Thoughts on preventing Infectious Disease Spread
One of my many geeky interests is infectious disease. After reading The Coming Plague, I fantasized about being a “disease cowboy” investigating new outbreaks around the world. I enjoy trying to control infectious disease in the game, Pandemic, and enjoy spreading disease in the game, Plague.
COVID-19 and risks to healthcare workers
Thus, I have been watching the spread of COVID-19 with horrid fascination and thinking about the important ways in which healthcare workers need to help stop disease spread, help patients survive emerging diseases, and simultaneously protect themselves.
The holes in the overall healthcare response to infectious disease became national news when a case of Ebola was treated in a Texas hospital. Two nurses contracted the disease from a patient due to inadequate infectious disease protection. According to the nurses, they did not have enough training or available written protocols to really protect themselves. In the current Coronavirus outbreak, the LA Times reported this week that over 3000 health workers have been infected with the virus from patients they have treated.
Zoonotic disease risks to Veterinarians
We are very lucky that the vast majority of dog and cat diseases are not transmissible to people. However, ringworm, leptospirosis, plague, and rabies are some notable exceptions. In addition, just like our human healthcare counterparts, we can act as fomites, passing disease from one patient to another with our hands, our clothes, and with our tools, such as stethoscopes.
We are also lucky that there is currently no evidence that dogs or cats contract COVID-19 or transmit the virus. However, Dr. Scott Weese, in his excellent blog, Worms and Germs, recently discussed a study showing that COVID-19 might be able to bind to cells in pigs, ferrets and cats. He is thus recommending that quarantine and investigation of human cases should include questions about pets and animal exposure.
Effective precautions
It can be very hard to get people to be diligent about taking precautions to prevent infectious disease. We know from the SARS epidemic that washing hands can significantly decrease the spread of respiratory viruses. However, we also know that getting people to consistently wash their hands before and after every patient is incredibly hard. In a study of medical students in Hong Kong, only 35% of students remembered to wash their hands before seeing a patient. This percentage doubled after the SARS epidemic but this was still only 60% of the time. Despite many interventions and trials looking at ways to improve hand hygiene among healthcare workers, hand washing percentages remain low.
Do Veterinarians wash their hands?
A study published in JAVMA in 2012 revealed that only 20% of interactions between clinicians and patients had proper hand hygiene. The good news is that an educational campaign improved this to 40%, which is still sadly less than HALF THE TIME.
Using a crisis for teaching and learning
I have often been told to never waste a crisis as an opportunity for change. I think discussion of COVID-19 can be used to discuss the risks of infectious disease spread between our veterinary patients and among people in our hospitals. Here are three simple things that make both pets and people safer in your hospital.
1) WASH YOUR HANDS
We know that education and frequent discussions can improve the percentage of times healthcare workers wash their hands. Using humor and video can often help make messages stick. This excellent, short hand washing video will likely make an impact with your staff. I would also love to see a veterinary video on hand washing as fun as this one.
When discussing hand washing, it is important to discuss both washing long enough and also the five moments of washing for health care workers:
- Before touching a patient
- Before clean or aseptic procedures
- After body fluid exposure
- After touching a patient
- After touching patient surroundings.
2) MAKE HAND SANITIZER READILY AVAILABLE
Alcohol based gels are as effective as hand washing in removing bacteria and viruses in many cases. These gels do not remove physical matter, do not kill clostridium, and do not kill parvovirus, but they are effective in most other cases. In cold winter months when hands get dry, people are more likely to gel consistently than to wash. Thus, it is important to have these available in convenient locations AND to make sure the dispensers stay filled.
3) ENCOURAGE YOUR STAFF TO STAY HOME WHEN THEY ARE SICK
It is really hard to work short staffed and as a previous practice owner I know first hand how hard it is when people call out sick. On the other hand, one sick person coughing throughout your hospital is likely to lead to even more sickness and call out days. In addition, if that sick person is seeing clients, they are putting numerous people at risk.
For more information about COVID-19:
CDC Website information on COVID-19
AVMA Information Page on COVID-19
WSAVA Advisory Document on COVID-19
For Additional Infection Control Recommendations:
2018 AAHA Infection Control Guidelines
2 comments
As usual, excellent and timely information. Thank you.
Good points. I would add that thought should be put into this when designing clinics. Inadequate numbers of hand washing stations, or stations positioned farther away from working areas reduces how much workers wash their hands.
Also the average length a flu or cold virus case lasts is on the order of 1-2 weeks. Most of our staff are not paid enough that they can afford to take time off like this so inevitably they come back to work ill. Provisions for adequate amounts of sick pay for these workers should be considered.
And a culture that promotes healthy attitudes among staff should be developed. Most clinics have an unspoken rule that you come to work even if your sick, just “push through it”. This is particularly true among the veterinarians. This actually promote the spread of disease among workers.