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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