Education and Awareness

Education of all personnel regarding infectious disease hazards to themselves, patients, and veterinary practices is essential to the long-term success of any infection control program.

Written Protocols

The first step to ensuring that necessary information is dis­seminated to all personnel is to document policies and protocols in writing. This effort is valuable for all veterinary practices but is especially critical in larger and more complex veterinary hospitals. This relatively simple step has many benefits. First, documenting procedures requires a thorough review, which by itself is beneficial. Second, documenting policies and protocols in writing imbues the infection control program with a sense of purpose and commitment. Third, documenting procedures helps to ensure consistency in application across all personnel as well as over time. As discussed, all infection control procedures are inherently inconvenient, and the natural tendency is for personnel to drift toward more convenient ways of performing activities that may not provide an adequate degree of protection against HAIs. Fourth, documenting policies demonstrates a degree of due diligence, which is useful from a legal liability standpoint relative to the occurrence of HAIs or zoonotic infections.

Once these protocols have been documented, it is important to require their use as a reference and to make a specific effort to educate personnel about the policies and procedures. A written document serves no purpose if it is not used.

Training Programs

It is also important to consider the differences in training and experience among personnel. By their nature, infection control programs are dependent on adherence to important protocols by all personnel regardless of their position description. Nonveterinarians are invaluable members of most veterinary practice teams, and even personnel who may never touch patients but instead serve as receptionists or have the single specific task of cleaning are absolutely critical for the success of infection control programs and may be exposed to infectious agents on periodic or routine bases. Veterinarians sometimes underappreciate how their specialized training has provided them with a broad appreciation for basic principles of contagious disease transmission and control. Without the experiences of a veterinary education, many personnel simply do not have the same understanding of contagious diseases. Telling people to follow certain rules without them understanding why the rules are necessary leads to inevitable compliance problems.

Another important aspect of education and awareness is to instill a need to lead by example and to empower all person­nel to hold anyone else in the practice accountable for their actions. The hierarchy in authority that is often used in the delivery of patient care (e.g., veterinarians at the top of the hierarchy, personnel without formal training at the bottom) can interfere with optimal infection control. A common non sequitur related to infection control is that those with the most training can be the persons least likely to adhere to important policies. This is true in both human and veterinary medicine, as has been repeatedly shown relative to hand hygiene.^39,40 In numerous studies conducted in a variety of settings, physicians and residents have been shown to be significantly less likely than nurses to adhere to appropriate hand-hygiene protocols. Observations in the veterinary setting suggest that the same trends are true for hand hygiene as for appropriate use of barrier nursing precautions. All people pick up cues for behavioral expectations from their surroundings. If personnel who clearly understand the importance of preventive measures (physicians and veterinarians) such as handwashing fail to routinely follow best infection control practices, there is little hope that trainees and laypersons will routinely trouble themselves to habitu­ally use an important albeit inconvenient practice.

One way to improve compliance and counter the influences noted previously is to use disseminated enforcement by actively encouraging all personnel to call attention to noncompliance. Once it has been determined which procedures are required for a particular situation and this has been documented, there is no reason why nontechnical staff should be any less capable than a veterinarian in determining whether a procedure has been followed correctly. It is important that this community enforcement be empowered by all in a spirit of friendly camaraderie and team building. Some hospitals have noted significant improvements in compliance using this method of enforcement and have even used competitions among “teams” with the incentive of agreeing that the loser must pay a reward to the other team (e.g., pizza lunch).

Zoonosis Awareness

Every patient, healthy or sick, carries multiple potentially zoonotic pathogens in their commensal microbiota. Some patients pose higher risks because of additional pathogens, shedding of higher levels of common opportunists, or disease or behavior factors that increase the risk of transfer of pathogens.

One of the most important objectives for an infection control program is to protect personnel and clients from illness associ­ated with zoonotic pathogens. This is another area in which veterinarians sometimes forget that not all personnel understand hazards or how to take appropriate actions to protect themselves. Without this knowledge, personnel may take inappropriate risks or may overreact to perceived hazards in a low-risk situ­ation.

Personnel With Increased Risk of Infection

All personnel are at some risk of zoonotic infection, through being at increased risk of either disease following exposure to a pathogen or serious disease compared to lower risk individuals. Some individuals may be at increased risk because of concurrent disease (e.g., immunosuppressive disorders, skin diseases or lesions), treatments (e.g., immunosuppressive therapy, antimicro­bial therapy), age, or pregnancy. Being “immunocompromised” or “high risk” is not a single state, and there can be marked differences in the degree of increased susceptibility as well as the risk posed by particular pathogens. Quantifying the degree of risk is difficult, and specific information about risks posed by certain conditions and the effect of preventive measures is generally lacking. In general, preventive measures are the same for high-risk individuals, as strict compliance with core infection control practices is likely the most important factor.

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■ TABLE 46.3

Zoonotic Diseases of Domestic Large Animal Species That Are Transmissible Through Occupational Exposures to Veterinary Personnel—cont'd

Continued

■ TABLE 46.3

Zoonotic Diseases of Domestic Large Animal Species That Are Transmissible Through Occupational Exposures to Veterinary Personnel—cont'd

Continued

■ TABLE 46.3

Zoonotic Diseases of Domestic Large Animal Species That Are Transmissible Through Occupational Exposures to Veterinary Personnel—cont'd

■ TABLE 46.3

Zoonotic Diseases of Domestic Large Animal Species That Are Transmissible Through Occupational Exposures to Veterinary Personnel—cont'd

Continued

^aThis is not a complete list of all zoonotic diseases; less common diseases and those with vector-borne or solely foodborne routes of transmission are not included.

In some situations, use of enhanced barriers, avoiding certain procedures, or avoiding specific patients might be indicated, but these are uncommon.

One potential weak link in the management of higher risk personnel is identification. Some individuals do not realize their increased risk, highlighting the importance of general infection control training to ensure that individuals can self­identify as higher risk. Higher risk individuals also need to be able to take precautions while reducing any concerns about stigma, privacy, and job security. Involvement of the person's physician (or an Occupational Health or Infectious Disease physician) may be indicated.