Download Infection Control Manual - University of Saskatchewan

Western College of Veterinary
Medicine
University of Saskatchewan
Veterinary Teaching Hospital
Small Animal Clinic
Infection Control Manual
Draft 7
Prepared April 2009
Dr Chris Clark
WCVM – Infection Control Manual – SAC
1
Contents
Introduction
Abbreviations
Contacts and Resources
Small Animal Clinic – Area Definition
General Biosecurity / Biosafety Guidelines
Routine Patient Hospitalization
Small Animal Clinic Biosecurity/Biosafety Standard Operating Procedure (SOP)
Guidelines for Small Animal Patients Presenting with Suspected Contagious
Disease
Guidelines for Dealing with Exotic Species and Wildlife
Small Animal Surgery SOP
Small Animal Anaesthesia Biosecurity/Biosafety SOP
Radiology Biosecurity/Biosafety SOP
Pharmacy Biosecurity/Biosafety SOP
Central Supply Biosecurity/Biosafety SOP
Small Animal Isolation Protocols
Barrier Nursing Unit
Release of Remains Policy
VTH Visitors Policy (SAC and ICU)
Appendix 1 Risk Group 3 pathogens and CFIA reportable diseases
Appendix 2 VTH Disinfection Protocols
Appendix 3 Surgery Protocols
Appendix 4 WCVM rabies policy
Appendix 5 Accident/illness reporting form
Appendix 6 Waste disposal
Appendix 7 Emergency response plans
Appendix 8 Nosocomial Notification Form
WCVM – Infection Control Manual – SAC
3
5
6
7
9
14
16
20
24
28
33
37
39
40
42
44
47
48
51
57
60
65
68
69
73
76
2
Introduction
The Veterinary Teaching Hospital (VTH) at the Western College of Veterinary
Medicine (WCVM) is no different from any other hospital, be it veterinary or human.
It exists to diagnose and treat animals suffering from a wide variety of ailments, a
large proportion of which are infectious in origin. The presence of a large number of
animals some of which have infectious diseases being housed in close proximity to
healthy as well as immunosuppressed animals necessitates that procedures be put
in place to fulfill two vital functions.
1. Many animal diseases are zoonotic in nature and may be transmitted to
humans. Everyone has the right to work in an environment where they are
not exposed to either injury or disease. This is a requirement of law and we
must also consider the clients and lay staff within the facility who may not be
informed as to the risks of these diseases. The prevention of disease in
humans within the workplace is generally referred to as “biosafety”.
2. Prevention of the transmission of disease between animals within the VTH is
a key component of our “duty of care”. The prevention of disease
transmission between animals is generally referred to as “biosecurity”. It is
unsettling that an animal should be exposed to and develop disease while in
our care, but this is sometimes unavoidable. There are numerous examples
in the veterinary literature documenting disease outbreaks in veterinary
facilities in both large and small animals. Such cases have a profound effect
on the economical stability and reputation of a facility and are extremely hard
to explain to the client. In severe cases, these outbreaks may result in the
death of the animal and/or legal action. For all these reasons, it is vital that
the VTH at the WCVM be proactive in this area and develop protocols to
prevent the transmission of disease between animals.
The role of this document is to generally standardize the “common sense”
behaviours used by most workers within the VTH. Some of the procedures will
necessitate changes in behaviour and may result in some inconvenience. However,
the goal of the guidelines is not to create problems for the staff of the VTH, but to
protect the health of our students, employees and our patients. It is also important
to remember that in many cases, the exact nature of the disease is not known on
presentation. Consequently, animals in which the diagnosis remains open should
always be approached with caution until the exact nature of the disease is
determined. It is also simpler to approach all cases in the same manner and to
develop the habit of a safe work practice all of the time so that these protocols
become “second nature”.
WCVM – Infection Control Manual – SAC
3
Guidelines such as these are dependent on all employees, students and staff
working together to implement them. Therefore, we ask that you familiarize yourself
with the Standard Operating Protocols (SOPs) applicable to your area of operation
and help each other to follow them.
It should be noted that the current design of some areas of the VTH hampers both
biosafety and biosecurity. These guidelines will be easier to follow and subject to
change with the redesign of the VTH over the coming years.
The guidelines contained within this manual are applicable to the following
groups:
WCVM Faculty – esp. members of Dept. Small Animal Clinical
Sciences (SACS)
Designated WCVM Staff
VTH Staff
WCVM veterinary students
Visiting veterinary technician students
Visiting students
Visiting scientists
Visitors and clients of the College should always be under the supervision of
the above individuals and are expected to abide by these guidelines at all
times.
Note: During Vetavision, it is expected that the public will only be visiting areas that
are not in use for clinical service. Furthermore, the public will be under the
supervision of veterinary students at all times. Most of this manual will not apply in
this situation, although all visitors are encouraged to wash their hands when leaving
the facility.
These Guidelines were developed by the WCVM-VTH Infection Control Committee.
If you have problem with any aspect of these guidelines, please feel free to
approach any member of the committee with your comments. These protocols will
be reviewed annually and your input is appreciated.
WCVM - VTH Infection Control Committee:
Chris Clark
Cindy Shmon
Jennifer Ogeer
Elizabeth Snead
Trisha Dowling
Ruth Black
LAS
FS
Devin Elias
Manuel Chirino
WCVM – Infection Control Manual – SAC
4
Mandate:
1. To develop, maintain and update SOPs to prevent disease transmission in
the WCVM-VTH.
2. To review cases of disease transmission in the WCVM-VTH and investigate
outbreaks.
3. To review special case scenarios and develop protocols to care for these
cases based on the current SOPs.
List of Abbreviations
ACU – Animal Care Unit
BNU – Barrier Nursing Unit
ICC – Infection Control Committee
ICU – Intensive Care Unit
LAC – Large Animal Clinic
MDR – Multi-Drug Resistant
PHAC – Public Health Agency of Canada
PPE – Personal Protective Equipment
SOP – Standard Operating Protocol
SAC – Small Animal Clinic
VTH – Veterinary Teaching Hospital
WCVM – Western College of Veterinary Medicine
WCVM – Infection Control Manual – SAC
5
Contacts and Resources
VTH Director - Dr Jacques Messier – 7109
WCVM Buildings and Resources – Susan Cook - 7373
VTH Infection Control Officer – Dr Chris Clark – 7165
WCVM Rabies Program Coordinator – Liana Kinar - 7271
University of Saskatchewan Biosafety Manager – Andrea Smida – 8496,
Fax No. - 8394
E-mail: [email protected]
Contact if a Level 3 pathogen is suspected, there is a case of human
exposure to a zoonotic disease or there is the potential of a nosocomial
disease outbreak (see Appendix 1 (pg 51)).
Canadian Food Inspection Agency- Regional Office – 975-418.
Inform of all confirmed or suspect reportable diseases
University of Saskatchewan Biosafety resources:
http://www.usask.ca/dhse/biosafety/index.html
Biosafety Code: http://www.usask.ca/dhse/pdf/biocode.pdf
Biosafety Manual:
http://www.usask.ca/dhse/pdf/Biosafety%20Manual%20January%202005.pdf
Hazardous Waste Manual:
http://www.usask.ca/dhse/pdf/Hazardous%20Waste%20Disposal%20Manual.pdf
WCVM – Infection Control Manual – SAC
6
Small Animal Clinic Area Definition
Protocols relating to cats, dogs and other small animals are applicable within the
Small Animal Clinic (SAC).
The SAC is defined as all areas within an area bounded by the breezeway, the main
corridor near necropsy and the corridor near the clinical pathology laboratory. In
addition the protocols also apply to the CT room, MRI, Radiation Oncology,
Medical/surgical exercises suite and E Ward.
Due to problems with the design of the building, it is not possible to isolate the SAC
from the remainder of the building. Any person travelling to the rest of WCVM must
remove their white coat and hands must be washed.
WCVM – Infection Control Manual – SAC
7
Fig. 1 Boundaries of the Small Animal Clinic
WCVM – Infection Control Manual – SAC
8
General Biosecurity/Biosafety Guidelines
1.
HAND WASHING—This is a proven step in preventing the transmission of
infectious agents!
A. Personnel having patient contact should maintain short fingernails.
B. Hands must be washed before and after attending to each individual
animal. It is a good idea to develop the habit of washing your hands as soon
as you enter an exam room.
C. Hand washing procedure:
If hands are free of gross contamination (i.e. not visibly dirty)
¾ Pump an aliquot of alcohol gel into the palm of one hand.
¾ Rub gel over all surfaces of the hands for 30 seconds and allow
hands to air dry.
If hands are grossly contaminated (i.e. visibly dirty):
When possible, use hands-free operation sinks:
¾ Pump antiseptic soap onto hands and wash for at least 30 seconds,
including fingernails
¾ Use a surgical brush and nail cleaner if nails are particularly soiled
¾ Use paper towels to dry hands
At regular sinks:
¾ Collect clean paper towels
¾ Wash hands for 30 seconds with antiseptic soap—including under
fingernails
¾ Use a surgical brush and nail cleaner if nails are particularly soiled
¾ Rinse hands
¾ Use paper towel to dry hands, and use paper towel to turn off tap
D. Do not touch clean areas (i.e., doorknobs, drawer or cabinet handles or
contents, equipment, or medical records) with soiled hands or gloves.
E. Remember that although gloves do provide an additional level of protection,
they can still have holes in them so hands should always be washed when the
gloves are removed. Hands should also be washed after removal of any
other forms of protective clothing.
WCVM – Infection Control Manual – SAC
9
2.
BARRIER NURSING—involves the use of disposable gowns, gloves, shoe
covers and footbaths to prevent a person from spreading organisms from one
patient to another. It is a proven step in preventing the transmission of
infectious agents. This technique is used in all isolation areas (Small animal
isolation ward p.42), the Barrier Nursing Unit (Barrier Nursing Unit p.44) and
for patients with special needs (e.g. immunocompromised patients).
3.
STANDARD ATTIRE
A. Daily attire should be neat, clean and professional.
B. Footwear must be safe, protective, clean and cleanable. Closed toe
footwear is required. Personnel must be willing to clean their footwear.
C. Three options for clothing exist for those working in the small animal clinic in
direct contact with animals:
I. A white coat (provided by the VTH) worn over regular “street clothes”.
II. A white coat worn over patterned scrubs.
III. Blue scrubs (tops and bottoms) provided by the VTH.
D. White coats must be removed when you leave the VTH and cannot be worn in
other areas of WCVM. People wearing blue scrubs must change before they
leave the VTH. Blue scrubs must never be worn home. (Green scrubs are to
be worn in Operating Rooms, laundry area, anaesthesia and ICU only.)
E. Students must always have a minimum of 2 sets of standard attire available.
F. Standard outerwear should be clean and must be changed immediately if it
becomes soiled or a case with a potentially infectious condition is handled (e.g.
coughing dog, parvo suspect, open wound).
G. Lab coats should be washed regularly while on rotation, and especially when
changing services.
H. Protective clothing is worn to protect “street clothes” and prevent carrying
infected material away from the VTH. It should not be worn within the main
area of WCVM or outside of the building. Hooks are provided in the main
corridor and at the bottom of the stairs and should be used to hang up lab
coats if you are leaving the SAC for a brief period. Wearing of white coats in
the buffeteria is prohibited.
I. It is acknowledged that the current design of WCVM presents some problems.
Coat hooks are provided and students and staff should carry rather than wear
protective clothing from locker rooms to the VTH.
WCVM – Infection Control Manual – SAC
10
4.
STANDARD EQUIPMENT (please see each section for additional required
equipment):
¾ Stethoscope
¾ Pen light
¾ Thermometer
5. BASIC DISINFECTION TECHNIQUES (SEE APPENDIX 2 FOR ADDITIONAL
DETAILS)
A. Disinfectants:
Spray bottles and Pump sprayers should be available in all parts of the
hospital. When empty they should be returned to Pharmacy for refilling.
I.
II.
Peroxigard– Accelerated Hydrogen Peroxide – the proper dilution =
1:16, contact time 30 secs for sanitization, 10 mins for chemical
sterilant activity. (See Appendix 2)
70% alcohol solution – used to wipe down instruments etc. that cannot
be cleaned using the above solution
** DISINFECTANTS SHOULD NEVER BE MIXED **
B. Routine Cleaning
Routine cleaning and disinfection consists of:
I.
II.
Spray the area with Peroxigard and wipe down with paper towel.
Spray area thoroughly with Peroxigard and leave to dry.
C. Disinfection Protocol for Contaminated Surfaces
I.
II.
III.
IV.
De-bulk bodily secretions (feces, urine, blood, respiratory secretions,
etc.) with paper towel and rinse area
If the area was heavily contaminated wash area thoroughly using a
detergent used at the label concentration and rinse.
Spray the area with Peroxigard and wipe down with paper towel.
Spray area thoroughly with Peroxigard and leave for at least 5 minutes
D. Disinfection Protocol for Instruments and Equipment
I.
II.
III.
Students using their own thermometers should use thermometer
covers where available. Thermometers and stethoscopes should be
disinfected with alcohol (available in most areas) between each
patient.
All patients admitted to ICU, BNU and isolation should have their own
thermometers.
Routine equipment (e.g. bowls, muzzles etc) should be cleaned with
soap and water and disinfected with Peroxigard after use.
WCVM – Infection Control Manual – SAC
11
IV. Wipe all equipment down with Peroxigard prior to returning to Central
Supply (p.40).
V. After use endoscopes should only be cleaned by faculty or staff members.
6.
