Are the Hands of Veterinary Staff a Reservoir for Antimicrobial-Resistant Bacteria? A Randomized Study to Evaluate Two Hand Hygiene Rubs in a Veterinary Hospital

Educational intervention to improve infection prevention and control practices in four companion animal clinics in Switzerland

BACKGROUND

Infection prevention and control (IPC) practices vary among companion animal clinics, and outbreaks with carbapenemase-producing Enterobacterales (CPE) have been described.

AIM

To investigate the effect of an IPC intervention (introduction of IPC protocols, IPC lectures, hand hygiene campaign) in four companion animal clinics.

METHODS

IPC practices, environmental and hand contamination with antimicrobial-resistant micro-organisms (ARM) and hand hygiene (HH) were assessed at baseline, and 1 and 5 months after the intervention.

RESULTS

Median IPC scores (% maximum score) improved from 57.8% (range 48.0-59.8%) to 82.9% (range 81.4-86.3%) at 1-month follow-up. Median cleaning frequency assessed by fluorescent tagging increased from 16.7% (range 8.9-18.9%) to 30.6% (range 27.8-52.2%) at 1-month follow-up and 32.8% (range 32.2-33.3%) at 5-month follow-up. ARM contamination was low in three clinics at baseline and undetectable after the intervention. One clinic showed extensive contamination with ARM including CPE before and after the intervention (7.5-16.0% ARM-positive samples and 5.0-11.5% CPE-positive samples). Mean HH compliance improved from 20.9% [95% confidence interval (CI) 19.2-22.8%] to 42.5% (95% CI 40.4-44.7%) at 1-month follow-up and 38.7% (95% CI 35.7-41.7%) at 5-month follow-up. Compliance was lowest in the pre-operative preparation area at baseline (11.8%, 95% CI 9.3-14.8%) and in the intensive care unit after the intervention (28.8%, 95% CI 23.3-35.1%). HH compliance was similar in veterinarians (21.5%, 95% CI 19.0-24.3%) and nurses (20.2%, 95% CI 17.9-22.7%) at baseline, but was higher in veterinarians (46.0%, 95% CI 42.9-49.1%) than nurses (39.0%, 95% CI 36.0-42.1%) at 1-month follow-up.

CONCLUSION

The IPC intervention improved IPC scores, cleaning frequency and HH compliance in all clinics. Adapted approaches may be needed in outbreak situations.

Colonization of methicillin-resistant Staphylococcus species in healthy and sick pets: prevalence and risk factors

BACKGROUND

The characterization of staphylococcal species that colonize pets is important to maintain animal health and to minimize the risk of transmission to owners. Here, the prevalence of Staphylococcus spp. and methicillin resistance was investigated in canine and feline isolates, and risk factors of staphylococcal colonization were determined. Pets were examined and separated into four groups: (1) healthy dogs, (2) healthy cats, and (3) dogs and (4) cats with clinical signs of bacterial infections of skin, mucous membranes, or wounds. Specimens were collected by a veterinary physician from six anatomic sites (external ear canal, conjunctival sacs, nares, mouth, skin [groin], and anus). In total, 274 animals (cats n = 161, dogs n = 113) were enrolled.

RESULTS

Staphylococcus species were highly diverse (23 species; 3 coagulase-positive and 20 coagulase-negative species), with the highest variety in healthy cats (19 species). The most frequent feline isolates were S. felis and S. epidermidis, while S. pseudintermedius was the most prevalent isolate in dogs. Risk factors of staphylococcal colonization included the presence of other animals in the same household, medical treatment within the last year, and a medical profession of at least one owner. Methicillin resistance was higher in coagulase-negative (17.86%) compared to coagulase-positive (1.95%) staphylococci. The highest prevalence of methicillin-resistant CoNS colonization was observed in animals kept in homes as the most common (dogs and cats).

CONCLUSIONS

The association of methicillin-resistant CoNS colonization with animals most often chosen as pets, represents a high risk of transmission between them and owners. The importance of nosocomial transmission of CoNS was also confirmed. This information could guide clinical decisions during the treatment of veterinary bacterial infections. In conclusion, the epidemiologic characteristics of CoNS and their pathogenicity in pets and humans require further research.

