Every veterinary practice should have a documented ICPB program. At a minimum, this should be a collection of agreed-upon basic infection control practices and accompanying SOPs, growing into a formal manual incorporating specific staff education and training, client education, surveillance, and compliance programs. The prospect of developing or refining an existing infection control program may seem daunting to veterinary staff. Most staff have not received formal training in this area, and the value of providing the required resources (e.g., time, finances) may be questioned. However, the process of instituting a program need not be an “all or none” approach. Importantly, a significant percentage of HAIs in veterinary practices can likely be prevented with proper compliance to basic, practical infection control practices that a hospital can build over time.18 An incremental approach to program development and refinement can be done in a step-by-step process that is practical, economical, and effective. Ordered steps to develop an ICPB program are as follows:
- Assign a staff member to oversee and champion the development of and implementation of the ICPB program.Commonly referred to as the infection control practitioner (ICP) or infection preventionist, this individual serves a critical role in infection control
- program development, maintenance, compliance, and evaluation;
- staff training development and documentation;
- protocol compliance evaluation; and
- receipt of actionable infection control concerns, including suspected HAIs.
- Identify and develop protocols and checklists. Protocols serve as the main resource for guidance of many components of an ICPB program and should be compiled within an infection control manual. To be effective, protocols must consist of agreed-upon steps that will be taken by all practice members. Existing protocols developed as general guidance or for a specific practice are an excellent starting point for ICPs.4,7 Protocols should be customized for the given needs and resources of the practice. Sample protocols for key areas of a practice’s ICPB program include
- Hand hygiene.
- Cleaning and disinfection.
- Sequence for putting on and removing PPE .
- Identifying high-risk patients; questions to ask when making appointments.
- Placing and maintaining intravenous and urinary catheters.
- Entering and exiting isolation or dedicated areas for highrisk patients.
- Necropsy procedures.
- Checklists of key tasks are known to improve compliance throughout the practice workplace, including infection control and the reduction of HAIs.22 Checklists are encouraged for cleaning and disinfection, surgery (pre- and postoperative), and any commonly performed duty that benefits from a reminder and communication system.
- Perform an initial assessment of the facility to identify strengths and areas for improvement. To best prioritize resources, ICPs should identify ICPB strengths and weakness of the practice. Tools have been developed to assist with this process (Practice biosecurity tracker). Regardless of the tool used, it is most important that all key areas of a program are examined (e.g., hand hygiene, cleaning and disinfection, identification of procedures used to treat and house high-risk patients, PPE) and the continuum of effective risk mitigation is included (e.g., presence of written protocols, staff knowledge of and compliance with protocols). A properly performed assessment will indicate areas of the facility on which to focus most immediate attention. The ICP should then begin to develop and refine an infection control manual containing protocols for identified areas.
- Develop a staff education and training plan. All personnel, including temporary lay personnel, kennel staff, veterinarians, technicians, receptionists, students, and volunteers, should receive education and training about infection control. Training should occur during orientation and at least annually. Training should be tailored to individual job duties, but in all cases emphasize health risks and existing protocols to reduce patient, staff, and client infection-related hazards. A checklist of required readings, meetings with key staff, and electronic resources to review should be provided and completion documented. An assessment (examination) to document staff knowledge and comprehension should be performed after trainings.
- Identify a staff member to collect client education materials specific for use in your practice. Efforts should be made to identify, catalog, and make readily available appropriate materials that assist clients in understanding infectious and zoonotic disease risks and the basic steps they can take to protect themselves, household members, and their animals. Several sources provide client-appropriate materials on these topics, such as Worms and Germs blog’s pet resources, the CDC’s Healthy Pets Healthy People, the Center for Food Security and Public Health, and these AAHA resources.
- Develop and implement a surveillance program. Surveillance, the routine collection of information with defined responses, is critical for effective infection control. It provides feedback to determine if a practice’s infection control practices are effective at controlling disease, helps to identify areas of weakness, and provides a warning to allow for an early response to a concern, reducing patient and staff illness, expenses, and time. Many forms of surveillance are easy, inexpensive, and can be readily incorporated into day-today veterinary practice. Some form of surveillance (either passive or active) should be used by all veterinary facilities. Passive surveillance involves using data that are already available (e.g., client-paid bacterial culture and susceptibility results, identified surgical site infections [SSIs]) to determine clinically relevant elements such as disease rates, antimicrobial susceptibility patterns, and trends and identify changes that may indicate an important infection control problem (e.g., increase in SSI rate). Routine recording of animals with specific diagnoses (e.g., SSIs, MDR organisms) or syndromes (e.g., vomiting, diarrhea, coughing) is another simple method of collecting information that can help in the prevention and early detection of outbreaks. The key to passive surveillance is to centralize available data, with the ICP compiling and evaluating data and reporting results on a regular basis. Many electronic medical record systems can be set to track and report on certain diagnostic codes that the ICP has designated for surveillance. Active surveillance involves gathering data specifically for infection control purposes. An inexpensive, highly effective example of active surveillance for environmental cleaning is fluorescent tagging. This process involves applying marks only visible under ultraviolet light (so staff are not aware marks have been placed) that are easily removed with routine cleaning and monitoring surfaces for presence of marks after cleaning was to occur (e.g., 24 hr after mark placement).23 Regularly marking and collecting this information provides insight into cleaning deficiencies (e.g., locations or objects often missed), allowing for targeted adjustment to cleaning and disinfection protocols or staff training. Culturing environmental surfaces or diagnostic samples from animals is another example of active surveillance, but due to expense would generally be reserved for an outbreak investigation.
- Establish and maintain a compliance evaluation program. Although the development of an effective ICPB program is a primary goal, only with regular compliance self-auditing can a practice ensure that their practices align with their protocols, goals are being met, and continued improvement occurs, resulting in lowering HAIs and worker safety risks. A comprehensive audit can build from the previously mentioned initial assessment using the same audit tool. The audit should include inspection of the physical environment, review of workplace ICPB practices, and assessment of workers’ knowledge and application of infection control principles. Regular audits (at least annually) by the ICP will allow for the establishment of benchmarks, identify and prioritize needs, and identify resources and timelines to meet benchmarks. Incorporating other team members in the audit process is encouraged to provide additional perspectives and further buy-in by practice staff.
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)