GENERAL INFORMATION
A. Personal belongings must be left in your locker or office.
B. Because of the potential for disease transmission food is not permitted in the
C.
D.
E.
F.
7.
Veterinary Teaching Hospital where animals are examined, treated, or housed
(reception area and film reading area of Radiology is exempt).. Food
storage is not allowed in any refrigerator or freezer used for medications,
animal samples. Water bottles and coffee cups are not allowed in the VTH or
the corridor adjacent to the VTH. Water dispensers with disposable cups are
available for when you are not able to leave the clinic for a break. A break
room (Rm 1412) is provided for the use of all staff and should be used to
store, prepare and consume food and drink. All individuals should be
allowed sufficient “breaks” to eat and drink when required. Note: clean
lab coats are permitted in the break room as it is only used by staff and
students. Ideally, lab coats should be hung on the coat rack by the door.
Students should use the buffeteria during work hours, but between 6pm and
8am and or weekends they may use the break room.
All multiple use areas where animals are examined or treated should be
cleaned and disinfected immediately after use by personnel responsible for
the patient irrespective of infectious disease status of the individual animal.
Exam rooms must never be left dirty with the intent to return later. If the
emergency nature of the case does not allow this, request help to ensure the
room is cleaned.
Traffic between the small and large animal areas of the hospital should be kept
to a minimum.
Entry to the main areas of the College through the VTH is not permitted.
Traffic through the Breezeway to the Small Animal Clinic, Exotic/Zoological
Medicine Ward, MRI, CT and Radiation Therapy Unit is limited to those with
official hospital business.
Important Personal safety information
Working in a hospital environment generates large numbers of disposable
“sharps”, including hypodermic needles, scalpels, suture needles, glass, etc. It
is the responsibility of anyone generating such waste to ensure that they are
disposed of appropriately in the labelled “sharps containers” throughout the
VTH. (For further details see Appendix 6). Needles should not be recapped
to avoid accidental injuries
WCVM – Infection Control Manual – SAC
12
8.
Sample Submission to PDS
A. Blood samples and fluids should be submitted to the Clinical Pathology
Laboratory (Rm 1550) in clean vacutainers.
If containers become
contaminated during collection they should be cleaned and disinfected with
Peroxigard prior to submission.
B. Cytology slides should be placed on a slide tray before submission to the
Clinical Pathology Laboratory.
C. All other samples should be submitted to the PDS office (Rm 1608). Samples
should always be submitted in a clean appropriate container. If there are any
concerns regarding the cleanliness of the container, samples must be sealed in
a Ziploc bag.
D. All samples submitted from animals with a suspect infectious disease (including
all Risk Group 3 organisms) should be placed in Ziplock bags.
E. Cadavers from the SAC may be submitted for necropsy by placing them in a
black plastic body bag. They should be carried or wheeled to the necropsy
suite through the door in the main corridor. A necropsy form must accompany
the body. Bodies for cremation should be placed in a black plastic body bag
with a patient label clearly visible to identify the body and an Orange Private
Cremation Form (See release of Remains Policy p. 47).
F. Out of hours or if the cadaver is being collected by the client or the private
cremation service the body should be stored in the cooler in the CT room (Rm.
1430 ) as soon as possible. The client and patient name, date body was put
into the cooler, clinician name and the cremation company whose services are
being contracted must be recorded in the book beside the cooler.
G. When there are any concerns that samples come from an animal potentially
suffering from a communicable/infectious disease, the suspected disease
must be prominently displayed on the sample form and the specimen marked
with a red dot.
WCVM – Infection Control Manual – SAC
13
Routine Patient Hospitalization
1.
NO PATIENT IS TO BE PLACED IN ANY WARD WITHOUT THE
PERMISSION OF A CLINICIAN OR TECHNICIAN.
2.
CONTAGIOUS INFECTIOUS DISEASE STATUS INDICATORS: All VTH
patients evaluated at the VTH should be evaluated for contagious infectious
disease risk by the clinician and student on the case. It is the responsibility of
the primary clinician on each potentially infectious disease case to review
the Biosecurity SOP and to institute containment procedures before
admission to the SAC.
RED KENNEL CARD: Animals with known highly contagious or
zoonotic disease. Red cards should be used for animals in Small
Animal Isolation or Barrier Nursing Unit.
YELLOW KENNEL CARD: Animals suspected to have contagious
disease or animals at increased risk for acquiring infectious disease,
housed in general hospital population.
BLUE KENNEL CARD: Animals at high risk of developing an infectious
disease (Immunocompromised) requiring special precautions such as
barrier nursing.
WHITE KENNEL CARD: Animals with no historical, laboratory, or
physical examination evidence of infectious disease.
A. The appropriate kennel cards must be placed on all kennels, runs etc.
This system will allow technicians to handle contaminated patients, areas,
bedding, used litter, etc. appropriately.
B. Samples submitted to VTH service areas should be labelled with the
appropriate yellow or red dot if infectious diseases are suspected or
known. Do not place dots on any forms. List the suspected or known
infectious agents on the submission form
C. If yellow or red Kennel Cards are used the suspect agent must be marked
on the back of the card.
D. Be aware that the infectious disease status (and corresponding color) of an
individual case may change during hospitalization.
E. If an animal should develop an infection of any kind while hospitalized the
clinician must complete a Suspected Nosocomial Infection Form (Appendix
8) and submit it to any member of the Infection Control Committee
3.
RESEARCH OR TEACHING ANIMALS
A. The wards of the SAC are for the use of patient animals only. The only
exception to this rule is blood donor animals.
WCVM – Infection Control Manual – SAC
14
rd
B. Teaching animals used for 3
year activities are housed in the teaching
area or E ward.
C. Small Animal Laboratories: students participating in any Small animal labs
D.
E.
F.
G.
using live animals or cadavers must wear a lab coat. Surgical scrubs are
required for surgical exercises.
Research animals should be housed in the ACU. Research animals
requiring surgery should recover in the VTH before being moved back to
the ACU.
SPCA animals used for NEBs etc. should be housed in E ward.
If the need arises for housing of research or teaching animals with the
general hospital population, the researcher must prepare a Biosecurity
protocol to be submitted to the VTH Infection Control Committee at least
one month in advance to allow adequate time for approval.
Staff animals requiring treatment should be housed as patients. If a staff
member lives alone and is working a shift longer than 12 hours, they may
house their animal in E ward. The staff member is responsible for cleaning,
disinfection and feeding. VTH bedding supplies may not be used. Staff
should be aware that animals housed with SPCA cases may be at risk of
acquiring infections.
WCVM – Infection Control Manual – SAC
15
Small Animal Biosecurity SOP
1.
PERSONNEL ATTIRE/HYGIENE
EMERGENCY RECEIVING
FOR
GENERAL,
TRIAGE,
AND
A. Students are expected to have a digital thermometer (use thermometer
covers), stethoscope, and penlight.
B. Clean lab coat or blue scrubs (tops and bottoms) and closed-toe shoes
should be worn at all times. Shoes should be cleaned and disinfected
whenever soiled with feces or other bodily fluids. Lab coats should be
changed whenever soiled with medications, blood, feces or other bodily
fluids.
Lab coats should also be changed after exposure to potentially
infectious cases.
C. The VTH will launder white coats and scrubs. This clothing should never be
taken home for cleaning.
D. Hands must be washed prior to and after examining each patient.
E. Clean and disinfect all equipment such as a thermometer and stethoscopes,
between patients.
F. All equipment or objects, including dental instruments, muzzles, mouth
speculums, etc., and thermometers if used without a thermometer sleeve
should be disinfected with Peroxigard before and after use on any patient.
G. Areas or equipment contaminated by feces, secretions, or blood should be
cleaned and disinfected immediately by the personnel in charge of the
patient. Cleanliness is the responsibility of ALL persons involved in the
small animal services.
2.
GUIDELINES FOR SMALL ANIMAL PATIENTS WITH SUSPECTED
CONTAGIOUS DISEASE
A. Contagious diseases:
Special procedures are in place to deal with animals presenting with clinical
signs or history consistent with diseases which are considered to be of risk to
other animals or human health. It is the responsibility of the veterinarian
responsible for the case to help identify these cases before they enter
reception. Receptionists should also be on the look out for animals with the
following presenting signs:
I.
Gastrointestinal Disease. There are many bacterial, viral, and
parasitic causes of vomiting or diarrhea in dogs and cats that are
infectious to other animals or people. All small animals with
vomiting or diarrhea should be considered possible sources of
nosocomial or zoonotic infection (p.20).
II.
Respiratory Disease Any sudden onset respiratory disease with fever,
oculonasal discharges or productive cough, particularly if the animal is
from a crowded environment like a breeding facility, boarding facility, or
humane society. (p.21).
WCVM – Infection Control Manual – SAC
16
III. Multi-resistant bacterial infection. Any animal presenting from a
referring veterinarian with a history of a multi-drug resistant bacterial
infection or bacterial culture and sensitivity results that document
resistance to 3 or more classes of antimicrobial. (p.22)
IV. SPCA cases. Any case brought to WCVM from an animal rescue center
requires special procedures. (p.23)
V. Rabies.
(p.23)
Any unvaccinated animal with unusual neurological signs.
VI. Blastomycosis.
Any case referred to WCVM for treatment of
Blastomycosis or with a suspicion of Blastomycosis (p.23)
VII. Naïve animals. Kittens or puppies under 5 months of age that require
full admission to the hospital as In-patients. (p. 24)
VIII. FeLV,FIV. Any cat known to be positive for either FeLV or FIV should be
identified on the medical record and requires a yellow cage card. (p. 24)
IX. Exotics animals. Many exotic species may require specific protocols.
(p.24)
Reception Policy for Potentially Infectious Cases
I. Whenever possible avoid bringing the animal into reception.
II. Front desk personnel should indicate disease of concern clearly on the
hospital record.
III. If the case is referred for evaluation of acute disease, the student
assigned to the case should meet the client in the parking area (conditions
allowing) to briefly triage the case when possible. If infectious disease is
suspected, the animal should be transported to Small Animal Isolation,
Examination Room 5 (Rm. 1511), or the BNU as indicated. Transport
should preferably be in a carrier placed on a gurney or directly on a
gurney to decrease hospital contamination. The supplies cart should be
removed from Rm. 1511 before the animal enters and the supply tote box
collected from the supply room.
IV. If a patient is presented directly to the reception desk, the receptionist
should contact the receiving service immediately and coordinate
placement of the animal in Examination room 5 to minimize hospital
contamination.
WCVM – Infection Control Manual – SAC
17
V. Treatment and diagnostic areas and hospital equipment, and
personnel clothing should be cleaned and disinfected immediately
after contact with animals with a suspected infectious disease regardless
of contamination. Lab coat or scrubs should be changed and hands
washed immediately after contact with patient with suspected contagious
disease.
VI. If a contagious infectious disease is suspected based on history,
physical examination, and evaluation of previously performed laboratory
work:
a. Close off exam room
b. Place a “Do not use exam room, special disinfection required"
sign (available in all exam rooms).
c. Notify SAC technician of the suspected agent and do not use
the room until a technician has removed the sign and adequate
cleaning/disinfection occurs.
VII. Animals with suspected contagious infectious disease should be treated
as outpatients when possible. If hospitalization is required, transport the
animal to the appropriate housing area (see Small Animal Isolation
Procedures p.42) using a gurney to lessen hospital contamination.
VIII. Immediately clean and disinfect the gurney and any hospital surfaces
or equipment contacted by potentially contaminated patient or persons
(including examination tables and doorknobs). Lab coats and or scrubs
should be changed, Hands should be washed and alcoholic gel used.
3.
INPATIENT SET-UP
A. Client beds, blankets, collar tags and leashes should be returned to the
B.
C.
D.
E.
F.
G.
H.
owner (they get lost, soiled and may become contaminated). Each dog is
given its own leash. Laundry service is not available for client blankets.
Locate a clean cage in the appropriate ward for the patient (feline versus
canine ward).
Prepare a cage card of the appropriate colour with the client/patient
information, student/clinician names, patient diagnosis or major clinical
sign to be placed on the cage immediately upon occupancy.
Place pertinent signs on cage with important information for animal care
attendants, (i.e. “Student Will Feed,” “Blanket at all times,” “Caution—Will
Bite,” etc.)
Provide fresh water, unless otherwise indicated by clinician.
Do not move animals from cage to cage—clean cage/run and return the
patient to the cage/run.
When the patient is discharged, throw cage card into the cage to indicate the
animal is gone.
If an animal is known or suspected to be infectious, place a “DO NOT
USE, SPECIAL CLEANING REQUIRED” sign on the cage, denote known or
suspected infectious agent on a white tape marker.
WCVM – Infection Control Manual – SAC
18
I.
J.
K.
L.
M.
To save a cage for returning day patients, write "Save cage until XXXX" on
the cage-card and note the last date the cage will be used.
Animals will not be fed raw food diets in the VTH unless specific arrangements
are made by the senior clinician responsible for the case.
Dog Walking Policy: Any dog that is healthy or that has an illness that is not
infectious in nature will be walked out side as directed in the medical orders
for the patient and allowed to urinated and defecate in the designated dog
walk area. Note: All feces must be disposed off in the bins provided.
Dogs that have an infectious disease will either not be walked out side (i.e.,
any dog in the isolation ward, or any dog with an MDR bacteria, etc) but will
have to defecate and urinate in is cage. The cage will be cleaned properly
with the person doing so wearing the appropriate personal protective clothing.
