2018 AAHA Infection Control, Prevention, and Biosecurity Guidelines
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A veterinary team’s best work can be undone by a breach in infection control, prevention, and biosecurity (ICPB). Such a breach, in the practice or home-care setting, can lead to medical, social, and financial impacts on patients, clients, and staff, as well as damage the reputation of the hospital. To mitigate these negative outcomes, the AAHA ICPB Guidelines Task Force believes that hospital teams should improve upon their current efforts by limiting pathogen exposure from entering or being transmitted throughout the hospital population and using surveillance methods to detect any new entry of a pathogen into the practice. To support these recommendations, these practice-oriented guidelines include step-by-step instructions to upgrade ICPB efforts in any hospital, including recommendations on the following: establishing an infection control practitioner to coordinate and implement the ICPB program; developing evidence-based standard operating procedures related to tasks performed frequently by the veterinary team (hand hygiene, cleaning and disinfection, phone triage, etc.); assessing the facility’s ICPB strengths and areas of improvement; creating a staff education and training plan; cataloging client education material specific for use in the practice; implementing a surveillance program; and maintaining a compliance evaluation program. Practices with few or no ICPB protocols should be encouraged to take small steps. Creating visible evidence that these protocols are consistently implemented within the hospital will invariably strengthen the loyalties of clients to the hospital as well as deepen the pride the staff have in their roles, both of which are the basis of successful veterinary practice.
Without effective infection control, prevention, and biosecurity (ICPB) implemented in the veterinary primary care and referral settings, the clinician’s efforts at disease prevention and treatment are compromised and, in some cases, nullified. Thus, ICPB is at the heart of the veterinarian’s pledge to protect animal health and welfare and public health, as well as the universal mandate among the healing professions to “first, do no harm.” Hospital-acquired infections (HAI), sometimes referred to as nosocomial infections, are an inherent risk in human and veterinary medicine, and breaches in ICPB can have direct and indirect financial, social, and environmental impacts on patients, clients, and staff. In a practical sense, any practitioner who doubts the value of ICPB need only experience a client’s displeasure, an animal’s health complications, or the consequences of an unflattering online review when a pet contracts infectious enteritis or respiratory disease during boarding or hospitalization or requires postsurgical treatment due to an HAI.1 The fact is, our best work can be undone by an infection control breach in the practice or homecare setting. The AAHA Infection Control, Prevention, and Biosecurity Guidelines are the first clinician-focused and practice oriented guidelines on this topic developed specifically for use in companion animal medicine. As such, these guidelines complement the growing emphasis in human medicine on infection control to prevent HAIs and exposure of patients and workers to infectious pathogens in the practice or laboratory and build off existing veterinary best practice and topic-focused documents.2–7 The increasing involvement of drug-resistant pathogens such as methicillin-resistant staphylococci in HAIs has created additional urgency for effective ICPB. Adding to the risk associated with ICPB lapses is the potential for in-hospital exposure to zoonotic diseases such as leptospirosis, rabies, salmonellosis, campylobacteriosis, and infections with ecto- and endoparasites (e.g., fleas, ticks, and helminths). Taken together, these factors created a strong motivation to assemble a task force of experts to produce these ICPB guidelines.
As many HAI likely occur unnoticed, solely relying upon the awareness of outbreaks as a measure of effective ICPB practices results in a false sense of security and unnecessary patient and staff health risks. As such, effective ICPB is dependent on the development of and adherence to standardized processes and protocols followed by self-audit and protocol adjustment. These guidelines provide a conceptual roadmap and specific, practical guidance on how to institute and evaluate ICPB standard operating procedures (SOPs) that will safeguard patients, staff, and clients from avoidable exposure to infectious pathogens. It is important to acknowledge that not all HAI will be prevented by following ICPB SOPs; however, studies indicate 10–70% of all HAIs in human medicine are preventable by using practical infection control measures, an estimate that is likely applicable to veterinary medicine.8 Even a 10% reduction in HAI would have large impacts on patient health, owner cost, and owner and staff satisfaction.
Implementing the various protocols specified in these guidelines or provided as online resources may seem daunting at first. However, most practices already effectively apply many infection control procedures as an aspect of sound clinical practice. These guidelines will nevertheless help any primary care or referral practices to systematize and strengthen their existing ICPB protocols and enlist the entire healthcare team in this essential aspect of high-quality veterinary care. To that end, the guidelines present a progression of interventions from most to least critical. Therefore, veterinary practices can implement the recommendations of the ICPB task force incrementally without being overwhelmed by attempting an immediate, complete overhaul of ICPB protocols.
As ICPB principles become part of a practice’s culture, the healthcare team can more confidently admit and treat all patients, including those with emerging or endemic infectious diseases, while minimizing the risk of exposing other patients, staff, and clients. An effective approach, strongly recommended by the ICPB task force, is to appoint a practice “champion” who takes primary responsibility for implementing ICPB protocols and ensuring staff compliance. This individual should focus on the two principal components of ICPB, which are to (1) limit pathogen introduction, exposure, transmission, and infection within the hospital population; and (2) evaluate the effectiveness of infection control practices at controlling disease.9,10
These guidelines were subjected to a formal peer-review process.
AHS (alcohol-based hand sanitizer); HAI (hospital-acquired infections); ICP (infection control practitioner); ICPB (infection control, prevention, and biosecurity); MDR (multidrug resistant); MRSP (methicillin-resistant Staphylococcus pseudintermedius); PPE (personal protective equipment); SOP (standard operating procedure); SSI (surgical site infection)
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These guidelines were prepared by a task force of experts convened by AAHA. This document is intended as a guideline only, not an AAHA standard of care. These guidelines and recommendations should not be construed as dictating an exclusive protocol, course of treatment, or procedure. Variations in practice may be warranted based on the needs
of the individual patient, resources, and limitations unique to each individual practice setting. Evidence-based support for specific recommendations has been cited whenever possible and appropriate. Other recommendations are based on practical clinical experience and a consensus of expert opinion. Further research is needed to document some of these recommendations. Because each case is different, veterinarians must base their decisions on the best available scientific evidence in conjunction with their own knowledge and experience.