Cover Page

Contents

Cover

Title Page

Copyright

Contributors

Foreword

Acknowledgments

Introduction

1: What Is Infection Control and Biosecurity?

DEFINITIONS OF DISEASE CONTROL TERMINOLOGY

EPIDEMIOLOGIC LEVELS OF DISEASE CONTROL ACTIVITIES

TARGETED ELEMENTS FOR DISEASE PREVENTION

EVALUATION OF RISK, FEASIBILITY, COST, AND EFFECTIVENESS

PREVENTION INTERVENTIONS

INFECTION CONTROL: STANDARD OPERATING PROCEDURES

WRITING THE INFECTION CONTROL PLAN

EDUCATION, TRAINING, AND ENFORCEMENT

CONCLUSION

REFERENCES

2: Microbiology Review

THE SCIENCE OF MICROBIOLOGY

SPECIMEN SELECTION, COLLECTION, AND TRANSPORT

LABORATORY DIAGNOSTICS

BACTERIA

FUNGI

VIRUS

PROTOZOA

PRIONS

CONCLUSION

REFERENCES

3: “Links in the Chain” of Disease Transmission

INTRODUCTION

DEFINITIONS OF KEY TERMS

COMMON LINKS IN THE CHAIN OF DISEASE TRANSMISSION

SPREAD WITHIN POPULATIONS

CONCLUSION

REFERENCES

4: Zoonotic Diseases

ANTHRAX

BRUCELLOSIS

CAMPYLOBACTER

CRYPTOSPORIDIUM

GIARDIA

LEPTOSPIROSIS

METHICILLIN-RESISTANT STAPHYLOCOCCUS

RABIES

SALMONELLA

TOXOPLASMOSIS

CONCLUSION

REFERENCES

5: Disease Prevention Strategies

INTRODUCTION

CONTROLLING THE INFECTIOUS AGENT

CONTROLLING THE ROUTE OF TRANSMISSION

PROTECTING THE PATIENT

CONCLUSION

REFERENCES

6: Guidelines for Effective Cleaning and Disinfection

DEFINITION OF COMMON TERMS

HOW TO READ A DISINFECTANT LABEL

FACTORS THAT CAN ALTER THE EFFECTIVENESS OF CHEMICAL DISINFECTANTS

SPAULDING CLASSIFICATION SYSTEM

CLASSIFICATION OF CHEMICAL DISINFECTANT ACTIVITY

ADDITIONAL CONCERNS WHEN USING DISINFECTANTS

CRITERIA FOR ESTABLISHING A DISINFECTION PROTOCOL

APPLICATION OF DISINFECTANTS

Creating a Disinfection Protocol

CONCLUSION

REFERENCES

7: Chemical Disinfectants

ACIDS

ALKALIS

ALCOHOL

ALDEHYDES

BIGUANIDES

HALOGENS

QUATERNARY AMMONIUM COMPOUNDS

PHENOLS

OXIDIZING AGENTS

CONCLUSION

REFERENCES

8: “Best Practice” Procedures Prior to Sterilization of Medical Equipment

CLEANING AREA DESIGN AND LOCATION

WATER AND CLEANING AGENTS USED IN THE CLEANING PROCESS

CLEANING METHODS

CLEANING PROTOCOLS

INSPECTION OF SURGICAL INSTRUMENTS

CONCLUSION

REFERENCES

9: Packaging, Preparation for Sterilization, and Sterile Storage of Medical Equipment

