How the universe evolved (and why you should care)

May 24, 2019
Jenifer Chatfield, DVM, DACZM, DACVPM
Jenifer Chatfield, DVM, DACZM, DACVPM

Dr. Jenifer Chatfield is the Staff Veterinarian at 4J Conservation Center, an instructor for FEMA/DHS courses, and a Regional Commander for the National Disaster Medicine System Team. She graduated from Texas A&M University's CVM and has pursued emergency medicine and zoo medicine throughout her career. She owned two emergency clinics and has been the Senior Veterinarian in a zoo. She completed fieldwork in Madagascar and South America and continues to explore new areas of medicine as an Associate Editor for the Journal of Zoo and Wildlife Medicine for more than 10 years. Dr. Chatfield is a Medical Reserve Corps member and developed the "Veterinary Support to Zoological Animals in a Disaster" for the National Veterinary Response Teams training curriculum. Dr. Chatfield has chaired the Florida Veterinary Medical Association's (FVMA) One Health Committee and co-chaired FVMA's Disaster Response Committee.

Its as important as the air you breathe and you should probably be wearing a veterinary surgical mask because of it. Lets talk biosecurity and the importance of universal precautions.

Your infection control plan doesn't have to include escaping to the safety of space. (Magdalena/stock.adobe.com)

How often do you think about infection control? Perhaps you think more often about its more glamorous cousin, biosecurity? Perhaps you even know the difference between the two?

Give yourself a gold star if you already know that biosecurity aims to prevent the introduction of pathogens (assuming no pathogens are present), while infection control aims to prevent or stop the spread of infections in a specific setting. In a clinical setting, infection control is one of the most important issues veterinarians face-and it's also one of the most underaddressed. A lynch pin of effective infection control programs is avoiding unnecessary contact with potentially infected blood, tissue, bodily fluids or potentially infectious material through the practice of “standard precautions.”

Standard (or universal) precautions weren't always part of our medical vernacular. In fact, before 1985, most medical practitioners, veterinary or otherwise, didn't worry too much about gloves, let alone masks and gowns for nonsurgical encounters. However, the emergence of HIV brought a revolution in the approach to infection control among human healthcare professionals and, in turn, among veterinary professionals.

Largely in response to the HIV epidemic, the CDC and OSHA developed and implemented the first universal precautions wherein the transmission of bloodborne pathogens was the focus. Then, it occurred to someone that perhaps blood was not the only potentially infectious bodily fluid, and the CDC augmented their guidelines to include other bodily fluids, calling the new guidance “body substance isolation” (BSI).

A key feature of the BSI guidelines was that they emphasized handwashing after removal of gloves only if hands were visibly soiled. Talk about trusting your gloves! By the way, does anyone else find it interesting that it took two years to figure out that feces, cerebrospinal fluid, saliva, sputum and other fluids should be avoided?

Finally, in 1996, the CDC combined the original universal precautions and BSI guidelines to create what are now called “standard precautions” that include disease transmission routes-airborne, droplet and contact.

Fast-forward to this century, and glove boxes are littered throughout human and veterinary medical settings alike. My mom's first question when looking at some pictures of my early field procedures was, “And where are your gloves?” Gloves, hand sanitizer and masks outside the operating suite have all become part of the norm. In fact, in human medicine, it's now a little weird if the doctor touches you with ungloved hands. In veterinary medicine, we still touch most of our patients with bare hands, but not all of them!

So how effective are these standard precautions? And are they really effective? I mean, distemper and influenza are airborne, right? So is wearing gloves and washing my hands until they crack really effective at preventing their spread in a clinic?

In short, yes-incredibly effective.1,2 Studies have found that having soap and water available and promoting handwashing decreases respiratory illnesses in a population.2 These days, with influenza working to expand its universe, everyone can use a little more frequent handwashing. Frequent handwashing (notice I did not say “hand sanitizer use”) should be practiced by all members of your team in your practice. In fact, all team members should understand and commit to practicing the infection control plan and standard precautions across the board.

An effective infection control plan is critical to not only protect patients and clients as they visit your practice, but to protect you and your team from infection as well. Communication with your practice team about the real risks that come with working in veterinary medicine should be direct and include protocols to protect them from infection. Veterinarians and their team represent the frontlines, the leading edge, the tip of the spear for development of emerging infectious diseases, and everyone should be engaged in infection control efforts.

If you're wondering where to start, the National Association of State Public Health Veterinarians (NASPHV) has a model veterinary clinic infection control plan that is downloadable and customizable. You can probably even get it done before your next team meeting when you want to talk about the new plan!

If you're not ready to take such a formal leap, feel free to share “Dr. Chatfield's tips for staying healthy”:

Don't lick gross stuff.

Close your mouth while at work (to prevent gross stuff jumping into it).

Don't hang out with sick people or sick animals.

Keep gloves in your pocket and use them.

That official NASPHV model plan is looking pretty good now, no? And remember: You should review “universal” or standard precautions with your team regularly-everyone forgets.

The bottom line is that universal AND standard precautions are called that for a reason. Emerging pathogens are a real thing, and around 75% of them are zoonotic. By instituting some small steps and encouraging your team to routinely follow basic steps such as gloves and handwashing, you can make a real difference in the lives of your patients, their owners and your staff.

References

Rabie T, Curtis V. Handwashing and risk of respiratory infections: a quantitative systematic review. Trop Med Int Health 2006;11(3):258-267.

Najnin N, Leder K, Forbes A, et al. Impact of a large-scale handwashing intervention on reported respiratory illness: Findings from a cluster-randomized controlled trial. Am J Trop Med Hyg 2019;100(3):742-749.

Dr. Jenifer Chatfield is staff veterinarian at 4J Conservation Center in Pasco, Florida, an instructor for federal disaster management courses and a regional commander for the National Disaster Medicine System Team. She has also chaired the Florida Veterinary Medical Association's One Health Committee and co-chaired its Disaster Response Committee.