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Infection prevention and control in veterinary workplaces

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Ratification Date: 21 Jan 2025

Purpose

To inform members of the veterinary profession about the key principles of infection prevention and control in veterinary workplaces, and point to useful further resources.

Policy

It is essential that Infection Prevention and Control (IPC) is integrated into every veterinary workplace to safeguard animals, staff and the public from infection.

Employers must establish protocols and provide information, training and supervision of IPC implementation.

Introduction

Animal hospitals and practitioners have a duty of care and must take reasonable action to prevent pathogen transmission from:

  • Humans to animals (reverse zoonoses) eg MRSA, COVID-19
  • Animals to animals eg Feline calicivirus,
  • Animals to humans (zoonoses) eg Q Fever, ABLV, Hendra, Salmonella, Dermatophytes
  • Humans to humans eg influenza, COVID-19

High risk groups (humans and animals) include those that are pregnant, juvenile, elderly and/or immunocompromised.

Definitions

Infection prevention and control (IPC)

“The creation of safe healthcare environments through the implementation of evidence-based‑ practices that minimise the risk of transmission of infectious agents.” (NHMRC 2019)

Standard precautions

The term “standard precautions” is used globally by both human and veterinary practitioners. It refers to the practice of “Routinely applying basic infection prevention and control strategies to minimise risk to both patients and healthcare workers, such as hand hygiene, appropriate use of personal protective equipment, cleaning, and safe handling and disposal of sharps.” This should occur regardless of the perceived or confirmed infectious status of a patient. (NHMRC 2019; AVA, 2017)

Healthcare associated infection (HAI, also known as Hospital Associated Infection/nosocomial infection)

“May be caused by bacteria acquired while in the hospital, or from an animal’s own microbiota, but in either case an HAI is associated in some way with the hospital environment or factors/procedures that occurred during hospitalization (e.g. surgery, catheterization).”(NHMRC 2019; Anderson et al, 2019)

5 Moments of Hand Hygiene

A validated hand hygiene compliance assessment tool developed by the World Health Organisation. Used by healthcare and veterinary care (NHMRC 2019; Anderson et al, 2014; Ryan et al, 2019).  (See: https://cdn.who.int/media/docs/default-source/integrated-health-services-(ihs)/infection-prevention-and-control/your-5-moments-for-hand-hygiene-poster.pdf?sfvrsn=83e2fb0e_6)

Veterinary workplace

Includes veterinary clinics, hospitals, mobile clinics, house call practice/farm visits/production animal practice.

One Health 

One Health' is an integrated, unifying approach to balance and optimize the health of people, animals and the environment.  IPC in veterinary workplaces should be viewed in the context of One Health, as poor IPC practices have the potential to impact health and well-being in humans and animals, and may lead to environmental contamination, spread of pathogens and antimicrobial resistance. 

Biosecurity

Biosecurity refers to procedures or measures designed to prevent pests and diseases entering, emerging, establishing or spreading in Australia [Biosecurity - DAFF (agriculture.gov.au)]

Antimicrobial resistance (AMR)

AMR refers to a change in bacteria, viruses, fungi and parasites over time such that they no longer respond to medicines, making infections harder to treat and increasing the risk of disease spread, severe illness and death.

Background

Compared with human health care, information about IPC practices in the veterinary context is fairly limited; however the evidence-base is showing similarities with the human health care sector.  For example, there is a body of published data on veterinary workplace-associated antimicrobial resistance (AMR) (Cocco et al, 2023; Worthing et al, 2018), healthcare-associated infections (HAIs) (Horsman et al, 2021; Keck et al, 2020; Deschamps et al, 2015), surgical site infections (Espinel-Rupérez et al, 2019; Verwilghen, D. and A. Singh, 2015; Schmökel, 2023), and ventilator associated pneumonias (Fox et al, 2021).  Veterinary practice has the added risk of zoonotic infections such as Q Fever (Kopecny et al, 2013) and Hendra virus (Annand et al, 2022; Mendez, 2015).