Animal care professionals' practice towards zoonotic disease management and infection control practice in selected districts of Wolaita zone, Southern Ethiopia

Veterinary practices or activities expose professionals to occupational hazards, including infection with zoonotic diseases, during contact with animals. To assess animal care professionals' practice towards zoonotic disease management and infection control practices (ICPs) in selected areas of the Wolaita zone, a cross-sectional survey was conducted using a structured questionnaire survey. A total of 287 animal care professionals were registered by the Wolaita zone livestock and fishery office and working in nine different districts of the Wolaita zone. Of these, 135 animal care professionals working across nine different districts of the Wolaita zone were interviewed in the current study. The survey showed that about 55% (74/135) of respondents were animal health assistants, and about 84% (114/135) of the professionals were males. In terms of utilization of ICP, about 72% of professionals routinely wash their hands before eating and drinking in their workplace. However, approximately 7% of professionals sometimes eat or drink at the workplace. Additionally, almost 32% of the professionals always wash their hands between patient contacts. In the survey, approximately 49% of veterinarians said they sterilized and reused disposable needles. When dealing with an animal suspected of carrying a zoonotic infection, nearly 25% of experts isolate or quarantine diseased animals, and only about 25% of the experts remove their personal protective equipment (PPE) before interacting with other animals. Approximately 62% of responders said they used outwear (PPE) when carrying out surgery and 28% when performing a necropsy. Nearly 39% of veterinarians reported using gloves and gowns when assisting with parturition or handling conception products, and around 36% of practitioners utilized proper PPE when handling blood samples. Our findings show that the veterinary community in the Wolaita Zone's selected sites needs to be educated about ICPs regularly. A better understanding of the risk of zoonotic disease exposure, as well as alternatives for reducing this risk and liability problems, may encourage the use of infection control measures. Successful partnerships across multiple professional sectors should use a One Health approach that includes stakeholders from the human, animal, and environmental categories.

Antimicrobial resistance pattern of methicillin-resistant Staphylococcus aureus isolated from sheep and humans in Veterinary Hospital Maiduguri, Nigeria

Background and Aim: Methicillin-resistant Staphylococcus aureus (MRSA), an important opportunistic pathogen, is a Gram-positive coccus known to be resistant to β-lactam antibiotics. Its virulence depends on a large range of factors, mainly extracellular proteins, such as enzymes and exotoxins, that contribute to causing a wide range of diseases in human and animal species. The major reasons for the success of this pathogen are its great variability, which enables it to occur and thrive at different periods and places with diverse clonal types and antibiotic resistance patterns within regions and countries. Infections caused by antibiotic-resistant S. aureus bring about serious problems in the general population (humans and animals). Infections with these pathogens can be devastating, particularly for the very young, adults and immunocompromised patients in both humans and animals. This study aimed to determine the presence of MRSA in both apparently healthy and sick sheep brought to the veterinary hospital as well as veterinary staff and students on clinical attachment in the hospital. Materials and Methods: A total of 200 nasal swab samples were collected aseptically from sheep and humans (100 each) for the isolation of MRSA. The samples were processed by appropriately transporting them to the laboratory, then propagated in nutrient broth at 37°C for 24 h followed by subculturing on mannitol salt agar at 37°C for 24 h, to identify S. aureus. This was followed by biochemical tests (catalase and coagulase tests) and Gram staining. MRSA was isolated using Clinical Laboratory Standard Institute (CLSI) guideline and confirmed by plating onto Oxacillin (OX) Resistance Screening Agar Base agar. The antimicrobial susceptibility pattern of the MRSA isolates was determined using the disk diffusion method against 12 commonly used antimicrobial agents. Results: The total rate of nasal carriage of S. aureus and MRSA was found to be 51% and 43% in sheep and humans, respectively. The MRSA prevalence in male and female sheep was 18% and 8%, while 9% and 8% were for male and female human samples, respectively. The antimicrobial susceptibility test showed 100% resistance to OX, cefoxitin, oxytetracycline, cephazolin, and penicillin-G (Pen) by MRSA isolates from humans. Conversely, there was 100% susceptibility to ciprofloxacin, imipenem, and gentamicin; for linezolid (LZD), it was 87.5%, norfloxacin (NOR) (71%), and erythromycin (ERY) (50%) susceptibility was recorded. The MRSA isolates from sheep recorded 100% resistance to the same set of drugs used for human MRSA isolates and were equally 100% susceptible to gentamicin, imipenem, LZD, ciprofloxacin, NOR (92%), and ERY (50%). Conclusion: This study determined the presence of MRSA in sheep and humans from the Veterinary Hospital, Maiduguri. It appears that certain drugs such as ciprofloxacin, imipenem, and gentamicin will continue to remain effective against MRSA associated with humans and sheep. Reasons for the observed patterns of resistance must be explored to reduce the burdens of MRSA resistance. Furthermore, the present study did not confirm the MRSA resistance genes such as mecA and spa typing to ascertain the polymorphism in the X-region using appropriate molecular techniques. Hence more studies need to be conducted to elucidate these findings using robust techniques.

Staphylococcus pseudintermedius: Is it a real threat to human health?

