Improving human health protection

Veterinarians will soon have more concrete infection control guidelines, thanks to the joint efforts of many individuals, including veterinarians and researchers at the Centers for Disease Control and Prevention, National Association of State Public Health Veterinarians, and AVMA.

At the 143rd AVMA Annual Convention in July, Drs. Jennifer G. Wright and Jennifer McQuiston, both U.S. Public Health Service veterinarians who work for the CDC, discussed the results from a 2005 survey of AVMA members on infection control attitudes and practices. Serious consideration of infection control was spurred by their experience responding to the 2003 monkeypox outbreak. Of the 49 confirmed and probable cases counted by the CDC, 13 of those cases were veterinarians and their staff. For Drs. Wright and McQuiston, and others, the monkeypox outbreak was a wake-up call.

"We've had a fairly casual attitude about infection control," Dr. Wright said. "Most of our infection control has been focused on making sure dog A doesn't get parvovirus from dog B. We've been good at preventing illness from spreading from animal to animal, but not as good at protecting ourselves."

Dr. McQuiston agrees.

"Veterinarians can be kind of like cowboys," she said. "We provide a high level of care despite less-than-ideal situations, especially in the field, and we develop a sense of invincibility. But it only takes one event to get somebody sick."

More than 3,000 veterinarians participated in the joint AVMA/CDC survey. In addition to demographic data, the survey asked detailed questions about what kind of infection control practices veterinarians employ as well as how often and under what circumstances. It also surveyed on attitudes and concerns about infection control and personal health risks.

Dr. Wright was pleased to report that many veterinarians are doing a lot of things well—although she sees room for improvement.

Case in point: Dr. Wright applauds the fact that 95 percent of veterinarians surveyed have had their rabies vaccine—but she noted that most are not checking their titer often enough. Veterinarians have an opportunity each year at the AVMA Annual Convention to be tested at the Wellness Center, which is sponsored by the AVMA Group Health & Life Insurance Trust. Of the 1,162 Wellness Center participants at the 2006 convention, 584 included the titer test among their other health screenings.

Another case in point: The survey revealed that about half of respondents reported washing their hands every time between tending to patients or before eating, which means that half do not.

"We also found that 80 percent to 90 percent of the veterinarians report eating in the animal treatment areas," Dr. Wright said. "Sometimes this is a function of lack of space, or it can be a lack of time."

Dr. Wright believes it is important to the health of veterinarians and staff to not only have a dedicated break room, but to also provide enough break time so that individuals can get out of treatment areas for lunch.

The study did not assess cleaning techniques. However, anecdotal evidence from case reports of Salmonella infection outbreaks suggested that surfaces such as treatment tables and floors are being disinfected properly, but organisms can certainly be present on other surfaces. Dr. Wright urges veterinarians to "think outside the box" when considering anything that might be touched and contaminated, from light switches to door knobs.

She also noted that 80 percent of small animal veterinarians have a quarantine area and 70 percent use it when available, but what defines a quarantine area can vary widely from practice to practice. While a defined, separate room is ideal, some practices merely "quarantine" sick animals to one side of a room.

Some of the important finds of the study were that more than 90 percent of veterinarians recap their needles, and more than 60 percent reported being stuck by a needle in the preceding 12 months.

"Needles should go straight into a sharps container," Dr. Wright said. "If you are in the field and must recap, lay the needle on a hard surface and use forceps to hold the cap."

The study revealed a substantial link between having a written infection control policy and good infection control practices, but fewer than 25 percent of veterinarians reported working in a practice that had a written policy.

Dr. McQuiston concurs that "having a written policy in place is a simple thing you can do that raises the awareness of infection control."

"Knowing where an animal has been is helpful," she said. "Are you checking a cat that has returned from a trip abroad with its owner? Are you examining a Greyhound coming from a (race) track with an ongoing outbreak of canine flu or kennel cough?"

The survey revealed that most veterinarians are more likely to use some sort of personal protection with an animal that is obviously ill than with an animal that doesn't appear ill.

"Practicing standard veterinary medicine does not always call for gowning, eye protection, or respirators," Dr. McQuiston said. But she and Dr. Wright think that taking a few extra precautions, even with apparently healthy animals, can be prudent.

"You don't always know what an animal is bringing into your clinic," Dr. Wright pointed out.

"One of my personal suggestions is to wear scrubs at work and to consider an on-site laundry (service) so your work clothes stay at work. That really lessens the chance of bringing in or taking home some kind of infection."

Dr. Wright realizes the idea of scrubs might not immediately appeal to all veterinarians.

"We're told from the very first day of school we're supposed to dress professionally. But we deal with a much wider range of situations than the typical physician," she said. "Very few human doctors are covered in feces and blood every day. It just makes sense to wear scrubs and even shoes that never leave the clinic."

Scrubs should not be worn outside a veterinary practice. If scrubs are worn outside, veterinarians or their staff members who also wear them risk spreading diseases to their family and pets, and to the public.

"Imagine if you have Salmonella-contaminated feces on your clothes and your child gives you a hug when you walk in the door," Dr. Wright said.

In addition to common risks such as Salmonella or Escherichia coli that veterinarians are already well aware of, Drs. Wright and McQuiston are concerned about the possibility of new diseases spreading in new ways.

"We must realize there could be new diseases sneaking across our borders. Veterinarians could be on the frontline," Dr. Wright cautioned. "We could take an illness home to family members ... or out to the community. Then it becomes a public health problem."

"In veterinary medicine, we do not routinely have to deal with bloodborne pathogens," Dr. McQuiston added. "But in today's world of emerging diseases, a bloodborne zoonotic disease could be just around the corner."

"Rather than scrambling during an outbreak to put procedures in place, do it now," Dr. McQuiston suggested.

Veterinarians looking for guidance in improving their infection control have access to numerous resources. For the past several years, JAVMA, working with the AVMA Council on Public Health and Regulatory Veterinary Medicine, has published "Zoonosis Updates," a series on zoonotic diseases. That valuable information can be accessed online.

Later this year, the National Association of State Public Health Veterinarians will make available online a draft of the first national guidelines for infection control in veterinary medicine. This important resource will contain a model draft of a clinic plan, adaptable to all practice types. Veterinarians are urged to visit the association's Web site, www.nasphv.org, to glean information and to provide comments. The feedback will be incorporated into the final version of the guidelines, which are scheduled to be printed in 2007.

The AVMA GHLIT supports all efforts that align with the Trust's goals of enhancing the health and well-being of veterinarians. For more information about health insurance programs and wellness benefits, call the GHLIT at (800) 621-6360.