PERSONNEL FACTORS

SELECTION OF PACKAGING MATERIALS

PACKAGE CONFIGURATION AND PREPARATION

LABELING

PACKAGE CLOSURE

LOADING THE STERILIZER

UNLOADING THE STERILIZER

STERILE STORAGE

CONCLUSION

REFERENCES

10: High-Temperature Sterilization

STRUCTURE AND MAKEUP OF A STEAM STERILIZER

BASIC TYPES OF STEAM STERILIZERS

STEAM STERILIZATION PARAMETERS

LOAD CONFIGURATION PRIOR TO STEAM STERILIZATION

WHEN WET PACKS OCCUR

STERILITY ASSURANCE

CONCLUSION

REFERENCES

11: Low-Temperature Sterilization

BASIC REQUIREMENTS FOR ALL LOW-TEMPERATURE SYSTEMS

ETHYLENE OXIDE

HYDROGEN PEROXIDE GAS PLASMA

OZONE

LIQUID PERACETIC ACID

CONCLUSION

REFERENCES

12: Processing of Complex Medical Equipment and Specialty Processing

ENDOSCOPES

POWERED SURGICAL INSTRUMENTS

PROCESSING OF OPHTHALMIC SURGICAL INSTRUMENTS

FLASH STERILIZATION

PROCESSING OF MEDICAL EQUIPMENT CONTAMINATED WITH PRIONS

REFERENCES

13: Surgical Textiles, Linens, and Laundry

HISTORY OF TEXTILES

GENERAL RECOMMENDATIONS FOR REUSABLE SURGICAL LINENS

ENVIRONMENTAL AREA FOR LAUNDRY HANDLING

HANDLING OF SOILED LINENS

LAUNDRY PROCESS

AORN POSITION ON HOME LAUNDERING OF PERSONAL SURGICAL ATTIRE

LAUNDRY AREA ENVIRONMENTAL CLEANING

CONCLUSION

REFERENCES

14: Infection Control: The Surgical Environment and Ancillary Areas

THE SURGICAL ENVIRONMENT

INFECTION CONTROL PRACTICES FOR ANESTHESIOLOGY

SPECIAL CONSIDERATIONS FOR THE DENTISTRY AND “DIRTY SURGERY” AREAS

REFERENCES

Appendix A: Medical Term Reference Information

Appendix B: Common Concentrate Dilutions

Appendix C: Table of Disease Transmission and Disinfection Guidelines

Appendix D: Donning and Removal of a Surgical Gown

Index

Title Page

Contributors

Audrey Ruple, DVM
Biosecurity House Officer/Oncology Fellow
Colorado State University
James L. Voss
Veterinary Medical Center
Fort Collins, CO

Nathan Slovis DVM, Dipl. ACVIM, CHT (Certified Hyperbaric Technologist), Director
McGee Critical Care and Medical Center
Hagyard Equine Medical Insititute
Lexington, KY

Barbara Jones, DVM
Appleton, WI

Kathleen T. Darling, MS, M, MT(ASCP), CIC
Infection Control Coordinator
Texas A&M University
Veterinary Medical Teaching Hospital
College Station, TX

Magda Dunowska, LW (vet), PhD
Senior Lecturer in Veterinary Infectious Diseases (Virology) Institute of
Veterinary, Animal and Biomedical Sciences Te Kura Mâtauranga Kararehe
Massey University, Palmerston, North New Zealand

Leslie Hiber, BS, CVT
Infection Control
University of Minnesota
Veterinary Medical Center
St. Paul, MN

Linda Caveney, LVT, RCST
Infection Prevention Specialty Technician
Cornell University Hospital for Animals
Ithaca, NY

Kristina L. Perry, CVT
Equine Medicine/Critical Care Nurse
Colorado State University

James L. Voss
Veterinary Medical Center
Fort Collins, CO

Foreword

There are a select number of defining moments in life that one never forgets. And then, there are those moments that are just simply memorable because the sights and smells of the experience have been forever etched into sensory recall.

It must have been the first day on my very first job back in 1983… I was an eager cage-cleaning acolyte of the veterinary profession, and one of my first tasks was to go in and clean up a rather unpleasant mess in an exam room at the veterinary clinic. A Doberman Pinscher had come in to be examined because of severe diarrhea and vomiting, and while in the exam room had provided more than ample evidence of his condition. At the time, I had no idea what parvovirus was, but you only need to be in a room with parvo diarrhea once to know you will never have a problem making that diagnosis in the future. As I cleaned up the mess on the floor, I knew nothing of infection control. I didn't really even know what a virus was other than something that gave you a cold.

Now, more than 25 years from that day, I have experienced both the basics and the complexities of infection control in veterinary medicine–from the viewpoints of a practicing veterinarian and a public health professional. In the latter role, I have had the opportunity to speak to human and animal medical professionals and students on issues surrounding infection control, mostly from the perspective of preventing zoonotic diseases. What I convey to them is how cavalier the veterinary profession has historically been with regard to preventing the spread of infection–underestimating the risks to themselves as well as to their patients. Often, veterinary professionals tend to think about infection control mostly in the context of sterile surgery, forgetting that every time we touch an animal, or blow our own noses, we have the potential to spread pathogens.