Unhealthy SPCA dogs, NEB dogs, dogs released from the nuclear medicine
facility, or dogs with infectious diseases that refuse to defecate inside will be
walked in an area where other healthy dogs are not walked. They should
ideally be carried or transported on a gurny or in a cart to the designated area
and then back into the VTH to their cage to limit unnecessary contamination
of the VTH.
WCVM – Infection Control Manual – SAC
19
GUIDELINES FOR SMALL ANIMAL PATIENTS WITH SUSPECTED CONTAGIOUS
DISEASES
1.
Patients presenting with or at risk of acquiring gastrointestinal infections
(fecal-oral route)
A. Dogs with gastrointestinal signs (anorexia, vomiting, bloody malodorous
diarrhea) from suspected or confirmed parvoviral enteritis or Salmonellosis or
Clostridial colitis should be housed in the Isolation ward. Other causes of
potentially contagious gastrointestinal disease (e.g. Cryptosporidium,
Camplyobacter, histoplasmosis, giardia, exposure to raw food diets) will be
housed in the isolation ward, or the Barrier Nursing Unit depending on the level
of care required (p.42).
B. Cats showing gastrointestinal signs from suspected or confirmed feline
panleukopenia, and Salmonella spp. infections, will be housed in the isolation
ward. Cats with other known causes of infectious gastrointestinal disease
(e.g., Feline coronavirus, toxoplasmosis, etc.) will be hospitalized in the
isolation ward or the Barrier Nursing Unit (p. 42).
C. Receptionists should instruct owners of patients with the above parameters to
leave the animal in the car until the student/clinician/technician has been
contacted. For animals with suspected parvoviral enteritis or panleukopenia a
Parvocite test should be done while the animal is still in the owner’s car prior to
bringing the animal into the hospital. . Animals that do come into the reception
area should be immediately placed in Examination Room 5.
I.
II.
III.
IV.
If clinical signs are noted, as above, the patient should ideally be
transported directly to the isolation area in a carrier or gurney and
hospitalized there (p. 42).
Take patients to the isolation facility by the most direct route which
minimizes exposure of other patients and contamination to the facility,
barrier clothing is required, wrap patient’s body (not the head) within a
green garbage bag to catch diarrhea feces, immediately clean and
disinfect contaminated areas).
If coming from the main small animal wards, or possibly an examination
room mark the cage or exam room with a “DO NOT USE, SPECIAL
CLEANING REQUIRED” sign and note potential or known pathogen on
a white tape marker.
Any major thoroughfare area, examination area, or equipment that is
contaminated with feces or other secretions must be cleaned and
disinfected immediately by attending personnel (Appendix 2).
WCVM – Infection Control Manual – SAC
20
V.
VI.
2.
If the patient requires diagnostics such as endoscopy and/or radiology
on admission, these procedures should be performed at the end of the
day when possible. The attending clinician is responsible for notifying
appropriate staff members of the suspected infectious agent and for
containment (this includes cleaning and disinfection after procedures).
Animals should be transported to radiology with their bodies enclosed in
a plastic bag to minimize contamination.
Special needs cases may be managed in the Barrier Nursing Unit
(p.44) by agreement between the attending clinician and one of the VTH
Section Heads.
Respiratory infection (aerosol spread)
Animals with the following should be housed in Small Animal Isolation Ward:
•
•
•
Feline Upper Respiratory Disease: fever, purulent ocular and/or
nasal discharge, anorexia, oral ulceration and rarely polyarthritis
(calicivirus).
Bordetella/kennel cough pneumonia – cough, anorexia, dehydration,
crackles, history of recent kennelling, etc..
Canine Distemper Virus Infection – ocular or nasal discharge,
coughing/crackles, anorexia, fever, lethargy, hyperkeratosis of nose
or footpads, myoclonus.
A. Receptionists should instruct owners of patients with the above signs or
laboratory abnormalities to leave the animal in their car until contacted by a
staff member.
I.
II.
Patients suspected of having a contagious disease should ideally be
taken directly to the isolation ward or Examination Room 5.
If the patient requires diagnostics such as endoscopy and/or radiology
on admission, these procedures should be performed at the end of the
day when at all possible. The attending clinician is responsible for
notifying appropriate staff members of the suspected infectious agent
and for containment (this includes cleaning and disinfection after
procedures. Endoscopy may be performed with care. The tower should
be draped in plastic and fully disinfected at the end of the procedure.
The endoscope should be cleaned and returned to central supply in a
biohazard bag.
B. If a hospitalized patient develops the clinical signs and laboratory abnormalities
consistent with a contagious respiratory infection, it should ideally be
transported to the isolation ward.
WCVM – Infection Control Manual – SAC
21
I.
II.
3.
If facility contamination should occur, the person transporting the animal
is responsible for immediately cleaning and disinfecting the area.
Mark the patient's stall in the main hospital with a “DO NOT USE,
SPECIAL CLEANING REQUIRED” sign and note potential or known
pathogen on a white tape marker.
Multiple drug-resistant infections
By definition multi-drug resistant infections can only be diagnosed by
microbiological culture and sensitivity testing. They are defined as bacterial
isolates resistant to 3 or more classes of antimicrobial. Clinical signs that may
be suggestive of a multi-drug resistant infection include any of the following
despite being currently treated with an appropriate antibiotic:
Concurrent antimicrobial therapy with:
• Fever
• Wound dehiscence
• Purulent discharge from surgical site
• Infection of cavity surgically explored (e.g., septic joint, septic
peritonitis, etc.)
• Elevated white blood cell count
In all suspected cases, bacterial culture and sensitivity is required.
A. These patients should be housed and managed in the Isolation Ward or the
Barrier Nursing Unit (p.42).
B. Should the senior clinician consider the use of imipenem, vancomycin or
fluoroquinolones for an in-patient approval should be obtained from the ICC.
C. If the patient requires diagnostics such as endoscopy and/or radiology these
procedures should be performed at the end of the day when at all possible.
The attending clinician is responsible for notifying appropriate staff members of
the suspected infectious agent and for containment (this includes cleaning and
disinfection after procedures. Endoscopy may be performed with care. The
tower should be draped in plastic and fully disinfected at the end of the
procedure.
The endoscope should be returned to central supply in a
biohazard bag.
D. If a hospitalized patient develops a MDR in the VTH it should be moved to the
Barrier Nursing Unit or Isolation ward.
I. If facility contamination should occur, the person transporting the animal
is responsible for immediately cleaning and disinfecting the area.
II. Mark the patient's stall in the main hospital with a “DO NOT USE,
SPECIAL CLEANING REQUIRED” sign and note potential or known
pathogen on a white tape marker.
WCVM – Infection Control Manual – SAC
22
III.
4.
All personnel handling the animal should be extra diligent in ensuring
handwashing and BNU protocols are followed to minimize potential for
contamination of other patients
SPCA cases for NEBs and Teaching
A. SPCA cases should be taken immediately to E ward.
B. Cases should be managed in E ward when ever possible.
C. If the animals require surgery they should be pre-medicated in the ward and
moved directly to the induction area.
D. After recovery from anesthesia animals should be returned immediately to E
ward.
5.
Rabies:
Animals suspected of having rabies should ideally be admitted to the isolation
ward with signs to designate them as a “Rabies Suspect;”. All personnel
working with these animals must have been vaccinated for rabies (see Rabies
Control Procedures, Appendix 3). If Rabies is strongly suspected then the
number of personnel handling the animal must be MINIMIZED and owners
should be strongly encouraged to euthanize these patients if they have
neurological clinical signs and questionable or unknown vaccination status.
6.
Blastomycosis
Dog with blastomycosis who do not have a fistulating wound will be treated
like other patients. These dogs typically have respiratory signs only, but
some also have generalized disease including lymphadenopathy. Regardless
unless they have a fistulating wound they are not considered contagious as
the fungus is in the noncontagious yeast stage.
For dogs diagnosed with or suspected to have blastomycosis that have a
fistulating wound they will be treated as an infectious disease patient and
housed in either ICU or the barrier nursing ward depending on the level of
care needed. The site of the fistulating wound will remain bandaged while in
the hospital and any bandage material removed from the wound will be
disposed off in a biohazardous waste bucket. Any VTH personal handling
these patients will be required to wear personal protective equipement
(gloves, gown and N95 mask). The patient will not be walked outdoors and
the number of personal involved in the care of the patient will be minimized.
WCVM – Infection Control Manual – SAC
23
7.
Naïve animals
Defined as a puppy or kitten under 5 months of age. Whenever possible
these animals will be treated as outpatients to minimize their risk of exposure
to contracting an infectious disease within the VTH.
If hospitalization is required then the following arrangements will apply:
Naive kittens, not on IV fluids or requiring involved treatments, will be housed
within a dog ward.
Naive puppies, not on IV fluids or requiring involved treatments, will be
housed within a cat ward.
Alternatively naive puppies and kittens that require IV fluid therapy or that
require extensive treatment and close monitoring will be housed within the
ICU with precautionary barrier nursing instituted as needed.
8.
FeLV, FIV. The cage card should be yellow and marked with the disease of
note. Hands should be washed after handling these animals and standard
precautions used to ensure there is no spread of infection.
Exotics and wildlife
Working with exotic species and wildlife results in a number of specific
biohazards that may be encountered; all personnel working with these
species should familiarize themselves with the SOPs in this section and
ensure that they are enforced.
Exotic pets
Reptiles
A large proportion of reptiles excrete Salmonella on an intermittent basis. All
reptiles should be considered potential carriers. All reptiles must be kept
within their transit container at all times unless being examined or treated.
Personnel working with reptiles should use barrier precautions. Hands must
be washed after handling reptiles and all contaminated areas thoroughly
cleaned and disinfected with Peroxigard 1:16 (See appendix 2).
Constricting snakes – are not treated at WCVM –VTH
Venomous snakes - are not treated at WCVM –VTH (an exception may be
made if the handler can produce documentary evidence of a certified handling
course).
WCVM – Infection Control Manual – SAC
24
Primates
Due to the potential biohazards primates are not treated at WCVM-VTH.
Exceptions can be made by the exotics specialist for animals from licensed
facilities which have complete health certification e.g. Forestry Farm Zoo.
Spiders
All exotic spider species presenting to the WCVM-VTH must remain in an
appropriate carrier at all times unless being examined or treated.
Venomous spiders - - are not treated at WCVM –VTH
Avian Species
All birds presenting to the WCVM-VTH must remain in an appropriate carrier
at all times unless being examined or treated.
Parrot species (Parrots, Budgies and Cockatiels) – may be carriers of
Chlamydiophilla psittici an important zoonosis. Typical clinical signs include
respiratory disease (nasal and ocular discharge) and green coloured feces.
All Chlamydiophilla suspects must be immediately moved to Exam Room 5.
Personnel examining these animals must wear separate lab coats, wears
gloves and a N95 mask.
All PPE must be disposed of as biohazard waste and the lab coats returned
to central supply in water soluble bags placed in a biohazard bag.
Mark the exam room with a “DO NOT USE, SPECIAL CLEANING REQUIRED”
sign and note potential or known pathogen on a white tape marker.
These animals cannot be admitted to the VTH for treatment
The names of all personnel having contact with the patient must be recorded
on the hospital record.
In event of a positive isolation; exposed individuals will be informed to contact
their medical practioners if they develop signs of respiratory disease.
Rodents
All rodents presenting to the WCVM-VTH must remain in an appropriate
carrier at all times unless being examined or treated.
WCVM – Infection Control Manual – SAC
25
There is a small risk that rodents (esp. hamsters) may be carriers of
Lymphocytic choriomeningitis virus LCMV. The risk of transmission to
humans is extremely small.
Precautions to minimize the risk include:
Wash hands after handling rodents.
Wear gloves if there are open wounds on your hands.
Do not kiss rodents.
Clean and disinfect all areas that have been in direct contact with rodents
(Appendix 2)
Wildlife
Bats
As a general rule bats are not treated at WCVM-VTH
If an otherwise healthy bat is presented to the clinic and there is no history of
anyone being bitten the animal may be referred for rehabilitation. Bats must
be maintained in a closed container at all times when not being examined or
treated.
Only rabies vaccinated personnel may handle bats and they must wear latex
gloves under leather gloves when handling bats.
If the bat dies or is euthanized it must be submitted to CCWHC for a full
necropsy.
If anyone is bitten by the bat contact the University Biosafety Manager and
their supervisor (Appendix 3).
Wildbirds
Pigeons, cormorants and gulls are not to be admitted to WCVM-VTH due to
concerns with Newcastle disease.
Many species of wildbird may be carriers of viral encephalitidies.
diseases are not directly transmissible to humans without vectors.
These
All birds must be treated on arrival with a topical ectoparasiticide.
Special care should be taken to avoid needle stick injuries.
Avian Influenza – any waterfowl presenting with signs of respiratory disease
should be considered potentially infected with avian influenza.
WCVM – Infection Control Manual – SAC
26
All AI suspects must be immediately moved to Exam Room 5. Personnel
examining these animals must wear separate lab coats, wears gloves and a
N95 mask.
All PPE must be disposed of as biohazard waste and the lab coats returned
to central supply in water soluble bags placed in a biohazard bag.
Animals must be immediately euthanized and submitted for necropsy.
Mark the exam room with a “DO NOT USE, SPECIAL CLEANING
REQUIRED” sign and note potential or known pathogen on a white tape
marker.
Wild mammals
All wild mammals must be treated on arrival with a topical ectoparasiticide.
Adult racoons, skunks, foxes and Coyotes will not be treated at WCVM-VTH.