Staphylococcus Intermedius Group (SIG) staphylococci, especially Staphylococcus pseudintermedius (S. pseudintermedius), share many features with the common human Staphylococcus aureus. The similarities concern both the phenotypic characteristics and virulence of the bacteria. It is a cause of difficulties in identifying the species of isolated staphylococci. Until now, S. pseudintermedius was considered a typically animal species, of marginal importance for humans. However, it is likely that the incidence of this staphylococcus in humans is underestimated due to the misidentification of S. pseudintermedius strains as S. aureus. The cases of infections caused by S. pseudintermedius both in humans and animals described so far in the literature show that these bacteria have a similar pathogenic potential. S. pseudintermedius also produces virulence factors that favor colonization of various body regions and infections, and may affect the species composition of the natural microbiota and the host’s immune response mechanisms. Also, S. pseudintermedius may show the ability to grow in the form of a biofilm, which significantly impedes effective antibiotic therapy in clinical practice. Due to its zoonotic potential, S. pseudintermedius deserves the attention of physicians and animal owners.

Hand Hygiene Evaluation Using Two Different Evaluation Tools and Hand Contamination of Veterinary Healthcare Workers in a Swiss Companion Animal Clinic

Hand hygiene (HH) is the most important measure to prevent nosocomial infections. HH compliance in companion animal clinics has been reported to be poor. The present study compared an online application with the WHO evaluation form to assess the WHO five moments of HH in a Swiss companion animal clinic. In 202 hand swabs from 87 staff members, total viable count (TVC) before and after patient contact was evaluated and the swabs were tested for selected antimicrobial resistant microorganisms of public health importance. HH compliance (95% confidence interval) was 36.6% (33.8–39.5%) and was similar when assessed with the two evaluation tools. HH differed between hospital areas (p = 0.0035) and HH indications (p < 0.0001). Gloves were worn in 22.0% (18.0–26.6%) of HH observations and were indicated in 37.2% (27.3–48.3%) of these observations. Mean TVC before patient contact was lower (0.52 log CFU/cm²) than after patient contact (1.02 log CFU/cm²) but was similar before patient contact on gloved and ungloved hands. Three hand swabs (1.5% (0.4–4.3%)) were positive for methicillin-resistant Staphylococcus aureus. Gloving should not be regarded as a substitute for HH. Overall, HH in companion animal medicine should urgently be fostered.

Infection prevention and control practices of ambulatory veterinarians: A questionnaire study in Finland

BACKGROUND

Veterinarians face the risk of contracting zoonotic pathogens. Infection prevention and control (IPC) guidelines stress the importance of proper hand hygiene and personal protective equipment (PPE) to prevent transmission of these pathogens.

OBJECTIVES

We aimed to assess how ambulatory livestock and equine veterinarians follow IPC guidelines, when working on farms and in stables.

METHODS

We studied hygiene practices of livestock and equine ambulatory veterinarians (n = 129) in Finland. A web-based questionnaire was used to obtain demographic information and information regarding hand-hygiene facilities and practices, use and cleaning of PPE and cleaning of medical equipment.

RESULTS

According to 66.9% of the respondents, hand-washing facilities were often adequate on livestock farms, but only 21.4% reported that this was the case in stables (p < .001). While 75.0% reported washing their hands or using hand sanitizer always before moving on to the next farm, only 42.5% reported doing this before moving on to the next stables (p < .001). Universal protective coat or coverall use was more common in livestock practice than in equine practice (91.6% vs. 27.7%, p < .001). Stethoscope cleaning was reported to happen less frequently than once a week by 30.0% of the respondents.

CONCLUSIONS

Finnish veterinarians' self-reported IPC adherence was far from uniform. IPC was more commonly followed in ambulatory livestock practice perhaps facilitated by better hand-washing facilities on farms than in stables. The study suggests that education of veterinarians is still needed and that hand-washing facilities need to be improved even in a high-income country.

Natural disasters and infectious disease in Europe: a literature review to identify cascading risk pathways

Background

Natural disasters are increasing in their frequency and complexity. Understanding how their cascading effects can lead to infectious disease outbreaks is important for developing cross-sectoral preparedness strategies. The review focussed on earthquakes and floods because of their importance in Europe and their potential to elucidate the pathways through which natural disasters can lead to infectious disease outbreaks.

Methods

A systematic literature review complemented by a call for evidence was conducted to identify earthquake or flooding events in Europe associated with potential infectious disease events.

Results

This review included 17 peer-reviewed papers that reported on suspected and confirmed infectious disease outbreaks following earthquakes (4 reports) or flooding (13 reports) in Europe. The majority of reports related to food- and water-borne disease. Eleven studies described the cascading effect of post-disaster outbreaks. The most reported driver of disease outbreaks was heavy rainfall, which led to cross-connections between water and other environmental systems, leading to the contamination of rivers, lakes, springs and water supplies. Exposure to contaminated surface water or floodwater following flooding, exposure to animal excreta and post-disaster living conditions were among other reported drivers of outbreaks.

