Policy and Protocols for Infectious/Contagious Disease Control for Small Animal Clinic Patients

Implementation Date: 4/2013

Date of Last Revision: 4/2018

Next Review Due:4/2023

 

Reviewed by VTH Administrative Team: 2/2013

Reviewed by VTH Board: N/A

 

Reviewed by Legal Counsel: N/A

Reviewed by Biosecurity Subcommittee: 4/2018

Subject to modification by the Biosecurity Subcommittee of the CVM Occupational Health and Safety Committee without approval.

Policy

1. Suspected or known Infectious/Contagious Disease (ICD) patients should be contained within predetermined areas to prevent spread of ICD. 
2. Use of the protocols for Infectious/Contagious Disease Control for Small Animal Clinic Patients will prevent:
     - spread of contagious disease from affected animals to susceptible animals
     - transmission of zoonotic disease from affected animals to students, clients, hospital employees and volunteers
     - exposure of contagious disease patients to other infectious agents
3. In order to maximize ICD protocols, it is imperative to:
     - identify animals likely to transmit disease 
     - effectively communicate infectious disease status to clients, students, hospital staff and laboratory personnel
     - maintain accessible information listing individualized management plans for hospitalization and handling of patients with those specific contagious diseases most          commonly seen by the UI VTH
   
   

Guidelines

Personnel: This policy applies to all faculty, staff (employees and volunteers), and students having direct contact with animals while working in the Veterinary Teaching Hospital (VTH). 

Limitation of Spread: This policy regards measures to limit the spread of infectious agents through the Hospital, indications for appropriate management of patients suspected/confirmed to have contagious/zoonotic infectious diseases and administrative monitoring of patients having infectious diseases

Procedure (if applicable)

I. Admission into the SAC Hospital

1. Admissions Procedure - ICD patients should, if known, be left in the car (taking appropriate safety measures in sunny, hot or cold weather) while the owner comes into the Admissions area to register the pet. The clinician and/or house officer who will be supervising the case should then be contacted informing them of the patient’s arrival – the attending DVM will determine how the patient should be brought into the hospital and where the patient examination will take place, accessing if necessary the VTH Guidelines list for individual infectious diseases.
2. Known or Suspected Parvoviral or Canine Distemper Patients - Animals with suspected or confirmed parvoviral infection or canine distemper should be transported from the client’s car in a carrier or on a gurney and brought into the VTH through the East door (access close to ER) and taken directly to the anteroom of the isolation ward (SAC 147) for initial examination
3. Known or Suspected ICD Patients Entering Admission Area - If the client enters the Admissions area with the animal suspected or confirmed to have an ICD, the animal should be quickly moved to an appropriate examination area (SAC 147 for parvoviral infection or canine distemper, otherwise SAC 107), the attending DVM contacted for additional instruction in handling the patient, and, when indicated, the kennel staff should be called to clean the Admissions area where the animal was present.
4. Suspected or Confirmed Patients with ICD Other Than Parvoviral, Canine Distemper, or Canine Infectious Tracheobronchitis (kennel cough) - For patients with other suspected or confirmed ICD, the attending clinician should be contacted for specific instructions. For ICD other than parvoviral infection, canine distemper or canine infectious tracheobronchitis (kennel cough), patients may be moved into room SAC109 (the designated contamination room) as quickly as possible and an “ICD” sign placed on the door.
5. Disinfecting Examination Area and Equipment - Following the examination of a patient with contagious disease, the examination area and equipment used should be thoroughly cleaned and disinfected before use with another patient. Cleaning should be performed with a broad spectrum disinfectant with anti-viral properties.

II. General Procedures for ICD Control in SAC Patients

1. Guidelines for proper clean-up of urine, feces, blood or other tissues or secretions from patients with suspected or confirmed contagious disease should be posted in main animal care locations and in both the student and house officer handbooks.
2. All kennel staff should be instructed in proper clean-up of urine, feces, blood or other tissues or secretions from patients with suspected or confirmed contagious disease.
3. Hands must be washed or cleaned with alcohol-based hand sanitizers between patients. Supplies for hand cleaning must be readily available in every exam, animal handling area and in main corridors throughout the VTH.
4. The exam table and any equipment used for patients must be thoroughly cleaned following each visit. Supplies for cleaning tables and equipment must be readily available in every exam and animal handling area. Cleaning should be performed with a broad spectrum disinfectant with anti-viral properties.
5. During handling of an ICD identified animal, personnel should wear an outer layer of barrier clothing that can be readily removed/changed:
   - For routine visits, a lab coat that can be readily changed if necessary after handling an animal that becomes an ICD suspect in the course of the initial evaluation          constitutes appropriate barrier clothing.
   - For visits in which the patient is known or suspected to have a contagious condition, consult individual disease listing in VTH guidelines to determine appropriate          barrier clothing.