Abandoned orphans of these species will be seen and immediately referred
for rehabilitation. If anyone is bitten by these animals they must be
euthanized and considered a rabies suspect
(Appendix 3). Note racoons may carry Baylisascaris a type of roundworm
that can cause visceral laval migrans. Avoid contact with racoon feces, wash
hands thoroughly and clean and disinfect contaminated areas.
Wild rodents may carry a number of important zoonotic diseases. Removal of
ectoparasites minimizes the risk of plague and tularaemia (from rabbits).
Small rodents may also carry LCMV(see pet rodents) and deer mice and
other rodents may carry Hanta virus. Precautions similar to those for LCMV
should be used when handling all wild rodents.
WCVM – Infection Control Manual – SAC
27
Small Animal Surgery Protocols (see Appendix 3 )
VETERINARY TEACHING HOSPITAL SURGICAL DRESS CODE
•
Green scrubs MUST be worn in the surgical area.
•
All hair/beards must be covered with a cap or a hood and beard cover in the
surgery area. Cloth caps can be worn only if all hair is covered.
•
Jewelry/rings are NOT to be worn in surgery. Earrings MUST be covered
with a cap.
•
ONLY designated, close toed shoes are to be worn in the surgery areas.
•
Boot covers MUST be worn over ANY other foot wear when entering the
surgical area and removed when exiting.
ANY foot wear worn outside of the Small Animal surgical area is NOT
considered designated foot wear, and the boot cover rule applies.
•
In surgical areas where supplies are opened and/or a patient is prepped,
caps, masks, and hospital issue greens MUST be worn.
•
Caps, masks, and green scrubs MUST be worn for any procedures preformed
in the induction area with an open wound or incision.
•
Lab coats MUST be worn and properly secured outside of the surgical area,
e.g. anesthesia and ICU.
•
Hospital issue greens MUST be changed daily or each and every time you
are mistakenly outside the surgical area without a lab coat, or if you become
contaminated. Also if working on animals with open wounds.
•
If you need to leave the surgical area briefly to access your office or get
something to eat you may wear a clean blue lab coat over your surgical
scrubs. You must not contact animals wearing this coat or you will have to
change your scrubs on returning to the OR and launder the blue coat.
WCVM – Infection Control Manual – SAC
28
Small Animal Preps
Animals that are exceptionally dirty should be bathed the day before surgery
Surgical sites should not be clipped before the induction of anesthesia as this
results in increased postsurgical infection rates
(note: Most ocular procedures should not be clipped).
1.
Clips
A. A warm up jacket or lab coat will be worn when clipping an animal.
B. Clip a minimum of 3" on all sides of the proposed incision site. With long
haired animals make sure the hair will not be falling onto the surgical site.
C. Hold clippers so head lies flat on the patient’s skin. Clean and oil clippers
between patients. Always check that the clippers are not burning the patient.
40 blade against grain for final clip
D. Dirty surgical sites should have a preliminary scrub (until the sponge is clean)
before being moved into the surgical suite.
2.
Prep (in the theatre)
A. Wash the operative area from the incision site outward. Use 3 x 3 gauze
sponges soaked with tap water and Germ-stat 4% (ocular procedures 1:25
Betadine). The scrub should be performed by moving the sponges in a
circular motion, starting at the proposed incision site, and working to the
periphery of the area; when the non-clipped skin has been reached, the
sponges are discarded. The scrub is repeated a minimum of three times
(with a minimum contact time of 3 minutes) but it is repeated as many times
as needed to cleanse the area (until the sponge is still clean). Caution should
be used when using the 3 x 3 sponges so as not to traumatize the skin
excessively. NOTE: one works from incision site out and dispose of the
sponges, then use a new one. When the area is cleaned, spray the area
with alcohol from the inside out. . The alcohol must be allowed to air dry
before the area is considered surgically clean. Require a minimum of 3
minutes of contact time but continue until the sponge is not visibly dirty. This
has been preformed in the surgical theatre with the tech or scrubbing person
wearing gloves and using sterile technique
NOTE: Do not limit yourself to a too small of a prep area. Animals requiring
additional clips should be returned to the induction area for clipping.
This should not under most circumstances be performed in surgery.
The patient’s skin is now surgically clean, not sterile.
WCVM – Infection Control Manual – SAC
29
Small animal patients with suspect contagious disease or those housed in
Isolation.
A. Clinician MUST alert anesthesia and surgical staff of the animal’s status on
the surgery/anesthesia request form.
B. The animal should be premedicated in its own cage/kennel if the infectious
disease is contagious.
C. Transport to anesthesia preparation room should occur just prior to induction. A
gurney or transport cage/carrier should be used to minimize hospital
contamination. When possible the animal should be induced on the gurney for
immediate transport into surgery. Barrier precautions should be instituted.
D. A remote induction and prep table should be used if the transport gurney itself
does not suffice.
E. Surgery should be performed in Operating room B. Every attempt shall be
made to gather all items necessary for the surgery ahead of time and a
circulating nurse should remain outside the theatre to obtain unplanned for
items. Shoe covers should be worn and removed at the door. Barriers
soaked in disinfectant shall be placed at the door. All contaminated linen,
scrubs are placed in the appropriate contaminated case routine bags and
sealed before transport to CSR. Contaminated instruments and reusable
equipment is placed within appropriate contaminated case routine bag and
sealed before transport to CSR. Large equipment is cleaned and disinfected.
F. If possible, all infectious animals should be operated on as the LAST case of
the day.
G. All items used in a contaminated surgery shall be sorted as to whether they
are reusable or disposable, use disposable items if at all possible.
Instruments, linens, and waste are to be handled according to biohazard
protocols.
Reusable items that cannot be sterilized must be thoroughly
cleaned with Peroxigard 1:16 before leaving the surgical suite, and should
remain out of circulation for 24 hours.
H. SCRUB SUITS shall be changed immediately following the surgery and
placed in dissolvable laundry bags, placed in a sealed and labeled biohazard
bag, then taken to CSR for cleaning. Wrap very wet linens in the middle of
dry ones, double bag in a dissolvable laundry bag, then place in a labeled,
sealed biohazard bag. Disposable gowns, caps, masks, and boot covers
should be worn during the procedure and disposed of as waste in the
biohazard containers which are then immediately sealed and removed from
the area..
I. The surgery suite shall be thoroughly cleaned with 1:16 Peroxigard solution,
and then left vacant the remainder of the day. The room is cleaned and
disinfected and left with a contaminated case – special cleaning sign with
potential pathogen clearly marked on the sign. The room is closed until
permission is obtained from the surgery nurse. (Usually room is recleaned in
the morning using normal protocol)
WCVM – Infection Control Manual – SAC
30
J. Patients with contagious infectious diseases shall recover from anesthesia in
Isolation or designated area when possible.
K. All of the above procedures will also apply to animals with infectious
diseases that require endoscopy.
WCVM – Infection Control Manual – SAC
31
Dental Procedures
1.
2.
3.
All dental procedures should be performed in the Dental Suite (Rm. 1513 )
Most dental procedures result in significant aerosol production, all personnel
present in the room should wear masks
The door to the room must be kept closed to prevent contamination of the
corridor during procedures.
WCVM – Infection Control Manual – SAC
32
Biosafety for Small Animal Anaesthesia (SOP)
1.
General Standard Procedures as per hospital policy
A. Wash hands between patients
B. All injections to be given in an aseptic manner, alcohol swab the injection port
prior to injection or alcohol the skin over the venipuncture site well before
injection.
C. Sharps to be discarded in designated sharps bins which are not over-full
D. Glass vials to be discarded in designated glass bins
E. Bloodied waste to be discarded in biohazard bags, not regular garbage
2.
IV and arterial catheter placement in anesthesia and ICU
IV and arterial catheters are placed after standard aseptic technique
A. Clip a wide area of fur over the vein to allow visualization and prevent any
catheter contamination. If the animal is very furry, do a circumferential clip
around the limb to decrease skin contamination and allow easier removal of
the tape when the catheter is removed.
B. Wash hands thoroughly for all cases (electives and non-electives prior to
catheter placement. If the animal is immunosuppressed, try to wear sterile
gloves to place the IV or arterial catheter.
i. For all cases (electives and non-electives): perform at least 3
scrubs with 0.5% chlorhexidine until clean
ii. Wipe the site clean with an individual use Betadine Swab
C. Clean the catheter site with alcohol soaked gauze squares, being careful to
use single lengthwise strokes over the vein or artery.
D. Do not palpate the vein or artery again after thorough cleaning of the site.
Use a 4X4 gauze square opened in half over the most distal portion of the
limb to cover the fur and to avoid dragging the catheter through any of the fur
that was not clipped and cleaned.
E. Where possible, keep the catheter guard in place to prevent blood loss
F. Place the IV cap on immediately, When possible, immediately connect to IV
extension set to avoid multiple disconnection and reconnections with injection
caps or catheter guards
G. Avoid replacing a stylet into catheter in case the end becomes sheared off
and possibly enters the circulation
H. Clean all the blood away from the area under the hub of the catheter and at
the insertion site. The blood acts as a nidus for infection at the insertion site of
the catheter.
I. Apply Betadine ointment at the insertion site of the catheter and the skin.
Cover the insertion site with a band-aid after you have secured the catheter
with one narrow strip of tape.
J. Finish taping the catheter securely to avoid migration of catheter out of vein or
artery.
WCVM – Infection Control Manual – SAC
33
K. A light dressing can be placed over the catheter site, without obstructing
access to the catheter
L. A light dressing (gauze and vetwrap) that acts as a pressure bandage should
be placed over the catheter site after removal or during any attempts at
catheter placement that were unsuccessful. Try to avoid putting bare fingers
over the insertion site or previous venipuncture sites.
M. Avoid using the thumb to prevent haemotoma formation
N. This same technique should be used for IV and arterial catheters the only
difference is that if the finger is used to locate and palpate the artery, an
alcohol soaked gauze should be used again to clean the site before catheter
placement.
O. All gel tubes found without secure tops are to be discarded (Muko/Tear Lube)
P. At end of day wash all heating mat covers with warm soapy water, spray with
Peroxigard at end of day and hang up to dry
Q. Treat as for induction table between patients on same day
R. Clean warm water circulating unit hoses and Bair-Hugger hoses with
Peroxigard at end of day and between patients if dirty (or patient
contaminated)
3.
Anaesthesia Protocol for Regular Patients
A. Patients should be brought to the induction area with their own leash and
medical records file
B. Patients are placed into a clean cage and a cage card completed
C. All labeled premedication drugs to be given in aseptic manner
i. Alcohol wipes not required for SC or IM injections
D. Premedication sign to be attached to cage after drugs are administered
E. Patient brought to cleaned induction table
F. Catheter placed as above
G. All anaesthetic drugs to be adequately labeled and needles must not be
contaminated
H. Endotracheal tubes to be kept clean and the distal ends placed on a dry
paper towel, not the induction table or countertop
I. Clean lubricating gel used for tubes and esophageal stethoscopes
J. Patient recovered in own anesthesia cage, cleaned ICU cage, or for
aggressive dogs use own ward kennel, and observed
4.
Anaesthesia Protocol for Infectious Patients
Clinician MUST alert anesthesia staff of the status of the animal on the
anesthesia request form and in person well in advance of a procedure.
A. Only required and experienced personnel should handle these patients.
Disposable gowns, gloves, caps, and masks should be worn.
B. Use disposable items when possible (Bains circuits). Dispose of these items
in a biohazard bag, seal, place in a biohazard bin (tan bin, grey/yellow bin),
WCVM – Infection Control Manual – SAC
34
label with a VTH small animal label, a hydroclave label and an infectious
waste label, send for incineration.
C. Non-disposable items MUST be washed down with warm soapy water,
rinsed, dried, sprayed with Peroxigard, and left to dry. These items should be
left unused for 24 hours and sprayed down with Peroxigard once more, and
used the following day (at least 12 hours time lapse).
D. The gurney assigned to the patient MUST only be used to transport the
patient. This gurney should also be used as the induction table. Thoroughly
clean the gurney after use using Peroxigard. Avoid using the blue mattress for
these patients as the mattress is hard to clean.
E. Recovery after anesthesia shall occur in the patient’s cage.
GENERAL CLEANING
1.
Endotracheal Tubes, Breathing Circuits, Oesophageal Stethoscope
Distal-Ends, Rebreathing Bags, Monitoring Probes
A. Thoroughly clean in warm soapy water, using clean tube brushes to remove
organic material before it dries
B. Soak in 0.5% chlorhexidine for at least 15 minutes and thoroughly rinse and
dry without dripping onto work surfaces and other equipment
C. Thoroughly clean Doppler probe ends and pulse oximeter probes in warm
soapy water and leave to dry. Do not detach Doppler probes from unit, but do
not let units come into contact with water.
D. Spray probes with Peroxigard if patient is contaminated or probe used on
contaminated part of body e.g. rectum.
2.
Anaesthetic Machines, Ventilators and IV Poles
A. Dismantle one-way valves and thoroughly clean in warm soapy water, dry
and replace
B. Replenish CO2 absorber and clean seals, and remove any debris
C. Clean any soiled areas with warm soapy water and spray with Peroxigard
D. Spray wheels with Peroxigard at end of day
E. Ventilators should be thoroughly cleaned every 2 months by a technician, and
after use on a contaminated patient
3.