Several years ago, I investigated an outbreak of salmonellosis among clients and staff of a large veterinary practice. Not only were humans getting ill, but the animals were too, providing a stark reminder that proper infection control provides protective benefit to both humans and animals.

Unfortunately, there are precious few resources for veterinary health professionals to look to for guidance on infection control, especially in the context of preventing nosocomial infections in veterinary practice.

In response to this need, in 2004, Drs. Joni Scheftel and Brigid Elchos, two forward-thinking and motivated public health veterinarians, proposed to the National Association of State Public Health Veterinarians (NASPHV) that the organization should take a lead role in developing guidelines for preventing the transmission of pathogens between veterinarians and their patients–guidance written by vets, for vets. The result was the Compendium of Veterinary Standard Precautions, now undergoing its third revision. I have had the honor and privilege of being part of the workgroup that developed that guidance.

Among the concepts in that Compendium (available at http://www.nasphv.org) is that simple precautions must become part of the everyday routine in veterinary medicine, internalized as part of our practice of medicine. The veterinary profession has been fortunate that some of the most serious zoonotic diseases, like brucellosis or canine rabies, have largely been controlled or eradicated in the United States. Yet there are still innumerable opportunities for transmission of pathogens between animals and people.

In addition to the NASPHV Compendium, a text reference such as this is long overdue in veterinary medicine and will help fill a great void in the education of both veterinarians and veterinary technicians. No longer should we be complacent about eating near the fecal microscope, washing our hands after every contact with patients, and using other basic infection control techniques. Think to yourselves … would you be happy if your doctor gave you a physical exam right after having his hands in his last patient's mouth, if he hadn't washed his hands? I think we would all be bothered by such a practice.

Yet, we are all guilty of that at various times in veterinary medicine–the nature of the beast, so to speak. The animal world is a dirty place, and we are accustomed to getting dirty with our patients. That does not mean, however, that we should simply accept the potential risk of pathogen transmission. Obvious examples like parvo, Salmonella, canine influenza, and methicillin-resistant Staphyloccus aureus remind us that nosocomial infections are not merely a nuisance, but are potentially fatal. Preventing transmission in the veterinary setting, whether from environmental contamination, respiratory droplets, or direct contact, should be a priority even when we must wrestle with our patients on the floor, in the kennel, or in the back seat of a client's car.

Infection control isn't just about disinfecting after parvo diarrhea (thankfully, now a rare occurrence) and using good sterile technique in surgery. As you read the chapters in this book, whether a student or a practicing professional, think about how the principles, guidelines, and best practices presented here can be, should be, or already are implemented in your work every day. We can always improve our infection control skills and habits. They are something we must constantly practice, hone, and keep in the front of our minds, until they become second nature.

Bryan Cherry, VMD, PhD, NYS Veterinarian, DYSDOH

Acknowledgments

We wish to acknowledge the professional expertise of the following individuals who offered technical and scientific advice on individual chapters: Chuck Hughes, BS, Head Educator and General Manager of SPSmedical Supply Corp.; Kirsten Thompson, Technical Service Expert of EcoLab; Derek Lashua, Marketing Director, Spectrum Surgical Instrument Corp.; John Caveney, Senior Service Technician, LBR Scientific, Incorp.; Roger Segelken, science writer and editor; and Kayla Kohlenberg, artist/illustrator.

And to Ms. Erica Judisch at Wiley-Blackwell, for all your encouragement, advice, and guidance throughout the entire publishing process of this text-thank you.

Introduction

At a time when cross-species disease transmission is prompting heightened concern among health care professionals and the general public alike, there is practically no science-based and practice-proven information available about infection control in the veterinary setting. What are the risks? What can be done to make animal care safer for patients and caregivers?

Dedicated animal caregivers–whether engaged in the veterinary medical field or dealing with animals in other settings–desperately need authoritative and up-to-date information to confront this growing threat to animal and human health. To the credit of their profession, more veterinary technicians are beginning to take the initiative, learning from best-practice human medicine and adding their specialized knowledge of animal health to design and implementing proactive infection control programs that should be the envy of human-medicine hospitals and clinics.

Now is the time to share that hard-won knowledge with veterinary practice managers, companion animal breeders, stable managers, and animal shelter managers.

Veterinary Infection Control and Prevention is a tool for animal caregivers to use to make informed decisions and develop facility-specific plans. These are the conscientious individuals who will educate staff members on best practice procedures to protect humans and the animals from disease transmission.