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Isolation Protocols

In most veterinary practices, the concept of Infection Control is usually limited to the efforts by staff to keep one animal from infecting another. Similarly, "isolation" is often nothing more than one animal physically separated from the rest of the population. Although these actions are surely steps that have a place, there is much more to the issue of isolation and infection control.

In today's clinical environment, we must approach the topic of infection control from a perspective of total staff and patient protection from pathogenic organisms while complying with government regulations pertaining to the activities performed. Although the procedures discussed here will work in any practice, because of the unique nature of each organization, it'll certainly be necessary to modify or tailor the steps slightly to fit the practice's special situations.

The actual procedures that are followed in each situation are practice-specific, however, there must be a system of standardization and communication in place FIRST. The doctors must decide when certain procedures will be enacted on a practice-wide basis and not a doctor-specific one. For instance, in most practices, the rule should be that stray, wild or feral animals are only handled by staff members who have been successfully vaccinated against rabies. Likewise, when the case includes a differential diagnosis that is zoonotic in nature, ALL doctors in the practice should follow the same steps in ordering a specific isolation protocol until the case is resolved or the zoonotic potential has passed.

Communication also includes the use of special signs or labels that alert staff members of the condition. Since every staff member should know what those signs and labels mean, we recommend a poster or placard describing them instead of relying on someone’s memory! Place the poster or placard in several locations throughout the practice, especially at the entrances to patient wards.

Universal Precautions

No matter what the disease, there are precautions that are warranted in almost all situations dealing with a potential zoonotic or contagious disease. These are known as “universal precautions.”

• Limit the number of staff allowed that come in contact with the infected animal. After all, the fewer people involved means fewer people potentially exposed. People not essential for the care or treatment of the patient should not be allowed to come in contact with the animal.
• Practice good personal hygiene after all contact with a sick animal and contaminated surfaces (to see the article on Handwashing, click here)
• The use of gown and gloves for any contact with the sick animal or contaminated surfaces as a physical “barrier” between the staff and the potential pathogen is highly recommended. However, it does no good to use a gown or apron more than once, so having a “community” gown outside the door to the isolation room does not help the situation and may allow pathogens to “escape” into the normal hospital areas.
• Contain and dispose of contaminated waste properly. In general, waste should be “bagged” in the area where it was generated (e.g., the isolation ward) and then placed inside of another bag once outside the infected area. Any material that is not designed to be reused, (and thus properly cleaned) should be discarded at the conclusion of the case.
• Enforce cleaning and disinfecting procedures for contaminated environmental surfaces. In most cases, any EPA-registered hospital detergent-disinfectant currently used by health-care facilities may be used. Of course, the manufacturer’s recommendations for dilution, contact time, and care in handling should be followed. It is not advisable to mix chemicals for a “special disinfectant” since efficacy and safety can not be ensured.

By following the universal precautions every time a patient is suspected of having a zoonotic or contagious disease, the staff may be exposed to the diseased patient, but they can truly minimize the chance of their contact with the pathogenic organism itself.

Specific Precautions

There are basically two reasons for the isolation of a patient in a veterinary practice: The patient is isolated either to protect it from the hazards of the facility or to protect the other occupants of the facility (people and animals) from the patient. However, there is only one purpose of an isolation ward: to enable specific, strict procedures to be followed without interrupting the day-to-day operations of the rest of the practice.

All isolation cases are not the same because the danger to the staff and to other animals is not always the same. Because there are differences in the degree of the hazard, there are differences in the degree of precautions. With that in mind, we’ve developed the following color-coded Infection Control Level system.

Green - This usually indicates no special precautions aside from normal animal husbandry and good personal hygiene. In the practical sense, a typical hospital ward would operate in the Green Condition most of the time. This is also used to denote that the isolation space has been properly cleaned and disinfected after use and is now ready for the next patient.

Yellow - This level is used when the condition of the patient warrants segregation from other animals, especially of the same species, but the condition is not considered contagious to the staff or general public. This category usually includes conditions like leukemia positive cats or parvovirus dogs.

Orange - Level Orange is used for patients which are highly contagious to other animals of any species but not considered contagious to the staff or general public. Diseases that typically warrant this level of precaution include upper respiratory infections, BSE, and Foot and Mouth Disease (FMD).

Red - Isolation Condition Red is the most severe. It is reserved for those cases where the patient's condition is not only contagious to other animals, but is hazardous to people as well. Diseases like rabies, brucellosis, leptospirosis, or even salmonella infections in foals fall into this category.

Purple - This level of precaution is for conditions that are hazardous to people, but not necessarily a concern for other animals. For instance, patients undergoing chemotherapy treatment with cytotoxic drugs would fit in this category.

In the end, it all boils down to understanding how organisms are transferred from one surface to another because containing or preventing the spread of a disease is the first priority when dealing with potentially dangerous organisms.

Additional information on selected diseases:

Rabies

Monkeypox (CDC website page)

Leptospirosis (CDC website page)

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