Evaluation of the efficacy of disinfectant footbaths as used in veterinary hospitals

The efficacy of a range of hygiene measures for boot cleaning to protect natural vegetation from Phytophthora cinnamomi

Phytophthora cinnamomi is an oomycete found in the soil and capable of invading the roots of a wide range of host plants globally, potentially killing them and affecting the ecosystems they inhabit. This pathogen is often inadvertently dispersed in natural vegetation on the footwear of humans. A range of equipment is often provided or recommended to be carried for cleaning footwear in places where P. cinnamomi poses a threat to biodiversity. These are typically a brush for mechanically removing soil and/or a disinfectant for killing the pathogen. Despite their widespread use, to our knowledge, the majority of hygiene measures have not been experimentally tested for their efficacy. In the current study, we tested whether two types of brush and the two most widely used disinfectants (70% methylated spirits and benzalkonium chloride) were effective in removing the pathogen from boots. We tested the brushes and disinfectants in two soil types and two moisture levels. All hygiene measures were found to be better than doing nothing, although some were only effective with sandy or dry soils. Benzalkonium chloride was largely ineffective as a spray but highly effective when used in a footbath. Brushing did not improve cleaning when used with 70% methylated spirits. None of the hygiene measures was completely effective for cleaning boots that had been in wet loamy soil. Our findings have important implications for management of this threat because some recommended hygiene practices are not doing what they claim.

Internal audits as a tool to assess the compliance with biosecurity rules in a veterinary faculty

Introduction

The present paper proposes a tool to follow up the compliance of staff and students with biosecurity rules, as enforced in a veterinary faculty, i.e., animal clinics, teaching laboratories, dissection rooms, and educational pig herd and farm.

Methods

Starting from a generic list of items gathered into several categories (personal dress and equipment, animal-related items, infrastructures, waste management, management of material/equipment and behavior), a checklist was created for each sector/activity mentioned above, based on the rules and procedures compiled in the Faculty biosecurity standard operating procedures. Checklists were created as Excel™ files. For each sector, several sheets were elaborated, i.e., one per specific activity: for example, the following sheets were created for the equine clinic: class 1-2 hospitalization (class 1 = non-infectious conditions; class 2 = infectious disease with a low or non-existent risk of transmission), class 3 hospitalization (class 3 = infectious disease with a moderate risk of transmission; these patients are suspected of having an infectious disease and being contagious for other patients and/or for humans) and consultation.

Results

Class 4 area, which corresponds to the isolation unit and aims at housing patients suffering from infectious diseases with a significant risk of transmission (including notifiable conditions), was not audited at that period, as it was undergoing renovation works. The audit relied on observations performed by a unique observer to ensure standardization. Observed items were presented as yes/no and multiple-choice questions. A scale from 0 to 3 or 4 (depending on the item) allowed scoring each item, i.e., 0 corresponding to 100% compliance with the procedure and the highest score to the worst situation. A median and average global score was also estimated by category and by activity.

Discussion

The methodology described in the present paper allows estimating the compliance with biosecurity standard operating procedures in a specific sector and/or for a given activity. The identification of criteria needing improvement is a key point: it helps prioritizing actions to be implemented and awareness raising among people concerned. Regular internal auditing is an essential part of a biosecurity plan, the frequency being conditioned by the risk linked to a specific activity or area (i.e., more frequent audits in risky situations).

Susceptibility of Escherichia coli O157:H7 to Disinfectants In Vitro and in Simulated Footbaths Amended with Manure

Escherichia coli O157:H7 is a human pathogen associated with gastrointestinal disease and hemolytic uremic syndrome. Direct contact with ruminants and their feces at agritourism or livestock interaction events is a known source of transmission. Footbath use is a pathogen reduction strategy that may decrease the transmission of E. coli O157:H7 at these interactions. The efficacy of chemical disinfectants in footbaths is not well reported. Our objective was to determine the susceptibility of E. coli O157:H7 toward commonly used disinfectants in vitro and within contaminated footbaths. The minimum inhibitory concentration and the minimum bactericidal concentration (MIC and MBC) and the time-to-kill were determined in vitro for seven E. coli O157:H7 strains using five disinfectant compounds (didecyldimethylammonium chloride [DDAC], glutaraldehyde, hydrogen peroxide, phenol, and sodium hypochlorite). Time-kill assays were performed within simulated footbaths at 22°C, 37°C, and 42°C with and without organic contamination using three commercial disinfectants with similar active ingredients (0.26% Clorox^® Bleach, 0.034% Virex^® II 256, and 1% Virkon^™ S). The MBCs of disinfectants toward E. coli O157:H7 were 3.2, 625, 40, 5000, and 320 ppm of DDAC, glutaraldehyde, hydrogen peroxide, phenol, and sodium hypochlorite, respectively. At 2 × MIC, E. coli O157:H7 reached a 3 log₁₀(colony-forming unit [CFU]/mL) reduction on contact with glutaraldehyde, by 20 min with DDAC and sodium hypochlorite, and by 4 h with phenol and hydrogen peroxide. In simulated footbaths, the commercial disinfectants reduced concentrations by 3 log₁₀(CFU/mL) on contact in the absence of organic contamination, but viable E. coli O157:H7 was recovered from organically contaminated Clorox Bleach and Virex II 256 footbaths. No E. coli O157:H7 was recovered from the Virkon S footbaths after 10 min. This study highlights the ability for organic contamination to compromise the efficacy of disinfectants in footbaths and the importance of choosing an appropriate footbath disinfectant to retain the efficacy.

