August 26, 2017

AAHA 2017: Does Your Practice's Biosecurity Protocol Need a Tune-Up?

To some, a mundane task like cleaning an examination table between appointments may seem unimportant. But this simple action, and its role in biosecurity, deserves more focus than it sometimes receives.
By American Veterinarian Editorial Staff
To some, a mundane task like cleaning an examination table between appointments may seem unimportant. But this simple action, and its role in biosecurity, deserves more focus than it sometimes receives. Infectious disease control protects patients, pet owners, and veterinary staff.

Conversely, failure to implement an effective cleaning and disinfection protocol endangers animals and humans alike. According to Lucas Pantaleon, DVM, MS, DACVIM, MBA, senior clinical veterinary adviser with Virox Animal Health, infection prevention is essential to providing good patient care and practicing high-quality medicine.

Dr. Pantaleon spoke with American Veterinarian® during the American Animal Hospital Association Annual Conference in Nashville.

Where are we now? 
Most veterinary practices already have some disinfection practices in place. What are we missing?
Lucas Pantaleon, DVM, MS, DACVIM, MBA: Using standards of practice and other veterinary guidelines, veterinary teams already do things like systematic hand washing, use of personal protective equipment, and instrument sterilization. However, in the hubbub of a typical day at a veterinary facility, strict and effective cleaning and disinfection are elements of infection prevention and control that can be overlooked.

What’s the connection between disinfection protocols and biosecurity, and why are they so critically important?
The issue is larger than it may seem. I consider biosecurity in veterinary medicine part of the One Health concept, which involves multiple disciplines collaborating and learning from each other with the objective of putting things into practice to help keep humans, animals, and the environment safe and healthy.

With respect to infectious disease prevention or biosecurity, veterinarians and physicians think in similar terms, so infectious disease control should be thought of from a One Health perspective—not only in terms of learning from different disciplines but also understanding that some of the things our counterparts in human medicine do to prevent hospital-associated infections could be applied to veterinary medicine so we can learn from each other and collaborate for the benefit of everyone. For example, 1 thing human hospitals do that veterinary practices could consider is the use of disinfecting wipes. Wipes are very prevalent in human health care. They’re being used in some veterinary practices, but I think their use is increasing and, in certain situations, [they] could be used more.

For example, because of the high flow of patients coming through exam rooms, you need a disinfectant agent with a shorter contact time (ie, capable of killing microbes quickly) to clean between appointments. Another thing that veterinary practices don’t do a lot is high-level disinfection of semicritical devices, such as endoscopes or other types of devices that come in contact with mucous membranes. Sometimes we’re not as good as we should be at disinfecting those devices; that’s something that maybe we can learn from our colleagues in human health.

Why Standardize Disinfection Protocols?
Why is it so important for a veterinary hospital to have a standardized disinfection protocol?
Aside from the issues of safety and biosecurity, cost is a consideration. Just 1 patient acquiring an infection while visiting the hospital often ends up costing more than using a state-of-the-art disinfectant and proper protocols for prevention of infectious diseases. In addition, the potential costs to clients should not be overlooked. Let’s take canine parvovirus and canine influenza as examples. Besides patient suffering and the emotional stress placed on families, clients could face significant treatment costs if their pet picks up either of these viruses at the hospital. Careful evaluation of disinfectants and implementation of proper cleaning and disinfection practices can prevent or minimize the likelihood of these kinds of infections and the added costs associated with treating them.

You mentioned parvovirus and influenza. Are these pathogens among the most difficult to eradicate?
There are many different classes of pathogens, and their risk for causing disease varies. Parvovirus is one that is concerning because it’s a very difficult pathogen to kill. It’s a nonenveloped virus and hence inherently more resistant to disinfectants. In contrast, influenza virus has an envelope membrane made of lipids, so it’s easier to disrupt with cleaners and disinfectants. Other pathogens that we worry about include the upper respiratory complex pathogens. They represent a mixed bag of bacteria, viruses, and mycoplasma, but they’re relatively easily killed by disinfectants.

How much of a concern is leptospirosis, and is it easily eradicated in a hospital?
There has been more talk recently about leptospirosis because its prevalence has increased. In terms of disinfecting, 1 good thing is that leptospirosis doesn’t survive very long in the environment. As long as the surface is dry and clean, the microorganism basically dies. It would persist for some time in water. In veterinary clinics, where surfaces are normally nonporous, using a hospital-grade disinfectant with an acidic pH will inactivate the bacteria in the environment.

