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Thursday, September 27, 2012

Biosecurity Challenges: Can we train an animal to cough into their elbow?

Biosecurity can have different connotations depending on who you are speaking with, but for the purpose of this blog, it means to protect the animal, human and environmental health against the threat of pathogenic microorganisms. From this definition it is important to highlight the fact that the three pillars upon which a biosecurity program should be built are the animal, the environment and the human.   Taking into account the “animal factor” is a key consideration in developing a biosecurity program because diseases can spread from animal to animal, from animal to humans (zoonosis) and, although less frequently, from humans to animals.

In veterinary medicine, as in human medicine, the human factor is crucial. People from different backgrounds are involved with the daily care of animals, that is veterinarians, veterinary nurses, veterinary assistants, veterinary students, cleaning crews, farmers, etc. all of which need to understand and be educated on general biosecurity and more specific biosecurity issues concerning their specific activity. Therefore education and compliance are two very important factors to deliver high levels of care for the animals and to protect humans, thus making a biosecurity program successful.

In the animal world there are many different contagious infectious diseases with the potential to cause outbreaks or serious diseases, not only in a hospital setting, but also in the field.  Infectious disease outbreaks are costly and can have devastating economic effects. Thus education of personnel is a very important factor in preventing outbreaks. While it would be nice to think we can train an animal to cough into their elbow, the reality is it’s not going to happen.  We have to rely on how people are handling the animals.  If properly educated and well trained, people can recognize an infectious disease early and have a biosecurity protocol in place, they can help prevent its spread. Adding to the importance of the human factor is the potential risk of zoonotic diseases. In survey of North America Veterinary Teaching Hospitals, 50 % of the participating institutions reported zoonotic infections; agents included Cryptosporidium parvum, MRSA, Salmonella enterica, among others. A key element of a biosecurity program is that animal care givers learn how to recognize and protect themselves from zoonotic diseases. 

Biosecurity education will also ensure compliance. In this sense, a biosecurity program needs to have the full support of the top level of the organization and trickle down; more importantly everyone should be engaged and understand the importance of biosecurity practices. Thus, multidisciplinary team work is paramount for a biosecurity program to be successful. This means that everyone in the organization involved with the care of animals from the CEO to the cleaning crew should be integral parts of this team, and the importance of their jobs should be highlighted and praised. 

I think that the human factor is paradoxically the most difficult to attain, since it is hard work to educate everyone and more so, even if efforts are made in education, compliance can be less than ideal. It is critical to understand that team work and effective leadership can be the difference between success and failure. 

Looking at the animal factor; animals can become ill with a wide variety of infectious contagious diseases. It is important to understand the difference between an animal being sick with a contagious infectious disease, being colonized or being a carrier.  In a hospital situation, admitting an animal that is sick with an infectious disease (i.e. fever, leukopenia and diarrhea) will prompt immediate placement of that animal in the isolation area, where high levels of biosecurity measures are implemented. More complex is the identification of an animal that can be a carrier of an infectious disease, but not sick at the time of admission.  These animals impose a high risk to a hospital environment. This is why a biosecurity protocol must always be in place and we should never lower our guard when it comes to infectious disease control. International animal travel is a great example of this risk and epitomizes the need for strict surveillance and biosecurity measures.

The environment is a complex issue in veterinary medicine; the reason being that so many different materials and designs are utilized to house and/or transport animals, thus making it difficult to implement standards across the board. The wide array in materials will have a direct impact on measures taken to prevent or mitigate the spread of an infectious disease. More importantly the efficaciousness of disinfectants is correlated to the surface to which it is applied.  For example, it is very hard or even impossible to properly disinfect untreated wood or dirt. Cleaners and disinfectants are best used on surfaces that are non-porous (i.e.  Epoxy painted concrete blocks, stainless steel, tile, etc.). Infectious diseases can also occur at the farm level, where control measures can sometimes be more challenging, especially if a biosecurity plan is not routinely used.

In North America a survey including veterinary teaching hospitals reported that 82 % of the institutions had an outbreak of nosocomial infection and 58 % of the institutions had to restrict patient admissions in order to control the outbreak. This paper did not include data from private veterinary hospitals, thus likely underestimating the overall importance on nosocomial outbreaks in the veterinary environment. The most common agent associated with nosocomial outbreaks, particularly in large animal hospitals, was Salmonella enterica. This is the reason why large animal hospitals utilize active surveillance to detect shedding of this bacteria among hospitalized patients. This highlights the importance of the environment as a source of infectious diseases, making environmental cleaning and disinfection very important.

Environmental cleaning and disinfection along with the use of appropriate products is an integral part of a multidisciplinary biosecurity protocol. That is environmental measures should complement but not replace other important aspects of biosecurity, such as education, hand hygiene, compliance, etc. Disinfectants should be chosen based on their microbicidal spectrum, contact time, compatibility with materials and finally safety.  One of the most serious flaws of disinfectants routinely used in veterinary facilities is a prolonged contact time required for microbial killing. Many disinfectants required microbicidal time of 10 minutes, but dry well before achieving this dwell time, thus creating a false sense of security and increases the risk for susceptible animals or humans at risk to become infected.  Choosing a disinfectant is more than a review of kill claims or price.  One needs to investigate the contact times, the safety profile not only for the animal but for the people who will be using the product and the environment because in rural areas, the run-off from disinfectants is not being routed into sanitary sewer systems for treatment.

Take a look at your biosecurity program to see if there are areas that need to be improved and be sure to give me a call if you successfully train the animals you handle to cough into their elbow!

Dr. Lucas Pantaleon is a Large Animal Board Certified Internal Medicine Specialist.  Dr. Pantaleon worked as the head of Medicine and Biosecurity at an equine hospital in Kentucky and has an ambulatory Internal Medicine Veterinarian in a practice in Kentucky.  He is currently the Director of Technical Services for Ogena Solutions who provide environmentally friendly bio-security products, equipment and protocols.

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