Summary

Without effective ICPB practices implemented in the primary care and referral settings, the clinician’s efforts at disease prevention and treatment are compromised and, in some cases, nullified. Because many pathogens in the hospital environment have zoonotic potential, barriers to human exposure to animal pathogens in a clinical setting also serve to safeguard public health. Taken together, the consequences of ICPB have profound implications for clinical practice and should be of high priority. Stated another way, the veterinarian’s best efforts can be negated if faulty ICPB results in exposure of the staff or patient to infectious pathogens.

The methodology of ICPB is largely procedural, meaning that it is based on protocols and SOPs that apply to the entire healthcare team. To adapt to changing circumstances at the local level, including staff turnover, these processes should be regularly revisited, followed by revision as needed, with refresher trainings for the entire healthcare team. Patient and staff flow, hand hygiene, cleaning and disinfection, and PPE serve as the foundation for ICPB practices and should be addressed in all practice programs.

Effective ICPB is based on control methods that form a hierarchy of effectiveness. Prevention (elimination) of microbial contamination by removal or denying access to general patient areas of the premises by high-risk patients (i.e., those considered likely to be infectious) is the most effective method of ICPB control, followed in declining order of efficacy by hospital design to mitigate exposure, administrative controls, and use of PPE.

Various situations in clinical practice require different approaches to ICPB to avoid contaminating the premises or exposing the patient or staff to opportunistic infectious agents. These specialized circumstances include surgery, dentistry, resuscitation, management of immunocompromised patients, admission of patients with infectious disease, obstetrics, burn care, rehabilitation areas, and handling of postmortem tissues and patients, including necropsy. In such cases, exposure to pathogens may be increased because of the nature of the procedure, through the generation of aerosols, direct contact with infected tissues, and contact with fomites. Additionally, surgical or trauma sites may place patients at increased risk of exposure to microbes.

In many veterinary practices, the clinical staff may not be formally trained in ICPB, and the various ICPB protocols may seem daunting to implement. However, these factors should not deter veterinarians from implementing a comprehensive ICPB program. Rather, the process of developing and systematically employing ICPB protocols can be done incrementally, building on and strengthening ICPB methods already in use. Improvements in a practice’s compliance with ICPB practices and reductions in related risks, ideally catalogued by the ICP dedicated to monitoring program success, will reinforce the tangible value of ICPB observed by the healthcare team. Managing ICPB requires focus and dedication of the entire staff, including education, training, and monitoring of the entire healthcare team to ensure comprehension, proficiency, and compliance with best practices. These efforts are enabled by the use of situation-specific protocols and procedures for ICPB, and by client education to inform pet owners of the importance of home care to avoid exposure of the patient and owner to infectious pathogens.

With the increasing complexity of care including the use of oncolytic agents, surgical implants, and the increase of MDR organisms, it is now paramount that the modern veterinary practice develop infection prevention and control protocols. For those practices with few or no infection control protocols, they should be heartened and encouraged to take small steps. As ICPB steps become prioritized, veterinary practice owners and employees will realize additional direct health benefits to patients, staff, and clients as well as indirect financial, social, and environmental positive impacts.

The AAHA Infection Control, Prevention, and Biosecurity task force gratefully acknowledges the contribution of Mark Dana of Kanara Consulting Group, LLC in preparation of the guidelines.