III. Procedures for SAC Patients with Suspected or Confirmed ICD 

1.  Patients with suspected or confirmed contagious disease should be transported by carrier, gurney, or covering cutaneous lesions so that environmental contamination is limited and surfaces can be disinfected following use.
2.  All faculty, staff (employees and volunteers), and students having direct contact with animals inside the hospital should remove all protective clothing (including laboratory coats and scrubs) prior to leaving the VTH. In addition, hand washing and/or alcohol-based disinfectants MUST be used between patients.
3. As request forms are updated in the future they should include a specific prompt regarding infectious/contagious disease status as a required field (including anesthesia, imaging, surgical procedures, internal medicine procedures, clinical pathology and diagnostic lab submissions, all consult forms): e.g.
   Patient ICD status - infectious? Y/N      Contagious? Y/N        Specific disease:____________ (possible/likely/confirmed)

IV. Zoonotic ICD Procedure
If a diagnosis of a zoonotic contagious disease is confirmed, prompt and widespread notification of all parties with potential exposure is vital. All persons with direct and ongoing patient contact or exposure to patient tissues or body fluids and the Hospital Director/Chief of Staff should be notified immediately. If an infectious disease is diagnosed by culture or PCR at the CVM Diagnostic Lab, the director of Clinical Microbiology will communicate the results by e-mail to the attending clinician, the VTH Hospital Director/Chief of Staff. The Hospital Director/Chief of Staff will determine and initiate additional formal notifications, as dictated by the specific disease agent involved, to all VTH personnel (faculty, staff and students), the Clinical Pathology Lab Director and the Clinical Pathology Lab Supervisor.

V. Medical Record

1. Adding ICD Tag/Alert – The Senior Clinician/Faculty on duty will inform Medical Records personnel of the infectious disease status of a patient confirmed to have a contagious disease. Medical Records personnel will add an alert in the patient’s Health Information System record indicating the contagious disease agent present.
2. Removing ICD Tag/Alert – This alert will be removed from the record by Medical Records personnel once the disease is resolved. The identification of a “resolved” status MUST be done by the senior clinician/faculty on duty.

VI. Consultations 
If other service consultations will be required, the same protections should be adopted by the consulting services. The attending clinician/student MUST alert the consulting service about the ICD potential by indicating the infectious disease status on the consultation request form. If patients need to be moved through the hospital for diagnostics (e.g. imaging), the appropriate procedures should be followed for transportation. Whenever possible and without compromising patient care, the diagnostics should be performed at the end of the day so that appropriate disinfection can be completed afterward. 

VII. Rechecks - It is preferable to schedule the affected patients as near as possible to the end of the service’s receiving day.

• Re-examination of ICD Patients with Cutaneous Lesions – At the time of re-examination of skin lesions, it is at the discretion of the attending clinician whether to re-culture the lesions to verify absence/modification of the suspect organism.

VIII. Outpatient Diagnostic Imaging Service – The above procedures will apply to patients admitted through the diagnostic imaging service. 

IX. Hospitalized Diets – Raw food is not allowed to be accepted from owners of animals staying in the VTH.

X. Disinfection – Following examination and removal of the patient from the examination area, hospital personnel attending the patient or VTH caretaker staff will disinfect the area (room, gurney and scale used) with broad spectrum disinfectant with antiviral properties.

Definitions (if applicable)

Infectious/Contagious Diseases: The following represent infectious agents/diseases for which there is particular concern at the VTH because they are seen commonly in the VTH patient populations, because of their importance from the standpoint of student training or because of the severity of disease resulting from infection. For each of these infections, an individualized management plan will be formulated/discussed to include:

• Infectious agent:
• Route(s) of infection:
• VTH Patient Species At Risk For Infection:
• Zoonotic Potential:
• Animal Housing Recommendations to Limit Transmission:
• Animal Handling and Barrier Clothing Recommendations to Limit Transmission:

• Methicillin Resistant Staphylococci (MRS) • Drug resistant Pseudomonas • Sporotrichosis • Dermatophytosis • Pythiosis • Papillomavirus  • Mycobacteria • Tularemia • Giardiasis • Leptospirosis  • Salmonellosis • Canine Parvovirus • Tularemia

• Feline Panleukopenia • Feline Leukemia Virus (FeLV) • Feline Immunodeficiency Virus (FIV) • Feline Infective Peritonitis (FIP) • Canine distemper • Coronavirus • Calicivirus • Rabies  • Cryptosporidium • Infectious canine tracheobronchitis  (Bordetella)  • Acute feline viral upper respiratory infection • Mycoplasma  • Chlamydophila

 
Broad Spectrum Disinfectant with Antiviral Properties: aldehyde based (formaldehyde, glutaraldehyde), sodium hypochlorite based (bleach), oxidizing agents (hydrogen peroxide, Virkon S)

SAC: Small Animal Clinic

Veterinary Teaching Hospital (VTH): The collective clinical services of the Large Animal Clinic, Midwest Equine, the Small Animal Clinic, and the Veterinary Medicine South Clinic.