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Best practice infection control

It is important to minimise the risk of infection spreading whilst creating an optimum environment for patient care

03 September 2020, at 7:15am

Imagine this clinical scenario: a canine patient with possible leptospirosis is coming in for a work-up. The pathogen, Leptospira, carries serious contagious and zoonotic risks, so it is important to consider infection control, biosecurity and barrier nursing measures. The infection can spread through any form of contact with wounds or mucous membranes, directly or indirectly through urine, and can survive up to three months in contaminated water supplies. You want to ensure that your infection control procedures are up to standard to minimise the risk of the infection spreading to other patients and humans. What steps should you take?

With a potential infectious case, the aim is to provide optimum patient care where the risk of infection is minimised for other patients and the team. The principal component of infection control is breaking transmission; leptospirosis is largely spread through contact with urine from an infected animal, so cleaning and disinfection are important to maintain a safe environment.

The patient should be considered positive until proven otherwise. Therefore, the patient’s journey should be considered, starting from their entry into the practice. Where will the patient enter and be admitted? Think about the areas the dog’s nose may touch when entering the practice, and also the areas where the dog may urinate or meet other dogs, both inside and outside. Is it possible to send the patient straight into the consultation room, kennels or isolation? Can they avoid the reception area and waiting room or can the time they spend there be minimised? Is there time to disinfect the area before another patient has to enter?

Ideally, the possibility of leptospirosis should be flagged before the appointment to allow staff to create a plan and to discuss this with the owner. The kennel and isolation area can be prepped for the patient’s arrival and the owner will know to call ahead when they arrive. The patient can then enter through a separate exterior door (or be led straight through). It is important to keep track of where the patient has been - kennel logs are particularly useful to ensure the correct hygiene and cleaning procedures are followed.

While waiting for confirmation of the diagnosis, it is crucial to treat the patient as infectious. Ideally, the dog should be placed in isolation, either in a separate ward or in a designated area within the kennels that can be zoned off and separated from other areas. The isolation area will need separate equipment and consumables for each patient. These should be disposable or easily cleaned and disinfected. Placing hazard tape around the area, taking into account the potential risk from urination and splashes, can serve as a visual reminder to prevent unauthorised team members and those not wearing the correct PPE from entering. Preparing everything in advance is key, including the patient’s journey, procedures likely to take place, equipment and the team involved. It is beneficial to keep a minimal team and ensure everyone is wearing PPE. Staff with open cuts or skin lesions should avoid suspected or confirmed patients. If contact is essential, lesions should be covered with a waterproof dressing.

If possible, minimise the patient’s contact with the walkways by moving them on a trolley or stretcher. It is useful to assign a “clean runner”, someone who does not handle the patient but is responsible for helping to collect items and open doors, to minimise the infection risk.

In areas of the practice with high traffic, there is the potential for infection via fomites. How can you minimise the level of disruption to the rest of the practice, to reduce contamination risk for other patients and areas of the practice?

Ensure that the rest of your team are aware of the infection risk, to enable time for the diagnostic rooms to be fully cleaned between patients. The workspace should be clearly marked for cleaning before it is used again. It must be cleaned with a disinfectant suitable for the suspected pathogen at the recommended dilution rate. Be sure to identify anything that is potentially contaminated and mark it as such. The team member cleaning the room must wear the same level of PPE as was worn for the procedure. Specific policies and procedures for infection control, including the management of specific pathogens, patients and areas within the practice, will ensure that the whole team is prepared for such cases and aware of any restrictions.

A dedicated infection control group, including representatives from all areas of the practice, can take the lead in creating these policies and offering advice to the team regarding the management and prevention of infectious diseases. This can include: movement and care of infectious or immunosuppressed patients; barrier nursing; PPE guidance; cleaning and disinfection of areas and equipment; and advice in circumstances where there might be disease outbreak or changes. Including the whole team brings a range of ideas and can help increase compliance.

Visual reminders (eg checklists and cleaning schedules) are helpful. Auditing can identify if these are being completed and if they are effective, identifying areas that require further support, or equipment.

Further information and guidance can be found online.