Leading Off: How are you combating healthcare-associated infections in your practice?
Need-to-know information about minimizing the risk of disease transmission and documenting infection incidence in a healthcare setting.
It is clear that patients, veterinary personnel, and animal owners can be affected by healthcare-associated infections (HAIs) that can occur in veterinary care settings. There is good evidence that these risks can be substantial, both for epidemic disease (e.g. infection with Salmonella or viral respiratory agents) and for endemic risks related to common hazards (e.g. surgical site infections, infections related to intravenous or urinary catheters). Veterinarians have clear-cut ethical and legal responsibilities to minimize risks for infectious disease transmission in healthcare settings, and experts agree that there is a recognizable standard of practice for infection control in veterinary medicine.1,2
Paul S. Morley, DVM, DACVIM
Despite the general acceptance of these concepts, there is substantial evidence that the veterinary profession has not fully embraced the need to actively track and manage HAIs.2
Developing guidelines in your practice
All veterinary practices need to develop comprehensive infection control programs that are tailored to their specific facilities and patient populations.1 Several published references can guide development,3,4 and this type of focused effort has been shown to have a significant impact on the occurrence of HAIs. Good comprehensive programs will address all aspects of patient care, emphasizing the control of the most important and impacting problems.
GETTY IMAGES/ROEL SMART
However, focusing on protocol development can give a false sense of security. To be maximally effective we need to actually work to document outcomes that we are trying to affect (e.g. surgical site infections).
Can you document the quality of your patient care?
One of the major drivers of change regarding promotion of infection control in human healthcare has been the use of standardized surveillance tools. This helped demonstrate a need for these efforts, promoted the use of benchmarking to assess the quality of care that is being achieved at individual hospitals, and allowed greater comparability of research findings across different settings.
Unfortunately, this type of surveillance is not commonly used in veterinary medicine. Few would argue that a core goal for every clinical practice is to compassionately deliver the highest quality care to patients and clients. But what if I asked you to prove that you were meeting this goal in your practice—could you do it? What evidence can you provide documenting the quality of patient care in your practice?
This question strikes at the heart of the need to actively pursue excellence in infection control. You do not really know if you are controlling surgical site infections or catheter-related problems if you are not actively documenting their occurrence. This can be accomplished quite simply (e.g. tracking the number of catheters placed and the number that show defined evidence of problems) or can be implemented with a bit more rigor in more comprehensive programs. For example, syndromic surveillance methods are quite easy and inexpensive to implement and show great promise for use in veterinary settings.5
Regardless of the approach, it is clear that we need to improve our ability to develop formalized infection control programs for all veterinary care settings, and we need to develop methods that document the quality of our care if we are to compassionately deliver the highest quality care to our patients and clients.
Paul S. Morley, DVM, DACVIM, is a professor at Colorado State University (CSU) and the Director of Infection Control at CSU's James L. Voss Veterinary Teaching Hospital.
1. Morley PS, Anderson ME, Burgess BA, et al. Report of the third Havemeyer workshop on infection control in equine populations. Equine Vet J 2013;45(2):131-136.
2. Morley PS. Evidence-based infection control in clinical practice: if you buy clothes for the emperor, will he wear them? J Vet Intern Med 2013;27(3):430-438.
3. Morley PS, Weese JS. Biosecurity and infection control for large animal practices. In: Smith BP, ed. Large animal internal medicine. 4th ed. New York, NY: Elsevier, 2008;1524-1550.
4. Canadian Committee on Antibiotic Resistance (CCAR). Infection prevention and control best practices for small animal veterinary clinics. 2008 Available at: http://www.ovc.uoguelph.ca/cphaz/resources/documents/GuidelinesFINALInfectionPreventionDec2008.pdf. Accessed Aug 16, 2013.
5. Ruple-Czerniak AA, Aceto HW, Bender JB, et al. Using syndromic surveillance to estimate baseline rates for healthcare-associated infections in critical care units of small animal referral hospitals. J Vet Intern Med [In Press].