The AVA ‘Guidelines for Veterinary Personal Biosecurity 2017 - Appendix 1: Model infection control plan for veterinary practices’ sets a minimum standard for infection control in animal hospitals and in the field. The guidelines provide broad principles and a framework for developing infection control procedures to prevent spread of diseases between animals, and from animals to humans. Appropriate procedures will vary according to the size and nature of the practice and the facilities.

Recommendations

Implementation of IPC protocols requires top-down support from:

  • Professional standard-setting organisations such as the AVA
  • Workplaces (individual holdings or corporate)
  • Universities and regulators

It also requires united bottom-up actions, including:

Standard Precautions

Use of standard precautions by all personnel as a framework for IPC in veterinary workplaces. This should occur for all patients at all times, regardless of infectious status (NHMRC 2019):

  • Hand hygiene

Hand hygiene is considered one of the most important IPC strategies to reduce pathogen transmission  (NHMRC 2019; AVA 2017; Anderson et al, 2019; Stull et al, 2018). A pilot study of hand hygiene compliance using the ‘5 moments of hand hygiene’ tool in small animal veterinary practice revealed baseline compliance of 14%. All compliance periods (moments) were low, with particularly poor hand hygiene noted by staff after touching a patient’s surroundings, such as closing of cage doors or writing on cage cards hanging on cage doors (Willemsen et al, 2022).

Hand hygiene may be compromised with failure to provide enough hand washing stations or hand sanitisers, reduced compliance when busy, and it may induce dermatitis which further reduces compliance. Glove wearing does not replace hand washing but is a component of hand hygiene.  For further detail on hand hygiene see section 5.1, page 6 of the AVA Guidelines for Veterinary Personal Biosecurity 2017. 

  • Appropriate use of Personal Protective Equipment (PPE)

PPE use for standard precautions is designed to reduce the risk of contamination of personal clothing, reduce contamination of skin and mucous membranes and reduce transmission of pathogens between patients by veterinary personnel. (AVA, 2017) Correct removal and disposal of PPE is also very important; for further information see the AVA’s “Resource 3 – Putting on and removing personal protective equipment” and “Suit Up” video here.

  • Cleaning

Proper cleaning of environmental surfaces, including work areas and equipment, prevents transmission of pathogens. For further detail on ‘Cleaning and disinfection of equipment and environmental surfaces’ see section 5.1, page 13 of the AVA Guidelines for Veterinary Personal Biosecurity 2017. (AVA, 2017)

Regular monitoring of cleaning effectiveness using audits (process and outcome) with inspection using methods such as fluorescent gel markers, ATP bioluminescence and/or microbiological testing should be used. A surveillance program to identify the presence of multi-resistant organisms may assist in the identification of healthcare-associated infections or outbreaks. The NHMRC Guidelines include audit tools which can be downloaded (page 61 of document).

  • Sharps safety and disposal

Needlestick injuries are common in veterinary practice and are a potential source of pathogen transmission. It is important that sharps safety protocols are adhered to as outlined in Section 5.1 page 8, of the AVA Guidelines for Veterinary Personal Biosecurity 2017. (AVA, 2017)  Needleless injection ports and caps for multiuse vials can be used as an alternative to needles, thus reducing risk of needlestick injury.

  • Other standard precautions include cleaning and reprocessing of reusable medical equipment, handling and storing waste safely, and respiratory hygiene.

Transmission-based precautions

Transmission-based precautions are measures used in addition to standard precautions when a patient has a suspected or confirmed infection. This can include the need for isolation, enhanced PPE or other measures as required. (NHMRC 2019) Veterinary practices should ideally have a single-purpose isolation area for housing contagious patients, and this may be a requirement for veterinary premises registration. Section 5.2, page 15 of the AVA Guidelines for Veterinary Personal Biosecurity 2017 provide a great deal more detail on methods for isolating and barrier-nursing suspected or confirmed infectious patients.

An additional precaution to reduce risk is keeping human food and drink separate from treatment areas and other contaminants, and use of separate dedicated refrigerators for pathology samples or medications.