Anaesthesia Kennels
A. Clean all surfaces with Sunlight detergent & hot water solution include
walls,floors, and ALL kennel surfaces
B. Including cage bars & ceiling thorough cleaning is required to remove
surface dirt and to prevent inactivation of the disinfectant
C. Rinse thoroughly with clean, clear water
D. Spray all surfaces with PEROXIGARD 1:16 solution
WCVM – Infection Control Manual – SAC
35
E. Peroxigard solution is prepared in MM (Pharmacy ) at a dilution of 1:16 for
general disinfection and dispensed in 1 L (liter) spray bottles
F. Let stand 30 seconds - rinsing NOT needed.
G. READY FOR USE
4.
Anaesthesia Induction Tables
A. Cleaning - spray all surfaces with Peroxigard 1:16
B. Peroxigard solution is prepared in MM (Pharmacy ) at a dilution of 1:16 for
general disinfection and dispensed in 1 L (liter) spray bottles
C. Wipe down with paper towels
D. Re-spray all surfaces with Peroxigard 1:16
E. Let stand 30 seconds - rinsing NOT needed
F. READY FOR USE
WCVM – Infection Control Manual – SAC
36
Radiology Biosecurity SOP
1.
A.
B.
C.
D.
ROUTINE PATIENTS
Radiology staff should dress in accordance with the SAC dress code.
Radiology staff should wash their hands between patients.
Equipment that has contacted the patients e.g. table tops, wedge supports, lead
gloves, aprons etc. should be cleaned with Peroxigard between patients.
Food and drink is allowed in the film reading area only
2. HIGH RISK INFECTIOUS PATIENTS
A. Radiological procedures or examinations should not be performed on animals
with suspected infectious diseases unless required and, when possible,
scheduled at the end of the day.
B. It is the primary clinician's responsibility to notify Radiology and to state
procedures to be used to prevent spread of infection for animals with
potential infectious diseases (particularly respiratory, gastrointestinal, and
multi-drug resistant bacterial infections). Risk should clearly be marked on
request form.
C. It is the responsibility of the primary clinician to coordinate transport of
the animal to Radiology and indicate barrier clothing (gowns, gloves) and
procedures to be followed. A representative of the service should be
present to ensure all procedures are followed.
D. TRANSPORTATION: Only one assigned gurney shall be used by the patient
from the time it is admitted until discharge. Coordinate transportation with the
clinician, student or technician in charge of the case. The patient should be
isolated from other patients and is NOT to be placed in holding kennels.
E. Lead gloves with disposable covers (e.g. bags should be used).
F. The facility and equipment must be cleaned and disinfected immediately after
use. Radiology staff will supervise cleaning and disinfection of radiology
equipment.
G. Contaminated outerwear should be placed in water-soluble bags, marked with
the suspected infectious disease agent, and returned to Central Supply for
laundering.
H. All individuals contacting the animal must wash hands carefully when the
procedure is complete. Lab coats and/or scrubs should be changed as soon as
possible.
I. Following radiographic evaluation of cases with known or suspected infectious
respiratory disease, enteric viral or bacterial gastrointestinal disease, or
MDR bacterial infection the radiograph exam room should be closed and a “do
not use” sign placed for special disinfection.
WCVM – Infection Control Manual – SAC
37
3.
RADIOLOGY ROOMS AND EQUIPMENT
A. When possible the back room should be used for high risk patients.
B. Table surfaces where the animal has been MUST be immediately cleaned
and disinfected. Spray with 1:16 peroxigard, wipe down and let dry. If
possible do not use the table until the following day and spray down once
more before leaving for the night. Leave a sign stating that the area is
contaminated so it is not used after hours.
C. Spray or mop floor with Peroxigard disinfectant when contaminated, allow to
stand for 10 minutes.
D. Disposable items are to be placed in a biohazard bag or in double bagged
garbage bags, placed in a biohazard container (grey/yellow or a tan bin),
sealed, labeled with a VTH small animal label, a hydroclave label, and an
infectious waste label. The biohazard bin can then be sent for incineration.
WCVM – Infection Control Manual – SAC
38
Pharmacy: Biosecurity Policies to Prevent the Transfer of Infectious
Diseases
1.
SMALL ANIMAL – As a general rule, medications should not be removed from
the pharmacy Instead drugs should be used from the carts in the Small Animal
Treatment Room. It is recognized that in emergency situations it may be
necessary to remove sedative drugs or euthanasia solutions. Care should be
taken to ensure that the containers are as clean as possible. Should they
become contaminated, they should be wiped down with Peroxigard:
2.
Discontinued or unneeded medications should be returned to the Pharmacy for
appropriate disposal (Appendix 6)
WCVM – Infection Control Manual – SAC
39
Central Supply: Biosecurity Policies to Prevent the Transfer of
Infectious Diseases
1.
Contaminated linens from cases with infectious diseases will be sealed in a
Water-Soluble Bag labelled and transported to Central Supply in a Biohazard
bag. Wet linens should be wrapped inside dry linens. The agent of
contamination should be identified on the bagged materials. Important – do not
fill bags more than 2/3s full as they will not fit in the washing machine.
2.
Contaminated instruments/equipment must be cleaned and disinfected with
Peroxigard solution, placed in a Biohazard plastic bag, labelled with the
contents and with the contaminating agent, and transported to Central Supply.
3.
When tying the laundry bags and garbage bags closed try to get as much air
out as possible without expelling a gust of air into the environment
WCVM – Infection Control Manual – SAC
40
Small Animal Isolation
1.
2.
SMALL ANIMAL ISOLATION FACILITIES
A. The Small Animal Isolation facility is the area used for the hospitalization of the
majority of the infectious disease cases.
B. Selected small animal isolation patients requiring intensive care can be housed
in the Barrier Nursing Unit if they require intensive medical management or are
in a severely immunocompromized state. This unit can only be activated with
the permission of a section head
C. Cases with proven Salmonella infection, suspected rabies virus infection and
clinical signs of rabies, or infectious respiratory tract disease must always be
housed in the Small Animal Isolation facility. Dogs with confirmed or strongly
suspected parvoviral or distemper infections and cats with upper respiratory
infections or panleukopenia MUST be housed in the Isolation Ward.
D. Animals suffering from multi-drug resistant infections should be housed in
isolation.
E. Diagnostic procedures or treatments, which can only be performed in the main
hospital, should be performed at the end of the day to minimize exposure of
other patients, ancillary personnel, and the facility to contamination (see
Radiology p. 37, Surgery SOP p.28). The clinician in charge of the case is
responsible for warning other sections of the risk the hazard and ensuring that
protocols are in place and followed during the procedure. Note: many
procedures can be performed in isolation (p.42).
F. Small Animal patients admitted or transferred to isolation will not be returned to
the main wards.
Other recommendations
A. All patients housed in general wards with multiple-drug resistant bacterial
infections should be moved to a designated isolation area or discharged
immediately, following approval by the senior clinician.
WCVM – Infection Control Manual – SAC
41
SMALL ANIMAL ISOLATION PROCEDURES (RM 1503)
A. In the anteroom area the required masks, gloves, plastic boot covers and
gowns to be worn when working on patients within the isolation ward!
Gowns and gloves should be changed between patients. Staff should
double glove.
B. Plastic boot covers must be removed prior to exiting the isolation ward and a
foot bath used before you exit the anteroom off the isolation ward.
C. Thermometer and stethoscope are stored in the isolation ward. Wipe the
stethoscope down with 70% isopropyl alcohol after use; especially if using on
more than one isolation patient. Use thermometer covers provided and
ensure that any contaminated part of the thermometer is clean with
Peroxigard after use.
D. All persons working in the area are responsible for maintaining the
cleanliness of the facility. AVOID CONTAMINATING the ANTEROOM.
Change footbaths regularly.
E. Students are responsible for feeding patients in Isolation.
F. All users of this room are responsible for maintaining the cleanliness of
the anteroom: clean counter & doorknob. Technicians should change
footbath regularly when isolation is in use.
G. Uncontaminated waste (fluid boxes, etc.) can be disposed of in the garbage
can in the Isolation room.
H. Small Animal Isolation is cleaned after use by technical staff. Staff
should dress according to the protocols already listed. If the animal is
suffering from a level 2 or 3 pathogen all waste material must be placed in
grey biohazardous waste bins and disposed of accordingly.
I. Do not bring equipment from the main hospital into isolation unless absolutely
necessary. Check with the small animal technicians for items that may be
needed. Leave items in the anteroom - do not bring them back into the rest
of the VTH unless required and then only after the equipment has been
appropriately disinfected and cleared by a technician.
J. Do NOT return medications/fluids from Isolation to the Pharmacy.
K. How to use Peroxigard
L. Use 1:16 dilution at all times in Isolation for routine disinfection
M. Footbaths, use 1:16 Peroxigard—change footbaths at least twice daily and
when needed!
N. Extra disinfectant is always available from Pharmacy
O. Samples for ClinPath should be correctly labelled with case #, client name,
date, (& time of collection for fecal samples), then placed in a ziplock bag
and marked with a red dot.
P. Food and beverages are absolutely prohibited as is chewing gum.
WCVM – Infection Control Manual – SAC
42
Q. When leaving Isolation:
•
•
•
•
•
•
Remove outer pair of gloves prior to leaving isolation ward
Remove plastic boot covers
Remove Isolation gown
Remove second pair of gloves
WASH HANDS before leaving the Isolation facility in the sink
within the anteroom, washing them for at least 30 seconds
using antibacterial soap, then use alcohol gel.
Dip footwear in footbath prior to leaving the Isolation
anteroom
Procedure for preparing Isolation for a patient:
1.
Find a clean appropriately sized cage (use the disposable incontinence
pads for bedding unless otherwise instructed). Ensure that a cage card
with the patients hospital ID information is on the front of the cage with
the suspected or confirmed infectious etiology clearly visible and
legible. Isolation boot covers, protective outer gown, and gloves are
required).
•
Feed if appropriate and provide water if appropriate
•
Make sure anteroom is stocked
•
Set up footbath with 1:16 Peroxigard
•
Animals, should exit the VTH through the exit door right beside
the entrance to the isolation ward NOT through the main
enterance.
2.
Waste. All waste material generated in the Isolation ward should be disposed
of in the grey Biohazard Bins. These bins should be sealed when 2/3s full,
sprayed down with Peroxigard 1:16 and then removed to the waste storage
facility. Linens should be placed in a water soluble bag and then placed in a
biohazard bag before returning to Central Supply. Any other equipment
should be thoroughly cleaned and placed in a biohazard bag before returning
to Central Supply.
3.
Cleaning. The isolation facility should be thoroughly cleaned by the technical
staff after an animal is discharged (See Appendix 2). In certain cases it may
be necessary to perform environmental cultures to ensure that the area can
be re-used.
4.
Animals housed in the Isolation ward cannot be walked outside.
WCVM – Infection Control Manual – SAC
43
Barrier Nursing Unit
The Barrier Nursing Unit exists to fill a need for intensive care of high risk
patients. These patients may have communicable disease or be in a severely
immunocompromized state, consequently it is inappropriate to house these
animals in either isolation or the ICU. The Barrier Nursing Unit is a temporary
unit assigned to Room 1534.
The Barrier Nursing Unit can only be activated by the permission of a section
head and notification of the Infection Control Committee.
Preparation of the Barrier nursing Unit:
Remove all unnecessary supplies and equipment from the room.
The box containing all the supplies for the BNU is in the equipment room
Place “Barrier Nursing Unit” sign on door.
Lock the door accessing the main corridor
Prepare animal housing.
Ensure room is fully stocked with appropriate PPE.
1.
2.
3.
4.
5.
6.
7.
8.
Masks, gloves, plastic boot covers and gowns to be worn when working
on patients within the BNU. Gowns and gloves should be changed
between patients. Double gloving is required.
Plastic boot covers must be removed prior to exiting the isolation ward and a
foot bath used before you exit the BNU.
Thermometer and stethoscope are stored in the BNU. Wipe the stethoscope
down with 70% isopropyl alcohol after use; especially if using on more than
one BNU patient. Use thermometer covers provided and ensure that any
contaminated part of the thermometer is clean with Peroxigard after use.
All persons working in the area are responsible for maintaining the
cleanliness of the facility. AVOID CONTAMINATING the ANTEROOM.
Change footbaths regularly.
Students are responsible for feeding patients in BNU.
All users of this room are responsible for maintaining the cleanliness of
the BNU: clean counter & doorknob. Technicians should change footbath
regularly when BNU is in use.
Dispose of all waste in the biohazard bin.
Barrier Nursing Unit is cleaned after use by technical staff. Staff should
dress according to the protocols already listed. If the animal is suffering
from a level 2 or 3 pathogen all waste material must be placed in grey
biohazardous waste bins and disposed of accordingly.
WCVM – Infection Control Manual – SAC
44
9.
10.
11.
Do not bring equipment from the main hospital into BNU unless absolutely
necessary. Check with the small animal technicians for items that may be
needed. Leave items in the BNU - do not bring them back into the rest of
the VTH unless required and then only after the equipment has been
appropriately disinfected and cleared by a technician.
Do NOT return medications/fluids from BNU to the Pharmacy.
How to use Peroxigard
•
•
12.
13.
14.
15.
16.
17.
Use 1:16 dilution at all times in Isolation for routine disinfection
Footbaths, use 1:16 Peroxigard—change footbaths at least twice daily
and when needed!
Extra disinfectant is always available from Pharmacy
Samples for ClinPath should be correctly labelled with case #, client name,
date, (& time of collection for fecal samples), then placed in a ziplock bag
and marked with a red dot.
