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Front-line One Health

04 April 2019, at 9:30am

How can vets and nurses apply the One Health agenda in clinical practice?

One Health is a movement and superdiscipline which promotes collaboration between diverse professions to improve the health and well-being of people, animals and the environment, due to the interdependence of this triad.

The breadth of One Health is far-reaching, encompassing zoonotic diseases, comparative research of non-communicable diseases, the use of working animals worldwide for human livelihood, the human-animal bond, and the health of the environment underpinning all of the above.

The veterinary profession is a vocal champion of One Health, frequently raising awareness of the concept. Published literature often focuses on collaboration bet-ween governments, universities or multinational health organisations, particularly in research and policy. However, the One Health mission remains relevant to on-the-ground veterinary practitioners. Here, I discuss 10 ways veterinary professionals in practice can promote this agenda in their daily work.

1. Antimicrobial stewardship

The World Health Organization (2019) has named antimicrobial resistance as 1 of 10 major threats to world health in 2019. Vets are key global stakeholders in this challenge and can do their part by implementing antibiotic prescription auditing, morning inpatient rounds, case discussions or a regular journal club, which all create a culture of reflection and accountability.

2. Charity work and volunteering

Volunteering with initiatives whose work helps both people and animals enables vets and nurses to apply their skills in completely new, creative ways. Examples include charities such as Mission Rabies and StreetVet, whose work inherently carries the One Health ethos and raises the visibility of the veterinary profession in communities.

3. Safeguarding against zoonoses

In May 2018 in Kerala, India, 23 people presented to their doctors with pyrexia, delirium, coughing and vomiting. Eighteen subsequently died. The pathogen was Nipah virus, a fruit bat-derived zoonosis which causes encephalitis and respiratory disease. Patient zero was a 27-year-old man, who, through a cumulative series of errors, directly infected 20 other patients and staff (Arunkumar et al., 2018).

Though a slightly sensationalist hook, this highlights that human behaviour and small mistakes are sparks to kindling in fledging epidemics. For veterinary professionals, complacency is the enemy in the fight against zoonoses. Actions could include creating written practice rules on when to isolate suspicious cases and meticulous infection control. Important measures which are commonly neglected are washing hands between every patient, cups of tea in clinical areas and the use of gloves in the lab even when doing that routine urine dipstick!

In our ever-globalising world, an enquiry of pet travel history should increasingly feature in routine consultation history-taking. Infectious disease CPD can help keep clinical signs of non-endemic zoonoses on the radar.

4. Use of social media for client One Health education

Approximately three quarters of internet users are consumers of some form of social media. Why not harness this powerful platform to educate the public about the concept of One Health?

Do your clients know that leptospirosis is zoonotic? That their pet can suffer Campylobacter food poisoning? Are they aware of studies linking dog ownership to improved owner fitness and mental well-being (Wells, 2007)? Do they under-stand the effects of urbanisation and environmental change on the decline of UK hedgehogs? You can educate them!

5. Three Rs for the environment

  • Reduce: think about unnecessary invoice printing, lights left on at night and the carbon footprints of deliveries (which can be reduced by ordering stock in greater bulk).
  • Reuse: this is hard to achieve in clinical areas for obvious reasons but still applies to offices, kitchens and reception areas.
  • Recycle: work with local recycling authorities to find out which practice waste can be recycled. Plastics in particular are highly variable but are generated in large amounts, so are worth the enquiry.

6. Dog bite prevention

Children are over-represented victims of dog bite injuries due to their natural propensity to approach animals (with which they are often similarly sized) and relative lack of awareness of behavioural cues. This can be vastly improved through education. Veterinary professionals can deliver talks in schools, and tie in other One Health lessons such as safety around farm animals, leashing dogs to prevent worrying of livestock and respect for wildlife. This valuable work could save the life of a child, an animal or both.

7. Take health and safety seriously

Health and safety guidelines protect both animals and people from harm in the veterinary workplace. This includes ionising radiation safety, diligent use of PPE when handling chemotherapeutic agents and infrastructure for reporting not only of incidents, but also of near misses.

8. "Lifestyle medicine" - helping both people and their pets

How many of us have felt our hearts sink doing a first vaccination for a Border Collie whose owners live in a city centre flat, knowing what lies in store for all concerned? Or when we meet the parent who wants a placid therapy dog to provide company for a child with learning difficulties, only to buy the bounciest breed imaginable?

Imagine if small animal practices offered consultations for people that don’t (yet) own an animal. Practices could offer free or discounted 10-minute lifestyle consultations for prospective pet owners to help with decisions on their choice of future pet. This form of preventive medicine could immeasurably benefit the life ahead for an animal and the harmony of a family, as well as generating future custom from grateful owners.

9. Reporting suspected non-accidental injury

The correlation between animal cruelty and domestic abuse is well documented. It is lawful for veterinary professionals to consult the relevant agencies where there is serious concern for the welfare of an adult or child, just like any other concerned member of the public. Advocacy organisations like The Links Group provide information on the connection between different forms of abuse, as well as contact details for relevant organisations and agencies.

10. Supporting colleague physical and mental health

Employers can reward staff and support their health through discount partnership schemes with gyms and leisure centres, or by providing evening on-site yoga or Pilates classes. “Cycle to work” reward schemes have a big environmental impact, and additionally free up more spaces in the practice car park for out-of-town clients who may have no choice but to drive.

Practices can also support staff mental well-being, and many already do this very well.

Suggestions include:

  • Peer mentorship schemes
  • Democratic rota drafting
  • Investment in positive leadership courses for management
  • Provision of counselling for those in need
  • Treating mental ill health as a valid reason to be off sick

To provide gold standard veterinary care but neglect our silently suffering colleagues is to fail at One Health.

Summary

By considering the welfare of not only our patients but also of our clients, our colleagues, the environment and ourselves, front-line veterinary professionals in practice can contribute to the One Health mission through small incremental changes which could cumulatively make a difference.

References
Author Year Title
Arunkumar, G., Chandi, R., Mourya, D. T., Singh, S. K., Sadanandan, R., Sudan, P., Bhargava, B. 2018 Out-break investigation of Nipah virus disease in Kerala, India, 2018. The Journal of Infectious Diseases, jiy612
World Health Organization 2019 Ten threats to global health in 2019
The Links Group 2019
Wells, D. L. 2007 Domestic dogs and human health: an overview. British Journal of Health Psychology, 12, 145-156. Front-line One HealthVP

Matt Dickinson, BSc, BVSc, MRCVS, graduated from Bristol in 2015 with an intercalated BSc in Virology and Immunology and entered small animal practice. In 2016 he began a PhD in HIV/AIDS immunology at the University of Oxford, remaining clinically active as a locum.

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