Hygiene in medical environment - Focus on practical uses

Goals of this lesson

  • Focus on multidrug-resistant bacteria and viruses (PBFD…)
  • How to proceed in a clinical settings

Mutidrug-resistant bacteria

If the bacteria resist to more than 3 families of antibiotics

Virulence is not greater than other bacteria

Healthy carriage is possible

In exotic species, commensal flora of Birds and Reptiles, atypical mycobacteria (birds and ferrets) can be multidrug resistant bacteria

Presence or absence of MDR bacteria is a marker of the quality of care

  • Resistant virus

Distinguish enveloped and non-enveloped virus, more resistantto classic disinfection method

  • High risks from these pathogens for nurses, vets, owners and other pets

Which germs are encountered and dangerous in clinical settings?

Staphylococcus, Enterococcus, Enterobacteria, Pseudomonas, Acinetobacter

Mycobacteria (Atypical / tuberculosis)

Circovirus (PBFD circovirus)

Parvovirus (ADV ferret)

Calivirus (HVD rabbit)

Less resistant

Arenavirus (IBD pythons & boas)

Bornavirus (PDD Parrots)

When to suspect MDR Bacteria?

  • Invasive care in exotic species
  • Prolonged systemic antibiotherapy

Pyoderma, otitis…

  • Inappropriate use of antibiotics

Combination of different molecules

Inappropriate choice of the molecule

Inappropriate duration, administration or rythm

Invasive acts during antibiotherapy (urinary catheterization, drain…)

  • Immunodepression (chronic disease, treatment, age)
  • Intensive care, prolonged stay in vet clinics
  • Wounds, invasive procedures (non stable surgical implants)

Watch out for the licking of wounds!!!

When to suspect high contagious risk of viral disease?

Circovirus (PBFD circovirus)

Every parrots, every bird is suspect. Keep a strict hygiene.

Parvovirus (ADV ferret)

This disease can have a lot of clinical signs. Chronic wasting disease…

Calivirus (HVD rabbit)

Brutal death for the classical form

Hepatitis, fever and apathy in the mutated form

Arenavirus (IBD pythons & boas)

Neurologic signs.

Bornavirus (PDD Parrots)

Regurgitations and neurologic signs on birds.

To reduce the transmission of diseases

  • Know it and recognize it

Samples from environment are very useful if doubt

  • Inform the vet team and the owner
  • Respect a rigorous hygiene for every patient

Your hands are the main vector of contagious disease in a cinical settings. Material comes next.

For any patient, all the time

Systematic hand hygiene before and after care of the patient, before and after cleaning material, between differents tasks…

Wear gloves fo risky situations: reptiles, blood, stool, wound, dirty material

Keep clean bandages and prevent licking the wound

Do not mix species

1- Tidy

2- Clean

3- Disinfect

Be careful with biological samples (sealed and closed packaging)

Keep a maximum hygiene level near the sink (bacteria like wet places)

Reduce transmission of contagious diseases during invasive procedures

  • Prepare the material in advance on sterile stainless tray or field
  • Large clipping and asepsis

Attention to iatrogenic lesions

Use broad spectrum antiseptics (Chlorhexidine, iodine)

  • Careful handwashing and disposable gloves
  • Protect catheters

Close the perfusion connectors (needles and caps)

If urinary catheterization: close the catheter with a urine collection system

Change asap contaminated bandages

Do not keep IV catheter longer than 72h. First thing to do if fever is observed: REMOVE THE CATHETER

  • Wash your hands before leaving your post
  • Do not keep your professional clothes during the meal
  • Do not mix material from different species.

Do not put your tupperware in the same microwave than what is used for patients

If you suspect a contagious disease

1.Immediate isolation of the patient in a specific area of the vet clinic

2.Inform all the team

Put a poster on the patient’s cage

Inform the owner and explain: visits are prohibited

3.Identify and decontaminate environment, material, cage

F10 diluted to 1/125° (40ml in 5L water)

Wear gloves, goggles, masks, overshoes and gowns

Clean then disinfect: vertically and high spot, then bottom and horizontally surfaces

Do not forget small material: stethoscopes, necklaces, leashes, bowls, lead apron

Discard all consumables that have been in contact with the patient

Sterilize reusable material when possible. If not, discard

Clean the floor with dedicated mop then discard it

4.If available, use antiseptic’s fogger

How to chose an antiseptic

  • Consider the pathogen

Chlorhexidine, iodine are broad-spectrum antiseptic

Alcool has a broad spectrum but has a short duration and is painful

Quaternary Ammonium: Narrow spectrum

To avoid: H2O2, mercurial derivatives, dyes

  • Will increase antiseptic activity

Concentration

Contact time

Temperature

pH can have a variable effect

  • Will decrease antiseptic activity

pH can have a variable effect

Presence of organic matter (clean before disinfection)

Presence of soaps

UV light will decrease bleach efficacy

Water will decrease activity, except with alcool

Opening time, oxidation and contamination of the antiseptic

Procedure of cleaning

  • Wear gloves

It protects you against zoonosis and antiseptic toxicity

  • Cleaning
  • Rinse with sterile water (skin) or tap water (material)
  • Let it dry

Essentil to reduce inactivation of antiseptic with water

  • Antiseptic adapted to use and surface

Compatible with the soap

Inside to outside for skin ; from top to bottom for surfaces

  • Let it dry

Hydro-alcoholic Solution

  • How to use HAS?

Display in the structure and inform the team

  • Between two cares, if no dirt

Differentiate clean and dirt care

  • Only of hands are clean and dry

Not soiled, powder-free (gloves), not irritated

Short and clean nails, no jewelry

  • Two products pressures in the palm of your hand

Spread the product widely on the hands and wrists

Palm-Palm, Intertwined fingers, Palm on back, Finger on Palms, nails, inches

  • Let it dry

Do not rinse, do not wipe

  • Should we prefer handwashing with soap and water ?

YES!

–Use it only if no available water point, during epidemy

–Skin must be clean and dry. Think about your nails!

–Effective only if friction and contact time are respected on clean hands.

  • Risks associated to hydro-alcoholic solution

–First cause of contact dermatitis in healthcare professionals

–Too much HAS will distrub your commensal flora

  • Toxics ?

–Dangerous for child under 4yo (skin, mouth, eye)

–Triclosan: endocrine disruptor, allergy, cardiac toxicity…

–Ethers de Glycol: congenital malformation, sterility for males, irritant

–Don’t use it if your skin is damaged

What to bring at home?

  • Good practices of antibiotherapy
  • Respect strictly hygiene rules

It seems complicated; You can feel that you’re wasting time. You’re only making a high-quality care and protecting you and other patients from contagious diseases.

  • Protect wounds, prevent complications

Monitor carfeully your patient

Clean as much as needed, as soon as possible

  • Help your patient to fight the disease

Feeding, housing and handling practice adapted