Once a practice establishes a disinfection protocol, can the same protocol be used throughout the entire hospital?
No, because different areas of the hospital have different risks. For example, if you’re in a grooming area, you would assume that those animals are healthy for the most part. Similarly, you would hope that dogs coming into a boarding facility are required to be vaccinated and are generally healthy. So, the risks in those areas will be a little bit lower. However, you have to understand that a boarding facility is like a kindergarten; you have large populations of animals interacting and playing with each other—nose-to-nose contact, perhaps sharing the same toys, and the like. So, disease transmission would be easy there if something were to break out. A main concern with upper respiratory illnesses that are common in boarding facilities is the close contact between animals. So these areas do require a good cleaning and disinfection for sure.

In a hospital there is a higher risk for acquiring contagious diseases due to the fact that sick animals share a common environment. Hospitalized animals can be immunocompromised, making them more prone to acquiring an infectious disease from surfaces. So, the level of cleaning and disinfecting in hospitals should be higher than at a grooming facility. Within the hospital there are areas with variable risk. For example, there is more risk in an isolation area than in an exam room that is used for routine patient care, such as vaccination or yearly exams. These areas should be cleaned and disinfected differently.

Understanding Disinfectants
Are disinfectants really all that different? If so, how?
Each kind of disinfectant, whether it’s a single active ingredient or a combination of chemicals, carries its own advantages and disadvantages (TABLE). There are many products and many choices; some of the most common are bleach (chlorine), quaternary ammonium, phenols, accelerated hydrogen peroxide, alcohol, and some combinations of alcohol and quaternary ammonium.

Do any of those products work better than others?
They all have different parameters. Some work better because they have a broader spectrum and a faster contact time, so in certain situations they can kill pathogens quickly when time is critical. For example, quaternary ammoniums aren’t very good for hard-to-kill (nonenveloped) viruses, like parvovirus, while other agents, such as accelerated hydrogen peroxide, would work well for those types of viruses. Bleach is readily inactivated by organic material, so using products whose efficacy is less affected by the presence of organic material would be ideal.

How are disinfectants tested and regulated? Are manufacturers required to disclose specific information about efficacy?
In the United States, disinfectant products are tightly regulated by the Environmental Protection Agency (EPA). The products are put through very stringent tests in order to obtain the label claim for each pathogen. Products are tested for efficacy against specific pathogens at specific contact times. If the product passes the test, the manufacturer can then claim that particular disinfectant is able to kill specific pathogens at a certain contact time. So, manufacturers are regulated by the EPA regarding what they can say.

How important should safety be? And do we ever need to trade safety for efficacy when considering which disinfectants to use?
Safety is very important. Even today, products are still being used that are not safe for people or animals and can cause different side effects. Sometimes there are strong smells to be concerned about, or the active ingredient can cause a skin reaction if the worker comes in direct contact with it. So, I think it’s important to understand what types of products are being used, to use them properly, and to keep safety for animals, humans, and the environment top of mind when using some of these products. That should be paramount. An effective disinfectant doesn’t have to be harmful because now we have technologies that don’t have to be harmful to kill the pathogens. So, you have to try to select products that use newer technologies and are safer.

If you think about accelerated hydrogen peroxide, that particular product has a very high safety profile and a very high killing rate for pathogens. So, we don’t need to use something harmful to be able to kill pathogens.

Which products are safest for the environment?
When I think about something that is environmentally safe, I would say the accelerated hydrogen peroxide products are a good example. Accelerated hydrogen peroxide does not have residual activity and is safe for the environment because it degrades into water and oxygen. Furthermore, the surfactants in the accelerated hydrogen peroxide formulation are considered environmentally friendly.

Looking Ahead
What challenges are on the horizon for veterinary practices in this area?
I think people are taking biosecurity and infectious disease control seriously, and awareness continuous to grow. Regarding disinfectants, many veterinary practices select a product based on price and not on efficacy or safety. Sometimes practices don’t have someone in charge of infectious disease prevention with the knowledge to do that type of job. We all know that veterinarians are busy and that’s understandable, but unfortunately, they sometimes don’t really want to be the leaders or have time to understand more about biosecurity and why it’s important.

Biosecurity is an extremely important component of patient care. To that end, infectious disease prevention should be 1 of the things we do every day in order to provide the best care for our patients. Further, not only can choosing the right disinfectant help ensure the overall success of a biosecurity program, but it can have a positive and dramatic impact on facility maintenance costs and employee health. Veterinary practices should also understand that the entire veterinary team has a role in implementing disinfection procedures, so commitment from the top down is necessary for success.

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