Guidelines:

More resources, including videos on suiting up with PPE, can be found on this AVA webpage: https://www.ava.com.au/library-journals-and-resources/ava-other-resources/veterinary-personal-biosecurity/

References

  1. National Health and Medical Research Council (NHMRC, 2019). Australian Guidelines for the Prevention and Control of Infection in Healthcare., Australian Commission on Safety and Quality in Health Care, Editor. National Health and Medical Research Council: Canberra. p. 354.
  2. Australian Veterinary Association (AVA, 2017). Guidelines for veterinary personal biosecurity. 2017 May 2017; 3rd: Available from: https://www.ava.com.au/siteassets/policy-and-advocacy/biosecurityguidelines2017_update2025_melanie-latter.pdf 
  3. Anderson, M.E.C., M. Wimmers, and J.S. Weese (2019). Infection prevention and control best practices for small animal veterinary clinics. Ontario Animal Health Network: Guelph.
  4. Anderson, M.E., J.M. Sargeant, and J.S. Weese (2014). Video observation of hand hygiene practices during routine companion animal appointments and the effect of a poster intervention on hand hygiene compliance. BMC Veterinary Research, 2014. 10: p. 1-16.
  5. Ryan, K et al., Editors. (2019). Australian Commission on Safety and Quality in Health Care, 5 Moments for hand hygiene. Commonwealth of Australia. p. 126.
  6. Cocco, A., et al. (2023). Detection of Potential Zoonotic Agents Isolated in Italian Shelters and the Assessment of Animal Welfare Correlation with Antimicrobial Resistance in Escherichia coli Strains. Antibiotics, 2023. 12(5).
  7. Worthing, K.A., et al. (2018). Methicillin-resistant staphylococci amongst veterinary personnel, personnel-owned pets, patients and the hospital environment of two small animal veterinary hospitals. Vet Microbiol, 2018. 223: p. 79-85.
  8. Horsman, S., et al (2021). Environmental recovery of nosocomial bacteria in a companion animal shelter before and after infection control procedures. Front Vet Sci, 2021. 7: p. 608901.
  9. Keck, N., et al. (2020). Long-lasting nosocomial persistence of chlorhexidine-resistant Serratia marcescens in a veterinary hospital. Veterinary Microbiology, 2020. 245(0).
  10. Deschamps, J.Y., E. Topie, and F. Roux (2015). Nosocomial feline calicivirus-associated virulent systemic disease in a veterinary emergency and critical care unit in France. Journal of Feline Medicine and Surgery, 2015. 1(2): p. 1-9.
  11. Espinel-Rupérez, J., et al. (2019). Incidence of surgical site infection in dogs undergoing soft tissue surgery: risk factors and economic impact. Vet Rec Open, 2019. 6(1): p. e000233-n/a.
  12. Verwilghen, D. and A. Singh (2015). Fighting Surgical Site Infections in Small Animals. The Veterinary clinics of North America. Small animal practice, 2015. 45(2): p. 243-276.
  13. Schmökel, H. (2023). Balancing the prevention of surgical site infections with responsible antimicrobial use in companion animal practice. Veterinary Record, 2023. 192(8): p. 330-331.
  14. Fox, C., M. Daly, and T. Bellis (2021). Identification of ventilator-associated pneumonia in dogs and evaluation of empiric antimicrobial therapy: 13 cases (2012–2016). Journal of Veterinary Emergency and Critical Care, 2021. 31(1): p. 66-73.
  15. Kopecny, L., et al. (2013). Investigating Coxiella burnetii infection in a breeding cattery at the centre of a Q fever outbreak. Journal of Feline Medicine and Surgery, 2013. 15(12): p. 1037-1045.
  16. Annand, E., et al. (2022). Novel Hendra Virus Variant Detected by Sentinel Surveillance of Horses in Australia. Emerging Infectious Disease journal, 2022. 28(3): p. 693.
  17. Mendez, D.H. (2015). Identifying and understanding the factors affecting infection control and Hendra virus risk managment in private veterinary practices in Queensland, Australia, in James Cook University. 2015.
  18. Stull, J.W., et al. (2018). AAHA Infection Control, Prevention, and Biosecurity Guidelines. Journal of the American Animal Hospital Association, 2018. 54(6): p. 297-326.
  19. Willemsen, A., et al. (2022). Improving hand hygiene in small animal veterinary practice: A pilot trial. Australian Veterinary Practitioner, 2022. 52(3): p. 160-172.