Food and beverages are absolutely prohibited as is chewing gum.
The medical record should be maintained in the ICU
Ensure that all laboratory samples are submitted in Ziplock bags
When leaving BNU:
•
•
•
•
•
•
Remove outer pair of gloves prior to leaving BNU
Remove plastic boot covers
Remove Isolation gown
Remove second pair of gloves
WASH HANDS before leaving the BNU in the sink, washing them for
at least 30 seconds using antibacterial soap, then use alcohol gel
before leaving.
Dip footwear in footbath prior to leaving the Isolation anteroom
18.
Waste. All waste material generated in the Isolation ward should be disposed
of in the grey Biohazard Bins. These bins should be sealed when 2/3s full,
sprayed down with Peroxigard 1:16 and then removed to the waste storage
facility. Linens should be placed in a water soluble bag and then placed in a
biohazard bag before returning to Central Supply. Any other equipment
should be thoroughly cleaned and placed in a biohazard bag before returning
to Central Supply.
19.
Animals housed in the BNU ward cannot be walked outside.
Procedure for Decommissioning the BNU. When the animal has been
discharged the BNU will be fully decommissioned. The unit must be fully
cleaned (see Appendix 2) and all unnecessary equipment removed and
disposed of. The room must then be re-stocked for routine use. Note:
Environment cultures may be necessary before the room can be re-used.
WCVM – Infection Control Manual – SAC
45
Use of ultrasonography, radiography, or the EKG in Small Animal
Isolation / BNU:
A. Personnel from the Radiology section should wear gloves and barrier
clothing.
B. The technician and necessary equipment should only enter the anteroom NOT
the actual isolation ward.
C. After the EKG has been recorded, clean the leads with a sponge soaked in
disinfectant (0.5 % chlorhe70% alcohol), use particular care in cleaning the
clips. Before removing the equipment from the Isolation area, clean any gross
contamination from the wheels and cart, and disinfect the machine with 1:16
Peroxigard.
D. After the examination has been completed, clean and disinfect the U/S probe
with Peroxigard.
E. Before removing the equipment from the Isolation area, clean any gross
contamination from the wheels and body of the cart. Spray the cart and wheels
with Peroxigard.
WCVM – Infection Control Manual – SAC
46
Release of Remains Policy
If a post-mortem examination is conducted in the necropsy room the animal
remains may not be released to the owner. The remains may be collected by a
cremation company and the ashes returned to the owner
A cosmetic necropsy may be performed in the Dirty Surgery/Endoscopy room
(1533) and the remains may be returned to the client.
If a Risk Group 3 pathogen is suspected (see Appendix 1) the carcass must not
be returned to the client. A full necropsy must be performed for public health
reasons.
If a Risk Group 3 pathogen is confirmed the remains must be incinerated.
Ashes will not be available in these circumstances. If the diagnostic tests
are negative the remains may be released for cremation.
WCVM – Infection Control Manual – SAC
47
Client Visitation Policy – Small Animal Clinic
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
All visits to hospitalized patients must be approved by the attending clinician
or their designate (student, house officers). The attending clinician or their
designate must be present when the visit takes place, including visits that
occur outside of regular business hours. Unless approved by the attending
clinician or their designate, visits are limited to 30 minutes.
Visiting Times
Groups of visitors must remain with their group throughout the duration of the
visit. Children under the age of 16 must be accompanied by an adult at all
times. Other family pets, children under the age of 2 and strollers are not
permitted in the hospital area.
Visitors must sign in and out at the front desk when they visit, and must wear
a visitor's badge at all times. They must be escorted to the designated
visiting area, and back to the reception desk by the attending clinician or their
designate. Visitors are not permitted to enter other hospital areas, other than
the designated visiting area. This applies to spontaneous as well as prearranged visits.
Visitors must be accompanied at all times
Whenever possible the animal should be brought to see the visitors in an
examination room.
Attending clinicians will make an effort to meet with the visiting client during
their visit. However, if the visiting client expects to discuss the condition of
their animal(s) with the attending clinician during the visit, he/she needs to
make arrangements in advance.
Visitors must restrict their visit to their own animal(s). They are not allowed to
visit any other ward or hospital area without permission from the attending
clinician.
Visitors must direct any questions concerning the condition of their animal(s)
to the attending clinician or their designate. They must not inquire about the
condition of other hospitalized patients. Students and staff are instructed not
to answer questions about the medical status of patients in the hospital.
Visitors must not touch animals other than their own.
For safety and biosecurity reasons, visitors are not allowed to enter the
isolation ward, the hyperthyroid ward, the wildlife ward or BNU. Visitors
whose animal(s) are housed in these areas may request permission from the
attending clinician to view their animal(s) through the window in the anteroom.
Visitors to the isolation units must follow all instructions given to them by the
attending clinician or their designate.
Visitors must follow all instructions given to them by the attending clinician or
their designate, and may be asked to leave if they fail to do so. Visitors may
be asked to leave the hospital area during procedures performed on their own
pet or another animal(s).
VTH clinicians may, at their discretion, prohibit anyone’s access to the Small
Animal Clinic. Their authority to prohibit access supersedes any other
policies.
WCVM – Infection Control Manual – SAC
48
ICU VISITING POLICY
Monday to Friday:
Saturday – Sunday:
10:00 am
5:00 pm
10:00 am
5:00 pm
–
–
–
–
11:30 am
7:00 pm
11:30 am
7:00 pm
•
All visits to the ICU must to be arranged in advance with the primary
clinician on the case. Clients will not be allowed to drop in for unscheduled
visits.
•
When special visits must be arranged outside of the stated visiting hours,
it is important to avoid the main treatment times: 8-9 am, 4-5pm and 8-9
pm
•
When possible, stable patients should be moved to an examination room
or another area to visit rather than scheduling visits within the ICU.
•
Clients should sign in and out when they visit at the front desk and must
wear a visitor’s tag at all times.
•
Clients MUST use the hand sanitizer on entry and exit from ICU.
•
No more than 3 persons per pet should visit at any one time.
•
Children under the age of 16 must be accompanied by an adult at all
times. Children under the age of 2, strollers and other family pets are not
permitted in the hospital area. Immunocompromised individuals should not
be allowed to visit in the ICU but concessions can be made with respect to
this policy on a case by case basis.
•
In the event of an arrest or the arrival of a life-threatening emergency,
clients will be asked to leave the ICU immediately, but they can visit at a
later time.
•
Unless otherwise approved by the primary clinician, visits are limited to a
maximum of 15 minutes per visit, and visits are limited to once daily.
•
Clinicians or students familiar with the case are responsible for escorting
clients back to the ICU to visit with their pets, and when possible they
should stay with the client during the visit (this applies only to visits within
the ICU).
WCVM – Infection Control Manual – SAC
49
•
Technicians will not provide any medical information or give results to
clients; clients should be advised to direct any questions to the clinician on
the case.
•
Clients who are visiting in the ICU must be escorted back to the reception
are from the ICU and will not allowed to wander in the hospital’s hallways.
WCVM – Infection Control Manual – SAC
50
Appendix 1
Classification of Animal Pathogens encountered with the WCVM-VTH
All animal pathogens are considered Risk Group 2 pathogens by Public
Health Agency of Canada (PHAC) unless listed below.
Risk Group 2 (moderate individual risk, limited community risk). A
pathogen that can cause human or animal disease but, under normal
circumstances, is unlikely to be a serious hazard to laboratory workers, the
community, livestock, or the environment. Laboratory exposures rarely cause
infection leading to serious disease; effective treatment and preventive
measures are available and the risk of spread is limited.
Risk Group 3 (high individual risk, low community risk). A pathogen that
usually causes serious human or animal disease, or which can result in
serious economic consequences but does not ordinarily spread by casual
contact from one individual to another, or that can be treated by antimicrobial
or antiparasitic agents.
The following is the current list of PHAC’s Risk Group 3 Organisms:
Bacteria, Chlamydia, Rickettsia
ORGANISM
Bacillus anthracis
Brucella all species
Burkolderia (Pseudomonas)
mallei; B. pseudomallei
Chlamydia psittaci
avian strains only
Coxiella burnetii
DISEASE
Anthrax (sudden death)
Brucellosis (abortion)
Glanders (horses)
Francisella tularensis, type A
(biovar tularensis)
Mycobacterium tuberculosis; M.
bovis (non BCG strains)
Tularemia (rabbits)
Pasteurella multocida, type B
Hemorrhagic/septicemic from Bison
and Deer
all species
Rickettsia
WCVM – Infection Control Manual – SAC
Psittacosis (Respiratory disease/
green diarrhea in birds)
Q fever (abortion in sheep)
TB
51
Fungi
Moniliaceae
Ajellomyces dermatitidis (Blastomyces dermatitidis)
Blastomycoses – Respiratory disease in dogs (note danger of infection
only from
cuts or bites from clinical case. Cultured specimens are highly
dangerous)
Coccidioides immitis
Ajellomyces capsulatum (Histoplasma capsulatum including var. duboisii)
Paracoccidioides brasiliensis
Viruses
(Arthropod-borne viruses are identified with an asterisk.)
Arenaviridae
Lymphocytic choriomeningitis virus, -Rodents
neurotropic strains
Bunyaviridae
Unclassified Bunyavirus
Hantaan, Korean haemorrhagic fever
and epidemic nephrosis viruses
including virus responsible for
Hantavirus pulmonary syndrome)
Rift Valley fever virus
Murray Valley encephalitis virus
Powassan
West Nile Virus
Herpesviridae
Gamma herpesvirinae
Genus Rhadinovirus:
Herpesvirus ateles;
Herpesvirus saimiri
Retroviridae
Oncovirinae
Genus Oncornavirus C
Human T-cel lleukemia/lymphoma
virus
Genus Oncornavirus D
Mason-Pfizer monkey virus
Viruses from non-human primates
Lentivirinae
Human immunodeficiency viruses
WCVM – Infection Control Manual – SAC
-Rodents
- West Nile (horses and birds)
- Monkeys
-Monkeys
-Monkeys
(HIV - all isolates)
52
Rhabdoviridae
Genus Vesiculovirus
Vesicular Stomatitis Virus
Genus Lyssavirus
Rabies virus
- Vesicular stomatitis (horse)
- Rabies (mammals)
Togaviridae
Genus Alphavirus*
-EEE (horse)
Eastern equine encephalitis virus
Chikungunya
Venezuelan equine encephalitis
-VEE (horse)
Western equine encephalitis
-WEE (horse)
Prion diseases
Chronic infectious neuropathic agents
Bovine Spongiform Encephalopathy
-BSE (Cattle)
Other TSEs require enhanced level 2 procedures
-sheep, deer
None of these diseases are immediately identifiable on admission to the VTH.
Instead clinicians should always be alert to the potential for these diseases.
WCVM – Infection Control Manual – SAC
53
SAC
Exotic species require particular vigilance (see p.24)
Rabies
Presenting signs of importance include – unprovoked aggression
Biting
Lack of vaccination
Bizarre neurological behaviour
Blastomycosis
General clinical signs are fever, anorexia, weight loss, cough, dyspnea, ocular
disease (uveitis), lameness, or skin lesions.
Clinical signs may be present for a few days to weeks or even months.
The yeast form is not transmissible from animals to people or from people to
people.
Open, contaminated wounds can be infectious to other animals and people as
well as contaminated needles that cause accidentally inoculation.
WCVM – Infection Control Manual – SAC
54
LAC
Presenting signs of concern include:
Sudden death in ruminants
Large animal abortion or history of abortion/orchitis (esp. sheep)
Undefined neurological disease in large animals
Pruritis in sheep
Vesicular lesions in the mouths of large animals
All animals suspected of having an infection caused by a Level 3 organism
should be handled with full isolation protocols
Sudden death in ruminants:
Arrange for carcass .
Suspect Anthrax – (unlikely in LAC)
Large animal abortion or history of abortion (esp. sheep)/Orchitis: Suspect
Brucellosis or Q-fever
Animals should be placed in Food Animal Isolation and managed accordingly.
Pregnant females should have no contact whatsoever with such cases.
Undefined neurological disease in Food Animals / Pruritis in sheep: Suspect
Rabies, Prion Diseases.
Place animal in isolation stall and manage accordingly . If animal is
profoundly ataxic and the isolation stall presents a serious risk of injury, the
animal may be placed in the “downer stall” and the end of the Food Animal
Ward cordoned off. The animal must be managed in accordance with Food
Animal Isolation Protocols. Contact CFIA and the University Biosafety Office.
Undefined neurological disease in horses: Suspect Rabies, West Nile, Equine
Viral Encephalitidies.
Place animal in isolation stall and manage accordingly. If the animal is ataxic
and the isolation stall presents a serious risk of injury, the animal may be
placed in the “downer stall” and the end of the Food Animal Ward cordoned
off. The animal must be managed in accordance with Equine Isolation
Protocols. Contact CFIA and University Biosafety Office.
Vesicular lesions in the mouths of large animals:
Suspect Vesicular
Stomatitis (or Foot and Mouth Disease).
Place animal in isolation stall and
manage accordingly. Contact CFIA and University Biosafety Office.
If it becomes necessary, animals suspected of suffering from a level 3
pathogen may be sent to necropsy for examination and disposal. However,
they may not leave the VTH without first contacting Lois Ridgway in the
Necropsy Suite and informing her of the case and the suspected diagnosis.
Animals can only be transported to necropsy with her permission and must be
marked stating the suspected diagnosis.