Prevention of microbial species introductions to the Arctic: The efficacy of footwear disinfection measures on cruise ships

Biosecurity measures are commonly used to prevent the introduction of non-native species to natural environments globally, yet the efficacy of practices is rarely tested under operational conditions. A voluntary biosecurity measure was trialled in the Norwegian high Arctic following concern that non-native species might be transferred to the region on the footwear of travellers. Passengers aboard an expedition cruise ship disinfected their footwear with the broad spectrum disinfectant Virkon S prior to and in-between landing at sites around the remote Svalbard archipelago. The authors evaluated the efficacy of simply stepping through a disinfectant foot bath, which is the most common practice of footwear disinfection aboard expedition cruise ships in the Arctic. This was compared to a more time consuming and little-used method involving drying disinfected footwear, as proposed by other studies. The two practices were evaluated by measuring microbial growth on paired footwear samples before and after disinfection under both conditions. Step-through disinfection did not substantially reduce microbial growth on the footwear. Allowing disinfected footwear to dry, however, reduced the microbial burden significantly to lower levels. Thus, the currently adopted procedures used aboard ships are ineffective at removing microbial burden and are only effective when footwear is given more time to dry than currently granted under operational conditions. These findings underscore results from empirical research performed elsewhere and suggest the need to better relay this information to practitioners. It is suggested that footwear should minimally be wiped dry after step-through disinfection as a reasonable compromise between biosecurity and practicability.

Evaluation of the Efficacy of Disinfectant Footmats for the Reduction of Bacterial Contamination on Footwear in a Large Animal Veterinary Hospital

Background

Infection control is critical to providing high‐quality patient care. Many veterinary teaching hospitals (VTHs) utilize footbaths or footmats at entrances and key control points throughout the facility to decrease trafficking of pathogenic microorganism on contaminated footwear.

Hypothesis/Objectives

To compare efficacy of 4 disinfectants used in footmats for decreasing bacterial contamination of footwear in a large animal hospital.

Animals

A single adult dairy cow was housed in a stall for 4 days to facilitate stall contamination with fecal material.

Methods

Overboots were experimentally contaminated with organic material in a standardized manner. Each boot was randomly assigned to 1 of 5 treatments (no treatment, or exposure to 1 of 4 disinfectants: an accelerated peroxygen [AHP], a peroxygen [VIRKON], a quaternary ammonium [QUAT], and a phenolic disinfectant [PHENOLIC]) by stepping on a soaked footmat and collecting samples from boot soles. Generalized linear modeling was used to analyze differences in bacterial counts.

Results

Reductions in colony‐forming units (CFUs) on treated boots ranged from no detectable reduction to 0.45 log₁₀ and varied by disinfectant. Percentage reductions in total bacterial counts generally were larger (albeit still modest) for AHP and QUAT disinfectants (range 37–45%) and smallest for the PHENOLIC (no detectable reduction).

Conclusions and Clinical Importance

In general, use of disinfectant footmats was associated with significant reductions in viable bacteria on overboots—albeit with variable efficacy. Footmats may be useful adjuncts to cleaning and disinfection programs for decreasing trafficking of microorganisms throughout VTHs but should not be considered as a sole prevention method.

Shoe soles as a potential vector for pathogen transmission: a systematic review

Shoe soles are possible vectors for infectious diseases. Although studies have been performed to assess the prevalence of infectious pathogens on shoe soles and decontamination techniques, no systematic review has ever occurred. The aim of this study was to perform a systematic review of the literature to determine the prevalence of infectious agents on shoe bottoms and possible decontamination strategies. Three electronic bibliographic databases were searched using a predefined search strategy evaluating prevalence of infectious pathogens on shoe bottoms and decontamination strategies. Quality assessment was performed independently by two reviews with disagreements resolved by consensus. Thirteen studies were identified that supported the hypothesis that shoe soles are a vector for infectious pathogens. Methicillin-resistant Staphylococcus aureus, Clostridium difficile and multidrug-resistant Gram-negative species among other pathogens were documented on shoe bottoms in the health care setting, in the community and among food workers. Fifteen studies were identified that investigated decontamination strategies for shoe soles. A number of decontamination strategies have been studied of which none have been shown to be consistently successful at disinfecting shoe soles. In conclusion, a high prevalence of microbiological pathogens was identified from shoe soles studied in the health care, community and animal worker setting. An effective decontamination strategy for shoe soles was not identified. Studies are needed to assess the potential for contaminated shoes to contribute to the transmission of infectious pathogens.

