Traffic (people, horses, dogs, cleaning equipment, vehicles)
- Horse stabling
- Stall sanitation
- Manure, soiled bedding, and hay disposal
- Medical equipment sanitation
- Operating room sanitation
- Medical waste disposal
- Water source and disposal
- Feed and hay storage
- Vector and wildlife control (to include rodents, mosquitoes, ticks, and flies)
- Existing written infection control policies
An assessment of existing work-flow patterns and biosecurity protocols is a good place to start. Knowing your limitations will help you make critical decisions that will help protect your patients. For instance, deciding whether your clinic should admit a ‘fever of unknown origin’ patient. This initial assessment allows for a list of actionable items, interventions, and a long-term plan for improvements to your overall program.
This presentation will focus on general hygiene and effectively isolating patients to contain any infectious diseases.
General hygiene and cleaning and disinfection of the hospital and medical equipment is paramount to cleanliness and reducing pathogens in the environment. Some guidelines for cleaning the facilities and medical equipment are briefly summarized.
Stalls, Treatment Rooms, Animal Facilities
Remove all equipment, bedding, and organic material; then use a scrub brush to clean with soap and water getting into all corners and crevices, rinse with water, and then apply a disinfectant mix (Fig. 1). The disinfectant must be mixed as the label describes and appropriate protective clothing worn by the staff. The disinfectant should be allowed the amount of contact time specified on the label and then rinsed and the area allowed to dry. The disinfectant used in a hospital depends on safety, historical problems, cost, wear-and-tear on the facilities.a For some pathogens, such as Cryptosporidium sp., Clostridium difficile, and Rotavirus that are hardest to eliminate from the environment, a specific protocol may be set up for cleaning stalls and the surrounding area after the affected patient leaves. For example, 1:10 bleach solution is commonly used for eliminating Clostridium difficile spores. Rotavirus, a nonenveloped virus, requires an accelerated hydrogen peroxide, oxidizing agent, or phenolic compound.
Medical Equipment Such as Ultrasound and Radiological Equipment
This equipment should be spot cleaned after each use with a disinfectant wipe (Fig. 2). A regular schedule (every week, two-weeks, monthly) should be adhered to for a more aggressive cleaning of the entire piece of equipment and the cart upon which it is housed. In order to keep up with the regularly scheduled full-cleaning, have a sign-up sheet on the equipment with the date and signature of the person performing the cleaning.
Other Equipment
There are many items such as twitches, nasogastric tubes, brushes, and much more that come into contact with individual animals and should be cleaned between animals. If possible these items could be assigned for use in one particular patient and then cleaned after the patient is discharged.
Hand Hygiene
Hand hygiene is a very important part of a biosecurity program and cannot be stressed enough. Hands should be washed before and after handling each patient. Similar to human healthcare workers, one should wash hands when entering an examination room in front of clients. This sets a good example and shows that your practice cares about hygiene. Hands should be rinsed with water, soap applied, and then washed for about 20 s (sing “Happy Birthday”). [...]
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About
Affiliation of the authors at the time of publication
Department of Clinical Sciences, Cornell University, Ithaca, NY, 14853 (Perkins); and New England Equine Medical and Surgical Center, PLLC, Dover, NH, 03820 (Bartol)
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