WCVM – Infection Control Manual – SAC
55
CFIA Reportable diseases
African horse sickness
African swine fever
Anaplasmosis
Anthrax
Bluetongue
Bovine spongiform encephalopathy
Bovine tuberculosis {M. bom)
Brucellosis
Chronic wasting disease of cervids
Contagious bovine pleuropneumonia
Contagious equine metritis
Cysticercosis
Equine infectious anaemia
Equine piroplasmosis (B. equiand
B. caballi)
Foot and mouth disease (FMD)
Fowl typhoid (Salmonella gallinarum)
Highly pathogenic avian influenza
Hog cholera (classical swine fever)
Lumpy skin disease
Newcastle disease
Peste des petits ruminants
Pseudorabies (Aujeszky's disease)
Pullorum disease (S. pullorum)
Rabies
Rift Valley fever
Rinderpest
Scrapie
Sheep and goat pox
Swine vesicular disease
Trichinellosis
Venezuelan equine encephalomyelitis
Vesicular stomatitis
If any of the above diseases are suspected in a clinical case the CFIA 975-4185
should be contacted immediately. Also contact University Biosafety Office.
WCVM – Infection Control Manual – SAC
56
APPENDIX 2 - WCVM - VTH Cleaning and Disinfection Protocol
SMALL ANIMAL
1.
1
Dog / Cat / Anesthesia KENNELS
2
Small Animal Treatment Room
Exam Room
Anesthesia Induction TABLES
3
Small Animal Surgery (between cases) TABLES
4
Isolation Ward
5
Reception / Mop Pails
Dog / Cat / Anesthesia Kennels
A. Clean all surfaces with solution of detergent & hot water
- include walls, floors, and ALL kennel surfaces including cage bars
& ceiling
- thorough cleaning is required to remove surface dirt and to prevent
inactivation of the disinfectant
Rinse thoroughly with clean water
B. Spray all surfaces with PEROXIGARD 1:16 solution
- Peroxigard solution is prepared in MM (Pharmacy ) at a dilution of 1:16
for general disinfection and dispensed in 1 L (litre) spray bottles
C. Let stand 30 seconds - rinsing NOT needed.
READY FOR USE
Use of other disinfectants, such as quaternary ammonium compounds leaves
a non-visible residue on surfaces. Initially, contact with Peroxigard results in
breakdown of these compounds with resulting streaking visible on surfaces.
This streaking will resolve with continued use of Peroxigard as the broken
down compounds are gradually removed with each cleaning.
WCVM – Infection Control Manual – SAC
57
2.
Small Animal Treatment Room / Exam Rooms / Anesthesia Induction
TABLES
A. Cleaning - spray all surfaces with Peroxigard 1:16
Peroxigard solution is prepared in MM (Pharmacy ) at a dilution of 1:16 for
general disinfection and dispensed in 1 L (litre) spray bottles
B. Wipe down with paper towels
C. Re-spray all surfaces with Peroxigard 1:16
D. Let stand 30 seconds - rinsing NOT needed
3.
READY FOR USE
Small Animal Surgery Tables (between cases)
A. Clean all surfaces with solution of detergent & hot water
I. include walls, floors, and ALL kennel surfaces including cage
bars & ceiling
II. thorough cleaning is required to remove surface dirt and to prevent
inactivation of the disinfectant
Rinse thoroughly with clean water
B. Cleaning - spray all surfaces with Peroxigard 1:16
I. Peroxigard solution is prepared in MM (Pharmacy ) at a dilution of 1:16
for general disinfection and dispensed in 1 L (litre) spray bottles
II.
Wipe down with paper towels
III. Re-spray all surfaces with Peroxigard 1:16
IV. Let stand 5 minutes - rinsing NOT needed
4.
READY FOR USE
Isolation Ward
Exactly as above (SA Surgery) with Peroxigard 1:16
WCVM – Infection Control Manual – SAC
58
5.
Reception / Mop Pails
A. Prepare Peroxigard 1:64 Mop Pails by adding 2 pumps Peroxigard
concentrate per 4 L water.
B. Urine spills or fecal contamination should be removed, the area
mopped/cleaned thoroughly with Peroxigard 1:64, then sprayed with
Peroxigard 1:16 and left to stand 30 seconds. Floors may then be wiped
dry if slipping is a concern.
PROTOCOL FOR ROUTINE CLEANING KENNELS
1.
When an animal is sent home the cage card is usually placed inside the
kennel, this indicates that the kennel is no longer in use and needs to be
cleaned.
2.
Remove and throw away all newspaper, food and garbage (used and unused
litter). Blankets are to be placed in laundry hampers, and food dishes are to
be placed in the sink for washing.
3.
A bucket will be provided in each ward for the purpose of washing the
kennels. Make a solution of warm water and detergent (Sunlight, Ivory, or
Dove) in the bucket (concentration). Use a new j-cloth and soapy water
solution for EACH kennel to be cleaned.
4.
Wash kennel floor, walls, ceiling, and door with the warm soapy water
solution.
5.
Rinse and wipe dry with clean rag or paper towels.
6.
Spray kennel floor, walls, ceiling, and door with 1:16 Peroxigard.
7.
Let dry.
8.
Line the kennels in wards with newspaper. The kennels in ICU/Observation
are not to be lined with newspaper.
9.
Kennel is now ready for use.
WCVM – Infection Control Manual – SAC
59
APPENDIX 3 - Surgery Protocols
Surgical Hand Scrub
A five-minute surgical hand scrub must be carried out for all surgical cases.
PROCEDURE PRIOR TO BEGINNING A SURGICAL HAND SCRUB
¾ Be sure fingernails are short and free of nail polish. Remove all watches,
rings and bracelets and tuck in earrings and necklaces.
¾ Adjust O.R. cap to ensure complete hair coverage.
¾ Place clean mask over nose and mouth and tie securely (top tie up on head
and bottom tie around back of neck).
¾ Roll up sleeves well above elbow level and secure loose fitting scrub uniform.
SURGICAL HAND SCRUB
¾ Do a preliminary wash by:
¾ Wet hands and forearms.
¾ Apply soap from dispenser – use a sufficient amount of soap to work up a
good lather from hands.
¾ Rinse hands and arms thoroughly starting at hands making sure that you
do not bump the taps etc. with your hands or arms. Always ensure that
hands remain above elbows so that fluids drain from “clean to dirty”.
¾ Do a surgical hand scrub by:
¾ Open scrub brush. SUDS UP BRUSH WITH LOTS OF WATER. DO
NOT PLACE SCRUB BRUSH ON SOAP DISH OR LEDGE OF SINK.
¾ Clean fingernails under running water with the disposable plastic nail
cleaner supplied with the brush – dispose in garbage or drop into sink.
¾ Get sufficient amount of water on it, to give good lather by squeezing
brush and commence scrubbing.
¾ Scrub fingernails, sides of hand, fingers (and between them), palm and
back of hand. Use a circular motion. Repeat the same procedure for the
other hand. (Take one minute for each hand).
WCVM – Infection Control Manual – SAC
60
¾ Scrub arms with a circular motion. Beginning at the 1st wrist, scrub ½ of
that arm, then move to the 2nd arm and do the same. Continue up the 2nd
arm to 2” above the elbow. When 2nd arm is scrubbed, change back to the
1st arm and finish that arm to 2” above the elbow. (Take one minute for
each arm – thus 30 seconds for each ½ arm.)
¾ Get more soap from the brush into hands and discard brush by dropping
into sink or garbage receptacle.
¾ Rub just your hands together contacting all areas. (Take one minute
for this).
¾ Rinse hands and arms under running water ensuring that the hands
remain above the elbows.
¾ Allow the excess water from hands and arms to drip into the sink keeping
hands above elbow level and ensuring hands and arms are up and out
from scrub clothes.
¾ Dry hands and arms (to the elbow only), gown, and glove as the protocol
of your area dictates.
¾ Obtain more water during the scrub to obtain an adequate sudsing
action.
WCVM – Infection Control Manual – SAC
61
PROTOCOL FOR USE OF STERIGEL
A five minute scrub must been done at some point of the day prior use of
Sterigel. If you leave the surgical area you must rescrub
NOT TO BE USED BY STUDENTS.
Procedure
Wash your hands with soap and water and dry. Apply a liberal amount of
Sterigel to hands and arms, rubbing until dry. Once the Sterigel has dried,
your hands are considered surgically clean... Gown and glove as usual.
Sterigel is not to be dried from hands with a towel prior to gowning.
WCVM – Infection Control Manual – SAC
62
SURGERY SUITE CLEAN-UP BETWEEN CASES
1.
Remove all sharps. Cut needle off any suture material and dispose of sharps
into sharps container.
2.
Separate clean instruments from dirty instruments in all trays with spare huck
towel.
3.
Put all lids on plating sets and screw cage set, separate dirty instruments
from clean with spare huck towel.
Turn nitrogen offon the boom and bleed remaining pressure from the
drill/saw. Return power tool and its
components to appropriate tray,
again seperating dirty from clean with huck towel.
4.
5.
Put all items with red and gray tape or no tape into the clinic tray. In addition,
bulb syringe, light handles,
saline bowl, suction tip, and any other
unused items go into clinic tray.
6.
Separate all other dirty items into trays with corresponding coloured tape,
keeping the clean and dirty
instruments separate with a huck towel.
7.
Suction the remaining saline from bowl into suction bottle. Turn suction off at
wall source. Suction
hose, cautery and cord should be place in the
clinic tray.
8.
Remove suction bottle from wall suction. DO NOT REMOVE LID. THROW
BOTTLE AND CONTENTS INTO SEPARATE BIOHARZARD BIN. MAKE
SURE THERE IS YELLOW BAG
INSIDE THE BIN.
9.
Take all linens to linen hamper and towels to towel hamper in desk room.
10.
Remove all garbage bags put in biohazard bins and replace bags.
11.
Take blue bean bag to desk room beside sink.
12.
If yours is the last surgery of the day, or if blood is on the heating mat, clamp
off the heating mat, turn switch off, disconnect and leave at the desk room
sink.
14.
Remove organic debris prior to cleaning process. Heavily soiled surfaces
should be cleaned twice. Spray all surfaces with Peroxigard 1:16, let sit wet
for 30 seconds and with towel wipe dry. (this will clean and sanitize the
surfaces). Spray the surfaces once again and let sit 5 min (this will disinfect
the surfaces ready for next surgery).
15.
Turn off surgical lights.
WCVM – Infection Control Manual – SAC
63
FINALIZING A THEATRE
1.
Ensure all unused packs, dirty linen, mats, lamp handles, bean bags, sharps
in containers, and instruments are removed.
2.
Pour small amount of premixed Peroxigard 1:16 into cleaning pan found in
desk room by the sink. J-cloths and huck towels are in the cupboard above
the sink.
3.
If heavily soiled surfaces:
i. spray surfaces with peroxigard 1:16, let stand for 30 seconds.
ii. wipe surface dry with towel.
Disinfect table including drip tray and white bucket under the table, mayo
stands, kick buckets, all furniture, lights, doors, and windows
with
Peroxigard 1:16. Use wet J-cloth to wash and huck towel to dry.
4.
Wipe down heating unit and cords(hang cords on IV pole), and cautery units
and cords. Please wipe down radio as well.
5.
Replace garbage bags and suction bottles.
6.
Spot clean blood on floor.
7.
Lower table and mayo stands to lowest position.
8.
Please when putting things away, put them in the right spot.
WCVM – Infection Control Manual – SAC
64
Appendix 4 - W.C.V.M. RABIES IMMUNIZATION POLICY
Purpose
The WCVM Rabies Immunization Policy is designed to ensure that all faculty,
students and staff of the WCVM working with animals and animal tissues have the
opportunity to be protected from exposure to rabies.
Policy
Any faculty, students and staff at the WCVM and PDS staff who are at risk of being
exposed to rabies will be offered immunization against rabies or must accept liability
by signing an appropriate release. Other participants would be expected to abide by
this policy.
Rabies immunization will be available to all WCVM personnel.
Responsibilities
1.
The WCVM’s Rabies Program Coordinator is responsible for the
administration of the program. The University Biosafety Advisory Committee
is responsible to ensure that appropriate medical consultation is provided in
the event of a rabies exposure.
2.
The Dean, Department Heads, the Director of the Veterinary Teaching
Hospital, supervisors of WCVM research animal holding facilities and
research project supervisors are responsible within the area under their
jurisdiction for:
A. Compliance with this policy.
B. Advising all personnel of the hazards of rabies as it applies to their position.
C. Ensuring that all personnel complete the Rabies Vaccination Form indicating
whether or not they wish to be vaccinated against rabies.
D. Notifying the WCVM Rabies Program Coordinator whenever a new
appointee or a person with a change of duties under his/her supervision
requires immunization under this policy.
E. Strongly encouraging persons to be immunized against rabies at the time of
hiring, or at the initiation of a project which may expose the individual to the
disease.
F. Ensures that if a suspect or actual rabies case occurs, that the WCVM
Rabies Program Coordinator receives a list of individuals involved, as soon as
possible. All information regarding rabies exposure shall also be provided to
the University Biosafety Office, as soon as possible.
WCVM – Infection Control Manual – SAC
65
Specific Protocols for dealing with a hospitalized rabies case in the
WCVM - VTH
There are no signs that are specific for rabies in domestic animals but excessive
salivation, drooling, and other neurological signs such as seizures or ataxia may be
suggestive of infection. It is the responsibility of all staff in the VTH to be vigilant for
animals that may be showing signs consistent with a diagnosis of rabies (such as
undefined neurological disease, aggression or dysphagia).
