Preventing Spread of Infectious Disease in an Outpatient Setting

You have asked...

How do you prevent the spread of infectious disease among visiting patients?

The Expert Says ...

Companion animal veterinary clinics typically deal with both healthy and sick pets on a daily basis. There are many opportunities to spread infection, starting in the parking lot and outdoor areas on into the clinic itself. Dogs often touch noses and play together, and owners may pet or handle other animals while they are waiting. The hospital staff is aware of the importance of preventing contact, but they may be too busy to constantly monitor owners and pets. Once in the exam room or treatment areas, it becomes a little easier to control the spread of infection. The following are some guidelines to control infectious disease in an outpatient setting:

Establish a hospital policy that all personnel must wash their hands between patients. While this may seem obvious, it is well known from human medicine that handwashing practices in hospitals are not optimal. Antibacterial soap has not been shown to be more effective than plain, so choose a moisturizing liquid product that is acceptable to all staff to boost compliance.

Provide alcohol-based antibacterial gels in all areas of the clinic. Wall-mounted dispensers may lead to less clutter than individual bottles. Staff members can simply rub gel on their hands if they are in a hurry. Clients may use dispensers if offered in the waiting and exam rooms.

Designate an area in the clinic for pets with signs of infectious disease, such as coughing, sneezing, diarrhea, or hair loss suggesting ringworm or scabies. Staff should be trained to quickly recognize these types of conditions. Rather than allowing such animals to remain in the waiting room and increasing the risk for spreading infections, have the clients and pets immediately move to a more isolated location. If temperatures are not extreme, pets can wait outside or in the vehicle. I prefer to go outdoors to do preliminary exams of suspected contagious animals. The bed of a pickup or backseat of a car can serve as your "isolation" exam room!

Pets that are boarded or hospitalized face ongoing risk for infection. Nosocomial infections occur in 10% of people after admission to a hospital; although similar statistics are not available for veterinary clinics, many of us have dealt with angry phone calls about pets that may have become infected while under our care. Careful attention to aseptic technique minimizes the risk -not only in surgery but also during patient procedures, such as placing catheters. Proper cleaning and disinfecting of cages, runs, exam tables, floors, and other surfaces also help to decrease the spread of disease. Make sure the hospital staff is aware of the important "rules" of disinfection:

Soil and organic matter must be cleaned from surfaces before disinfectants are applied. Chemical disinfection cannot take place in the presence of dirt, blood, waste, etc.

Take the time to read the labels of cleaning and disinfecting solutions. You may be surprised to learn that many common veterinary products require at least 10 minutes of contact time before bacteria, viruses, and fungi are eliminated. A quick "spray-and-wipe" technique may be adequate for cleaning but does not actually disinfect. Also review the dilution instructions-the amount of product to be added to water may range from 1/2 ounce to 4 ounces per gallon. Under-dilution is a common problem in veterinary clinics which increases expense and waste without any additional benefit.

Household bleach is inexpensive and useful as a disinfectant. The usual dilution is 4 to 6 ounces (1/2 to 3/4 cup) per gallon of water. Recommended contact time is at least 5 minutes. Bleach is corrosive to stainless steel and often clogs spray bottles with metal parts. After using bleach, rinse surfaces with plain water. Diluted bleach must be freshly mixed each day, as it rapidly breaks down to salt and water. Be careful to purchase plain bleach; some products with additives, such as fragrances, are not EPA-registered disinfectants.

Make sure material safety data sheets are available for each chemical and cleaning product, and document your staff's training in this area. OSHA guidelines and work safety rules apply to veterinary clinics.

Taking the time to review your hospital policies on cleaning and disinfecting protocols can lead to fewer infectious diseases, happier clients, and healthier pets.