Infection Control: Lessons Learned
The keys to successful infection control in the veterinary practice after COVID.
Question: How do you get veterinary practices to consider infection control independent of COVID?
Infection control experts such as Jason Stull, VMD, MPVM, Ph.D., Diplomate ACVPM, think about this daily, particularly as the COVID public health emergency is ending. And it’s a question they want veterinarians and staff to think about just as often. Dr. Stull is an assistant professor in the Department of Veterinary Preventive Medicine at The Ohio State University and chair of the AAHA Infection Control Task Force that put together the 2018 AAHA Infection Control, Prevention, and Biosecurity Guidelines.
The AAHA guidelines offer practical standard operating procedures to guide veterinary teams in creating a clean and safe environment, including proper cleaning and disinfection, hand hygiene, personal protective equipment, identifying high-risk patients, and managing contagious patients in isolation.
“We approached this from the perspective of the busy veterinary team member, who often has little background in infection control, and we distilled key practices into a succinct ‘how-to manual,’” Dr. Stull told Veterinary Advantage in April 2020. “With these guidelines, every practice can have an infection control program they can be proud of, and that will protect patient, owner, and personnel health.”
Speaking with Veterinary Advantage today, Dr. Stull said the Guidelines continue to serve as a foundation for sound infection prevention. “The main goal was to create a document that people could pick up and move forward within their practices.”
The COVID interlude
But just two years after the Guidelines were published, COVID emerged, raising awareness – and fear – around the infectious-disease vulnerabilities of veterinary practices. Clinics that had an infection control program in place prior to COVID were able to pivot quickly when the Public Health Emergency was declared, he says. “They created protocols so that animals could be treated outside the hospital, that sick staff stayed at home, and that those at work always used personal protective equipment.” Some clinics made significant changes that will have long-term impacts, such as the installation of equipment with air ventilation.
Successful practices adapted the hierarchy of controls called for in the 2018 AAHA Guidelines, he added. That hierarchy begins with elimination (that is, removal or prevention of pathogens), followed by engineering controls (e.g., hospital design and setup), administrative controls (e.g., work policies and procedures) and personal protective equipment.
“Fear – and the need to make the hospital a safe environment – was a driving factor. It was about making people feel comfortable and safe. And in some cases, there were legal components.” But Dr. Stull has some concerns today. “Many of the measures taken were tied to COVID. Veterinary clinics – like the rest of society – are returning to ‘normal life.’ The challenge is how we reframe the concept of infection control so we get people to maintain certain practices. How do we get them to think about infection control outside of COVID?”
Veterinary teams that maintain the same level of concern they had at the height of COVID will build a new culture and rethink the purpose of infection control, he said. “But like so many public health measures, it’s difficult at the end of the day to say, ‘Doing this saved us X dollars,’ because we don’t know for sure what would have happened had we not taken such measures. But we do know infection prevention has very concrete benefits. It saves animals’ lives, reduces healthcare-associated infections, such as surgical site infections, and ensures the safety of staff and clients.”
Regarding infection prevention practices, human medicine is ahead of veterinary medicine, said Dr. Stull. For example, U.S. human hospitals are subject to specific state and federal performance-based standards designed to ensure that they monitor and reduce the risk of infection, including employing a certified infection preventionist.
But veterinary clinics can take action to catch up to their medical counterparts. For example, the 2018 AAHA Guidelines suggest that veterinary practices appoint someone on staff to act as an infection control practitioner. That person would oversee and champion the infection control, prevention, and biosecurity program through:
- Program development, maintenance, compliance
- Staff training development/documentation
- Protocol compliance evaluation
- Receipt of actionable infection control concerns, including suspected hospital-acquired infections.
Few veterinary clinics have the resources to hire a full-time infection preventionist, and few have anyone on staff to track and report on such things as how many days the practice has gone without a hospital-acquired infection, he said. “It’s not that people don’t care, but infection prevention can become a lower priority in busy offices.”
But veterinary practices can implement relatively easy measures to improve infection control. “Handwashing is not rocket science. It’s simple. We pushed it with COVID, but over time, people tend to feel less vulnerable, and they disassociate from their role in the transmission of infection. So a simple concept like handwashing gets forgotten or minimized.”
“Certain technologies can help, but a lot of it comes down to individual choice,” he said. “How do we instill the notion that the choices each of us makes every day affect every animal and every other person in the practice? Creating an infection control culture isn’t an easy thing to do.”
The practice owner or others in positions of authority can make a difference, he says. Simply modeling prudent infection control practices can have a far-reaching impact on everyone in the practice. A recently launched program is intended to help.
In March, the National Association of Veterinary Technicians in America, in partnership with Virox Technologies, launched the Infection Prevention Leader Certificate Program. The free online program is designed to provide animal care professionals with the knowledge needed to reduce the risk of spreading infection and create a safer workplace for their team, patients, and clients. The certificate program consists of four courses:
- Pathogens and disease transmission
- Infection prevention
- Cleaning, disinfection, and sterilization
- Implementation and communication
Upon completion of the four courses, students receive a certificate and five continuing education credits.
“This is one of those missing links,” said Dr. Stull. “If we can get a key group of individuals in veterinary practices, ideally every veterinary practice, to become certified leaders, they can get the conversation started and people moving. It’s important to build a sense of community, and we hope to do that with a message board that is part of the infrastructure connected with the Infection Prevention Leader Certificate Program. Veterinary medicine has a fragmented approach to infection control. We need every individual to step up.”
Image credit: istockphoto.com/feryjory