As soon as rabies is suspected in a clinical case the following protocols must be
used.
1.
Move the animal to an isolation stall or room and restrict access. Institute full
isolation protocols. A box of biohazard PPE is available in the pharmacy and
must be used for all further contact with the case (this includes face masks,
gowns and gloves).
2.
Anyone who has handled the case, particularly if they have any wounds on
their hands must immediately wash their hands thoroughly with an
antibacterial soap.
3.
Prepare a list of all people who have had contact with the case since its
arrival at the VTH (it will be necessary to check with all veterinarians,
technical staff, office staff and students to ensure that the list is complete).
Pay particular attention to each person’s level of exposure. Also ensure that
a contact telephone number is provided for each individual. Forms to record
this information may be found in the Biohazard PPE box.
Risk levels of exposure to a rabies case
High risk – bite wounds, oral examination without gloves, passage of a
stomach tube, anyone with an open wound on their hands at the time of
performing a physical examination
Moderate risk – anyone handling the animal directly but not involved in
any of the high risk activities mention above.
Low risk – anyone present around the animal or its pen that did not have
direct contact with the animal.
4.
The case should continue to be managed using full isolation protocols. The
number of people contacting the case must be kept to the absolute minimum.
Anyone involved in the management of the case must have current rabies
vaccine titers and must use the provided PPE.
WCVM – Infection Control Manual – SAC
66
5.
If the clinical signs persist, get worse or the animal is to be euthanized a full
necropsy is required. Before the animal is transported to the necropsy suite
ensure that Lois Ridgway (966-7318) and the “on duty” pathologist are
informed that a necropsy has been requested on a rabies suspect. The
animal can only be transported to necropsy with Lois Ridgeway’s consent.
The necropsy request must clearly state that the animal is a rabies suspect
and the animal must also be tagged as a rabies suspect.
6.
Any area or equipment that has had contact with the case must be disinfected
using 1:16 Peroxigard solution. All waste material that has had contact with
the case must be placed in red biohazard sacks and be disposed of into the
Biomedical Waste Bins, labeled as potentially contaminated by rabies.
Linens may be returned to the laundry in the water soluble biohazard bags,
which should be placed inside a Biohazard bag and labelled.
7.
A copy of the exposure list and a copy of the medical record must be taken to
the VTH office and given to the secretaries. If the client has also been
exposed to rabies this should be documented in the medical record.
The VTH secretaries will ensure that all the information is passed to the VTH
Director and University Biosafety Manager and that a copy of the exposure list is
sent to Liana Kinar (WCVM Rabies Coordinator). All contact with the Public Health
Agency will be through the University Biosafety Manager
WCVM – Infection Control Manual – SAC
67
Appendix 5 - Incident Reporting
The incident report form is now an on-line system:
http://www.usask.ca/dhse/
WCVM – Infection Control Manual – SAC
68
Appendix 6 - Waste disposal
These protocols are based upon the University Of Saskatchewan
“Hazardous
Waste
Disposal
Manual”
available
on-line
at:
http://www.usask.ca/dhse/pdf/Hazardous%20Waste%20Disposal%20Manual.pdf
Bedding:
In the small animal clinic waste bedding material is simply disposed of into the
garbage. Also cat litter.
Medical Waste:
Sharps – needles, scalpels, stylets – All “sharps” must be disposed of in the
designated “sharps” containers. These are to be found in all common areas of
the SAC. It is the responsibility of all persons generating sharp waste to ensure
that it is disposed of appropriately. Everyone should avoid placing used sharps
in their pockets as this is a serious health risk and can result in inappropriate
disposal. Do not recap any needles.
Sharps containers have also been placed in all student locker rooms to ensure
that any sharps accidentally carried back to the locker rooms in pockets can be
disposed of appropriately.
Used syringes – any used syringe must be disposed of in the grey biomedical
waste bin
Used blood vials – when possible the blood should be disposed of by mixing with
bleach and pouring down the sink with copious quantities of water and the vials
disposed of in the grey biomedical waste bins.
Body tissues and fluids
Any waste contaminated with body fluids – (blood) must be disposed of into the
grey biohazardous waste bins. Blood vials should be opened and when possible
the blood should be disposed of by mixing with bleach and pouring down the sink
with copious quantities of water and the vials disposed of in the grey biomedical
waste bins.
Tissues – all animal tissues removed surgically must be bagged and disposed of
by taking them to necropsy for incineration. (Note this applies to all tissues.)
All Biohazard waste must be collected and placed in either a biohazard waste
bag or a black garbage bag and placed in a biohazard bin (red cytotoxic bin, grey
bin with yellow lid, or tan bins). All biohazard bins are kept in the coolers outside
at the end of the breezeway. The first biohazard shed is for used bins and the
second is for clean bins. The keys are kept in a drawer in the treatment room.
WCVM – Infection Control Manual – SAC
69
All garbage/biohazard bags must be tied shut with tiewraps before securing the
lid on any of the biohazard bins. A VTH small animal sticker, an infectious waste
sticker and a hydroclave sticker must be placed on all secured biohazard bins.
The bins are now ready to be taken out to the first biohazard cooler for pick up. If
the outer of the bin is considered contaminated it should be sprayed with
Peroxigard.
Drug vials
Pharmaceuticals – empty vials should be disposed of in the large “sharps
containers”. Note – compounds with the potential to harm human health should
be returned to pharmacy (see list below). All unused or out of date medications
should be disposed of in the medication disposal containers found in pharmacy
Controlled drugs – should be disposed of by returning to pharmacy and the
volume of any discarded product recorded
Vaccines – unused vaccines should always be returned to pharmacy. Empty
vials should be disposed of in the “sharps container”.
WCVM – Infection Control Manual – SAC
70
PROTOCOL FOR DISPOSAL OF USED CONTAINERS IN
PHARMACY
1.
All vials or bottles containing liquid that require discarding should be placed in
plastic container by sink at back of pharmacy.
2.
Refer to MSDS sheets if not familiar with a product.
3.
Wear appropriate PPE (Nitrile gloves, eye protection, suitable lab coat)
4.
Open each vial or bottle using pliers if necessary to remove aluminum seal,
and empty remaining liquid in 10L collection container.
5.
Rinse container three times with tap water and add rinsate to 10L collection
container.
6.
Seals and lids may be disposed of in regular garbage.
7.
Rinsed glass containers should be disposed of in glass disposal container at
back of pharmacy.
8.
Rinsed plastic containers may be disposed of in regular garbage.
9.
Any used containers (including used test tubes) contaminated with animal
tissue (blood etc) should be disposed of in 3L sharps containers or 10L
container for large quantities labeled as biohazardous waste.
10.
Aerosol containers must be boxed and Hazardous Waste Disposal forms
must be filled out and faxed for pick-up.
11.
Mercury contaminated materials must be contained in sealed Mercury
Containers. These containers must be boxed and Hazardous Waste Disposal
forms must be filled out and faxed for pick-up.
12.
Plastic containers containing dry product (tablets etc.) can be discarded in
regular waste.
13.
Glass containers containing dry product should be discarded in glass disposal
container at back of pharmacy.
WCVM – Infection Control Manual – SAC
71
LIST OF LIQUID PRODUCTS NOT TO BE OPENED AND EMPTIED FOR
DISPOSAL
1.
2.
3.
4.
5.
6.
Regumate (altrenogest)
DMSO
Micotil (tilmicosin)
Hormones
- Estrogens or estrogen derivatives (Estrus, estradiol etc.)
- Progestins or progestin dervatives (progesterone, CIDR)
- Prostaglandins (Estrumate, Lutalyse)
- Oxytocin
- Gonadotropins (Chourulon, Cystorelin, Factrel, Folligon,
Folltropin, Lutropin, PMSG 600)
Vaccines, Immunoglobulins, Toxoids, Antitoxins, and other Biologicals
Anti-neoplastics
carboplatin (Paraplatin)
ifosfamide (Ifex)
chlorambucil (Leukeran)
lomustine (CeeNu)
cisplatin (Platinol)
l-asparaginase
(Kidrolase)
cyclophosphamide (Cytoxan, Procytox) melphalan (Alkeran)
cytosine arabinoside (Cytostar)
methotrexate
dacarbazine
mitotane (Lysodren)
dactinomycin (Cosmegen)
mitoxantrone
doxorubicin (Adriamycin)
vinblastine
epirubicin (Pharmorubicin)
vincristine (Oncovin)
hydroxyurea (Hydrea)
If you encounter used containers containing any of the above products, DO
NOT open containers. Pack sealed containers in cardboard box lined with
Biohazard plastic bag and packed appropriately to prevent breakage. Label
appropriately and fill out Hazardous Waste Disposal form and fax for pick-up.
WCVM – Infection Control Manual – SAC
72
Appendix 7 - Emergency Response Plans.
IN THE EVENT OF A FIRE
1. The person discovering the fire will:
2. Sound the fire alarm by pulling the handle on one of the fire alarm boxes
located in the hallways of the building. Sounding of the alarm will
automatically alert both the Fire Department and Campus Security.
3. Leave the area and clear the building a minimum distance of 50 feet.
4. All other persons, on hearing the alarm, will proceed out of the building to a
minimum distance of 50 feet. Area and Assistant Fire Wardens will direct the
evacuation. During inclement weather, proceed to the Agriculture Building.
5. Persons using gases, electrical or open flame equipment will turn such
equipment off before vacating the building.
6. Supervisory personnel must predetermine what special attention should be
given to cash, personal records, or classified material in their departments in
case of fire or other emergency. All doors should be closed. The supervisor
will co-operate with the Fire Wardens to ensure that all employees are aware
of, and periodically briefed on, action to be taken.
7. Safety of human life is the prime purpose of these procedures. Animals will be
housed and only evacuated under the direction of the City Fire Chief.
8. Outside normal working hours: the fire alarm should be sounded and the
building evacuated.
Fire Alarm Boxes
These are coloured red and are located in the hallways of each area.
Extinguishers
These are located on all floors and are for the use of all employees in an
emergency. Personnel should familiarize themselves with the location of
extinguishers in their area.
Exits
All students should familiarize themselves with the nearest exits from offices
and buildings and know the alternative exists. Illuminated red EXIT signs
indicate outside exits.
Return to Building
Re-entry to building only when okayed by Area Fire Wardens.
WCVM – Infection Control Manual – SAC
73
Power Outages
The SAC is equipped with emergency power providing emergency lighting in
all areas.
Red coloured power outlets also provide emergency power in event of a
power failure.
Spills
While spills may be common in the SAC they are rarely of significance.
There are no radioactive isotopes in use in the LAC
Biological spills are common and should be dealt with using the disinfection
protocols (Appendix 1)
There are few chemicals used in the SAC which represent a hazard to
employees or the environment. Almost all spills can be disposed of by
washing the area with copious quantities of water.
Human Medical Emergencies
In the event of a medical emergency;
1. Administer first aid. The surgical nurse is an R.N. and qualified in CPR
2. If the patient is stable and the severity of the emergency warrants it transport
the individual to the RUH ER or their doctor’s practice
3. In event of a severe injury or where there is concern about transporting the
individual contact emergency services and request an ambulance.
4. Ensure that an incident report form (Appendix 4) is completed at the earliest
opportunity and that the VTH office is informed of the incident.
WCVM – Infection Control Manual – SAC
74
Animal Escape
Animal escapes are to be avoided at all cost.
Protocols to avoid animal escapes within the VTH include:
1. Ensuring that cage and run doors are shut properly at all times.
2. If an animal escapes within the hospital, close off all possible exit doors to
contain the animal in a confined space. Calmly and with help try and get a
leash around a dog’s head. For a cat calmly and carefully use a blanket to
help recapture the cat without causing the cat overdue stress.
3. When transporting cats within the VTH use a carrier for fractious animals or
sedate the animal prior to transporting them. For nonfractious cats ensure
they are properly restrainted during transport within the VTH (secure scruff,
support under their ventrum).
4. For dogs use a properly fitted hospital leash when walking ambulatory canine
patients within the VTH. For fractious animals sedate them prior to transport.
Should an animal escape from the LAC:
1. Contact the receptionist (7200) and inform them that an animal has escaped.
2. Page all available clinicians to attempt to apprehend the animal.
3. Contact Campus Security (5555) and inform them that an animal has
escaped and its present location.
4. Try to ensure that the animal does not leave the campus. If the animal looks
like it will leave the campus area contact City Police (975-8300).
Should an animal escape from the SAC:
1. Contact the receptionist (7130) and inform them that an animal has escaped.
2. Page all available clinicians to attempt to apprehend the animal.
3. Contact Campus Security (5555) and inform them that an animal has
escaped and its present location.
4. Try to ensure that the animal does not leave the campus. If the animal looks
like it will leave the campus area contact City Police (975-8300).
WCVM – Infection Control Manual – SAC
75
Appendix 8
Suspected Nosocomial Disease Incident Report Form
This form is to be completed for all potential infections acquired while the animal is
under the care of the WCVM-VTH. Infections may only be discounted after
investigation by the Infection Control Committee.
VTH Case No:
Date:
Clinician:
Species:
Type of Infection: (Please mark all that apply)
Gastro-intestinal Disease
Respiratory Disease
Suture Line Infection
Post-operative Infection
IV catheter site
Uro-genital Infection
MDR infection
Joint Infection
Urinary catheter
Other (please give details)
Causative Agent if known:
Please return this form to either Dr Chris Clark or Dr Cindy Shmon
WCVM – Infection Control Manual – SAC
76