How equine veterinary clinics institute strict biosecurity measures to contain disease
Ah, 2020: The year the general public became acquainted with the terms quarantine and isolation, and PPE went from meaning “prepurchase exam” to representing “personal protective equipment.” Equine veterinarians like myself, however, were dealing with infectious disease outbreaks long before COVID-19 hit the scene. Since the advent of equine hospitals, their personnel have been tasked with biosecurity. In this article we’ll highlight exactly how clinics both prevent disease and control outbreaks.
Why the Worry?
Horse hospitals aren’t all full of sick horses. Rather, they see a plethora of cases, the types of which typically depend on the center itself. Surgical facilities, of course, see primarily surgery cases: orthopedic, soft tissue, and colic. Reproduction clinics are filled with broodmares and foals. Hospitals with internal medicine specialists might see horses with everything from pneumonia and eye problems to endocrine disease and neurologic conditions.
The problem is horses. Seemingly healthy horses can harbor diseases that only manifest during times of stress. These stresses can include things like trailering, new environments, and pain. See where I’m going with this?
Bacteria such as Salmonella and methicillin-resistant Staphylococcus aureus (MRSA) can lie dormant in the horse until a stressor causes him to start shedding the pathogen. Many hospitals and referral centers swab horses for Salmonella on admittance to know exactly how many carriers are entering and exiting the clinic. This practice can thwart outbreaks; for example, a hospital admitted a horse for castration, only to find the colt was a Salmonella carrier on arrival. The surgeon completed the procedure, but the horse remained in isolation during his visit, as he could’ve easily spread Salmonella to others in the main hospital barn.
Protocol and Principles
So how do clinic staff contain disease and keep their patients healthy? Tracy Norman, VMD, Dipl. ACVIM, has worked in both academia and private practice and highlights some of the hospital biosecurity principles she has spearheaded over the years.
Ease of Use
“Any written protocol devised by an infectious disease committee full of brilliant clinicians and scientists is only as good as the student or animal caretaker who is least interested in compliance,” she says. Protocols cannot be brimming with long, hard-to-understand words or be inconvenient, complicated, or poorly communicated. Staff simply won’t be able to follow them.
She suggests posting plenty of signs featuring photos or illustrations—and instructions in the languages spoken by personnel—and simple workflow protocols; establishing convenient and well-stocked hand-washing stations; and providing ample PPE in convenient locations, along with plenty of trash receptacles.
For protocols to be effective, everyone must adhere to them. “Whatever the higher-ups do (not say) is modeled by everyone else,” she says. “If the senior clinician skimps on PPE, so will the students, the techs, everyone.”
“There must be an area designated for isolated patients, a workflow or workforce to keep cross-contact to a minimum, and a traffic pattern that keeps the isolated area and the general population area distinct and separate,” Norman says.
Equine hospitals and referral centers are like snowflakes; no two are the same. “One of the key elements is to design the hospital with people traffic in mind, since people (via hands and shoes) could be a main source of spreading contagious infectious diseases around the hospital,” says Lucas Pantaleon, DVM, MBA, Dipl. ACVIM, owner of DVM One Health, in Versailles, Kentucky, a consulting firm specializing in infection prevention and biosecurity.
Diminishing traffic diminishes spread. Period. “It is key to have easy access to sinks with soap in order for people to wash their hands,” he says, echoing Norman’s recommendations. “If people need to walk from one end of the hospital to the other to wash hands, then it is less likely that they will do it, or on the way to wash their hands they could touch and contaminate surfaces.”
Having PPE—those gloves, shoe covers, and disposable gowns—available in multiple parts of the clinic is also a necessity.
Human traffic isn’t the only factor here. Minimizing horse traffic also reduces spread from the source itself. “The back (exterior stall) door should be used for horses and mucking stalls,” Pantaleon says. “The front door should be used for veterinarians and technicians attending the horses. This way, human traffic is mainly concentrated inside the barn and horses come in and out from the outside.”
Traffic principles can also apply to non-patients. While clinic cats are wonderful and a staple of most stables, they don’t need to nap in equine isolation before strolling through the surgical wing.
Autor Chris White, DVM