Conclusions

The cascade effects of natural disasters, such as earthquakes and floods, include outbreaks of infectious disease. The projection that climate change-related extreme weather events will increase in Europe in the coming century highlights the importance of strengthening preparedness planning and measures to mitigate and control outbreaks in post-disaster settings.

Zoonotic Disease Management and Infection Control Practices Among Veterinarians in the United Arab Emirates

This study was conducted to assess zoonotic disease management and infection control practices (ICPs) among veterinarians in the United Arab Emirates (UAE). A questionnaire was developed in SurveyMonkey, an online tool, and was distributed by email during February–May 2020 to 470 veterinarians practicing across the UAE. A total of 110 individuals completed the survey, giving a response rate of 23.4% (110/470). Results indicate that reported hand hygiene, sharps management, barrier or isolation practices, and personal choices for personal protective equipment (PPE) in common practice scenarios varied among practitioners. The majority (>75%) of veterinarians in all practice types reported always washing their hands before eating, drinking, or smoking at work. The survey revealed that 19% and 10% of large and small animal veterinarians indicated they sterilized and reused disposable needles. Veterinarians among all practices indicated high rates (75% to 80%) of recapping needles before disposal. When handling an animal suspected of having a zoonotic disease, most (90%) of small animal veterinarians reported always using practices such as isolating the animal and removing outwear before contact with other animals. However, only half (55%) of the large animal respondents reported always isolating the animal or sterilizing all equipment used on the animal of concern. Fewer than half of the large animal (35%) and mixed practice (44%) veterinarians indicated they would always be limiting human contact with the animal of concern. All of the small animal respondents reported full compliance with PPE while performing surgery and necropsy. Among large animal veterinarians, 44% reported not using respiratory or eye protection when aiding with parturition or handling conception products. Failure to use appropriate PPE when handling blood samples was the second most common noncompliant practice among large animal (39%) veterinarians and mixed practice (41%) respondents. Our study indicates a need for continuous education regarding ICPs in the veterinary community in the UAE. Better awareness of the risk of zoonotic disease exposure and options for managing this risk and liability issues could drive the adoption of infection control practices.

Transmission Chains of Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae at the Companion Animal Veterinary Clinic-Household Interface

Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) among animals and humans are a public health threat. This study analyzed the occurrence of ESBL-E in a high-risk environment in a companion animal clinic and two animal patients’ households. In an intensive care unit (ICU), rectal swabs from 74 dogs and cats, 74 hand swabs from staff and 298 swabs from surfaces were analyzed for ESBL-E. Seventeen hospitalized patients (23%) and ten (3%) surfaces in the ICU tested ESBL-E positive. Transmission chains for Klebsiella pneumoniae ST307 bla_CTX-M-15 and Escherichia coli ST38 bla_CTX-M-14, ST88 bla_CTX-M-14 and ST224 bla_CTX-M-1 were observed over extended periods of time (14 to 30 days) with similar strains isolated from patients and the clinical environment. After discharge, two colonized dogs (dogs 7 and 12) and their household contacts were resampled. Dog 7 tested repeatedly positive for 77 days, dog 12 tested negative; six (24%) surfaces in the household of the persistently colonized dog tested ESBL-E positive. The owner of dog 7 and one of the owners of dog 12 were colonized. Based on whole genome sequencing, isolates from the owners, their dogs and other ICU patients belonged to the same clusters, highlighting the public health importance of ESBL-E in companion animal clinics.

Biocide Potentiation Using Cinnamic Phytochemicals and Derivatives

Surface disinfection is of utmost importance in the prevention of bacterial infections. This study aims to assess the ability of ten phytochemicals and related derivatives as potentiators of two commonly used biocides-cetyltrimethylammonium bromide (CTAB) and lactic acid (LA). LA in combination with cinnamic, hydrocinnamic, α-methylcinnamic, and α-fluorocinnamic acids had a factional inhibitory concentration index (FICI) ≤ 1 for Escherichia coli and Staphylococcus aureus. Several phytochemicals/derivatives in combination with biocides improved the biocidal efficacy against early sessile bacteria. The most effective combination was LA with allyl cinnamate (2.98 ± 0.76 log CFU.cm^-2 reduction) against E. coli. The combination with CTAB was successful for most phytochemicals/derivatives with a maximum bactericidal efficacy against sessile E. coli when combined with allyl cinnamate (2.20 ± 0.07 log CFU.cm^-2 reduction) and for S. aureus when combined with α-methylcinnamic acid (1.68 ± 0.30 log CFU.cm^-2 reduction). This study highlights the potential of phytochemicals and their derivatives to be used in biocide formulations.