What is Biosecurity and Why Do We Need It?

In veterinary hospitals, the original meanings of the terms biosecurity (preventing introduction of a disease agent into a population) and biocontainment (controlling spread of an introduced agent) have been conflated so that biosecurity, often used interchangeably with infection control, refers to all practices intended to prevent or limit introduction and spread of infectious diseases within a group of patients and their human caregivers, thereby protecting human, animal, and environmental health against biologic threats. The nature of medicine and mission of veterinary hospitals are such that animals clinically affected by the very agents that have the potential to spread among the hospital population, as well as subclinical carriers that may go unrecognized, are always likely to be present. Moreover, hospitalized animals are not the same as animals in the general population. In the hospital, horses are more likely to shed or acquire an infectious agent than those in the general population because they are more likely to be under stress, may be less able to respond immunologically to infectious agents, have altered nutrition or disturbances in normal flora, may be receiving antimicrobials, may undergo procedures that are known risk factors for infection of various types, and are concentrated in close proximity with other animals that have similar risk factors. Additionally, horses come from different herds, so every admission mixes horses from separate populations, thereby providing an opportunity to introduce infectious organisms to potentially naïve individuals. Equine hospitals are undoubtedly places where introduction and reintro­duction of infectious agents occurs and where contagious disease-causing organisms reside (a greater proportion of which are multidrug resistant [MDR] than in the general community), may be present in high numbers, and can come into contact with susceptible animals. The fact that hospitals are themselves nodes in the contact network of equine populations means that their role in disseminating infectious agents to the rest of the population should also be borne in mind when considering the need for biosecurity. The standard of care at every veterinary hospital should therefore include a high standard of hygiene, awareness of the dangers of transfer of infectious agents between both animals and people, and procedures to reduce infection risk wherever possible. An infection control program (ICP) aims to establish those policies and procedures necessary to accomplish the objective of effectively managing and reducing infection risks, including infections that are hospital acquired.

Development and Implementation of a Biosecurity Program

There is no interchangeable, one-size-fits-all program that is appropriate for every veterinary facility, but certain aspects of an ICP should be considered by all equine hospitals. No matter what the size of the clinic, the need to engender support at all administrative levels and to involve and inform all hospital personnel in the process is important to success. The most effective ICPs are both proactive and evaluative; the ideal way to ensure this is to have an individual (or individuals) dedicated to biosecurity oversight and reporting. Although this may be possible and desirable at large clinics, it may not be feasible for small hospitals. For the latter, having someone proficient in data management who is capable of reviewing and manipulating surveillance data, monitoring infection status and infection control activities on a daily basis, and then reporting to a veterinarian or veterinarians responsible for setting policy may be a reasonable alternative. The basic steps necessary in establishing a comprehensive ICP are summarized (Box 29-1); although focused on the small to medium-sized hospital, the process is inherently similar for all sizes and types of equine hospital. The degree to which an individual equine clinic implements biosecurity practices is, however, contingent on a number of factors, including size and type of caseload, facility size and design, personnel and economic issues, and level of risk aversion.

Patients should be divided into risk categories: high, medium, and low are convenient and easily understood designations. As a guide, low risk comprises elective cases, whereas medium risk would include many nongastrointestinal emergencies and inpatients that receive antimicrobials for more than 72 hours. In some instances, high-risk categorization is largely predicated on vulnerability to infection, such as with neonates, particularly those that are critically ill. For others, high risk indicates presence of known or suspected infection or a past experience with similar patients that suggests the animal represents a risk to other patients, to the hospital environment, and to personnel in the case of zoonotic agents. There is ample evidence to indicate that equine colic patients are a dual threat in that they are at high risk for both developing various types of infection and shedding enteric organisms, notably Salmonella spp. Wherever possible, patients in different risk categories should be housed separately, and cross-traffic of both animals and humans should be limited or even prohibited (e.g., cross-traffic with isolation patients). If the risk status of a patient changes during hospitalization, it is critical that the client is informed immediately and that such communications are properly documented in the medical record. Every equine hospital should have an area designated for patient isolation (Box 29-2), ideally one that is physically separated from lower risk animals. At a minimum, a stall or stalls away from high traffic should be designated for isolation use. When occupied, access can be limited by placing barriers around the stall or between it and other areas of the hospital; although less than ideal, using something as simple as cones and tape can work.

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