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116 Nosocomial and Multidrug‐Resistant Infections 1061

Colonization versus Infection fingers, backs of hands and base of the thumbs, as these
VetBooks.ir Following exposure to an opportunistic pathogen, areas are often missed. Hand hygiene should occur
before and after every animal contact and after removing
animals may become colonized (pathogen multiplies
without tissue invasion/damage), infected (multiplies gloves.
Appropriate PPE use reduces the risk of contamination
with tissue damage and often signs of clinical disease), of personal clothing, reduces exposure of skin and
both, or neither. In animals, decolonization therapy for mucous membranes of veterinary staff to pathogens, and
MDROs has not been shown to be effective and unsuc- reduces transmission of pathogens between patients by
cessful attempts result in promotion of further resist- veterinary personnel. The use of PPE is especially impor-
ance. As such, therapy should be reserved for animals tant when handling animals with known or suspected
with clinical disease, regardless of the MDRO involved. MDROs. This includes the use of a barrier gown (dispos-
Animals without clinical signs of disease, assuming they able or laboratory coat that is not worn elsewhere) and
are otherwise immunocompetent and expected to dem- gloves. As animals with MDROs may be colonized or
onstrate clinical signs should infection occur, may be contaminated at locations distant to the infected site,
carefully monitored. Staff and clients should be informed these clothing precautions should be worn when
of the colonization status of patients, as these patients having contact with any MDRO patient or its housing
may nonetheless shed the pathogen, serving as a source environment.
for HAIs or zoonotic infections.

Patient Housing Cleaning and Disinfection
In order to protect other patients and clinic staff, atten- Evidence suggests environmental contamination in
tion to patient housing and animal flow is important in human hospitals increases the risk for HAIs and inter-
managing patients with MDROs. Patient cohorting ventions that reduce environmental contamination
entails housing together and maintaining a general flow reduce HAIs. This connection is less well established in
(e.g., assigning waiting and examination areas) of veterinary medicine, but it is logical to assume that it
patients that have similar infectious disease risks, exists. Examples of fomites that have been identified
including risk of shedding infectious organisms as well as reservoirs of HA pathogens include stethoscopes,
as vulnerability to infection. Additionally, animals computer keyboards, thermometers, examination tables,
infected or suspected to be infected with MDROs should and floors. The role of these items in HAIs is not known
be isolated. The specific protocols will vary with the but it is prudent to minimize contamination.
pathogen, severity of disease, and facility, but should Several key steps must be taken to ensure a disinfect-
include use of personal protective equipment (PPE), ant is effective, including ensuring the surface/item is
cleaning and disinfection, and restricted personnel clean and the product is applied at the manufacturer’s
access. Materials and equipment used for isolation suggested dilution and contact time (amount of time the
patients should be dedicated to the patient during its disinfectant is in contact with the item before being
hospital stay, after which they should be cleaned and removed). Disinfectants should be selected based on a
disinfected. number of criteria including the product’s spectrum of
activity, susceptibility to inactivation by organic matter,
Hand Hygiene and Contact Precautions and potential pathogens in the environment. Resources
are available to guide disinfectant selection (see
Hand hygiene and use of PPE, such as nonsterile gloves Chapter 117).
and gowns, are simple techniques that can reduce the Antimicrobial resistance does not necessarily indicate
risk of HAIs. A number of studies indicate that veteri- further resistance to environmental disinfectants,
narians and staff typically do a poor job at performing although the consequences for inadequate removal/
hand hygiene between patients or using PPE when indi- decontamination are greater. As such, it is prudent to
cated; improvement in these areas is desperately needed. consider the use of a “broad‐spectrum” disinfectant
Hand hygiene is described as the single most effective (e.g., oxidizing agents), for contact surfaces of patients
and underutilized infection control measure. Use of with HAIs or MDROs.
hand hygiene limits the spread of organisms between
patients and between patients and staff. Biocidal soap
and water and alcohol‐based hand sanitizers (AHS) are Zoonotic Concerns
most frequently used for this purpose. Individuals During their careers, many veterinarians report a major
should ensure hands have soap or AHS contact for at animal‐related injury resulting in lost work or hospitali-
least 15 seconds, paying attention to fingertips, between zation. Although not responsible for the majority of