Comparison of methods to control floor contamination in an animal research facility

The authors evaluated the effectiveness of adhesive mats, contamination control flooring, and shoe covers in decreasing the presence of microbial agents on animal holding room floors and footwear. Swab samples taken from animal holding room floors after the use of each product were compared with samples taken from rooms after no products were used. Swab samples were also taken from the heels and soles of the footwear of animal care staff before and after use of each product. The use of contamination control flooring or shoe covers significantly reduced the amount of organic material (as indicated by ATP levels measured by a luminometer) present on floors. Bacterial and ATP contamination of footwear was significantly lower after the use of shoe covers than after the use of adhesive mats or contamination control flooring, and the use of shoe covers led to a greater decrease in contamination before and after use than did use of either of the other two products. Although shoe covers were superior to both adhesive mats and contamination control flooring for decreasing contamination of animal room floors and footwear, facilities must take into account the contamination control standards required, the cost of the product, and the labor and time associated with product use when deciding which contamination control practices to implement.

Biosecurity on cattle farms: a study in north-west England

BACKGROUND

Few studies have considered in detail the range of biosecurity practices undertaken on cattle farms, particularly within the UK. In this study, 56 cattle farmers in a 100 km² area of north-west England were questioned regarding their on-farm biosecurity practices, including those relating to animal movements, equipment sharing and companies and contractors visiting the farms.

METHODOLOGY/PRINCIPAL FINDINGS

There was great variation between farms in terms of the type of, and extent to which, biosecurity was carried out. For example, the majority of farmers did not isolate stock bought onto the farm, but a small proportion always isolated stock. Many farmers administered treatments post-movement, primarily vaccinations and anthelmintics, but very few farms reported carrying out any health checks after moving animals on. In addition, there appeared to be much variation in the amount of biosecurity carried out by the different companies and contractors visiting the farms. Deadstock collectors and contracted animal waste spreaders, although likely to have a high potential for contact with infectious agents, were reported to infrequently disinfect themselves and their vehicles.

CONCLUSIONS/SIGNIFICANCE

These findings suggest that although certain biosecurity practices are undertaken, many are carried out infrequently or not at all. This may be due to many factors, including cost (in time and money), lack of proven efficacies of practices and lack of relevant education of veterinary surgeons, producers and other herd health specialists. Further research exploring the reasons for the lack of uptake is imperative if preventive medicine is to be utilised fully by the farming industry.

Detection and control of a nosocomial outbreak caused by Salmonella newport at a large animal hospital

BACKGROUND

Nosocomial salmonellosis is often assumed to occur because infection control and surveillance practices are inadequate, but published evidence is lacking to support the related contention that rigorous application of these practices can impact the severity of outbreaks.

OBJECTIVE

Describe active surveillance, early recognition, and intensive mitigation efforts used in an effort to control an outbreak of nosocomial Salmonella enterica serotype Newport infections without hospital closure.

ANIMALS

Large animals hospitalized at a referral hospital.

METHODS

This prospective outbreak investigation was initiated when Salmonella Newport infections were detected among hospitalized animals by active surveillance. Data were analyzed to identify temporal and spatial patterns for epidemic spread of Salmonella in the hospital. Mitigation efforts were aggressively adjusted in response to surveillance data. Genetic relatedness of isolates was investigated by pulsed-field gel electrophoresis.

RESULTS

Of 145 large animals sampled, 8 (5.6%) were infected with the Salmonella strain associated with this outbreak, and all but 1 shed Salmonella in the absence of or before the onset of disease. This strain was recovered from 14.2% (42/295) of environmental samples (ENV samples), indicating that widespread environmental contamination had occurred. Isolates of Salmonella Newport obtained from infected animals and the environment were genetically indistinguishable, confirming clonal dissemination.

CONCLUSIONS AND CLINICAL IMPORTANCE

Active surveillance allowed early detection of nosocomial Salmonella transmission and hospital contamination. Use of aggressive interventions was followed by cessation of transmission. Active surveillance can allow earlier recognition and mitigation compared with programs by only sampling of clinically affected animals.

Characteristics of biosecurity and infection control programs at veterinary teaching hospitals

OBJECTIVE

To characterize biosecurity and infection control practices at veterinary teaching hospitals located at institutions accredited by the AVMA.

DESIGN

Cross-sectional survey.

POPULATION

50 biosecurity experts at 38 veterinary teaching hospitals.

PROCEDURES

Telephone interviews were conducted between July 2006 and July 2007, and questions were asked regarding policies for hygiene, surveillance, patient contact, education, and awareness. Respondents were also asked their opinion regarding the rigor of their programs.

RESULTS

31 of 38 (82%) hospitals reported outbreaks of nosocomial infection during the 5 years prior to the interview, 17 (45%) reported > 1 outbreak, 22 (58%) had restricted patient admissions to aid mitigation, and 12 (32%) had completely closed sections of the facility to control disease spread. Nineteen (50%) hospitals reported that zoonotic infections had occurred during the 2 years prior to the interview. Only 16 (42%) hospitals required personnel to complete a biosecurity training program, but 20 of the 50 (40%) respondents indicated that they believed their hospitals ranked among the top 10% in regard to rigor of infection control efforts.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggested that differences existed among infection control programs at these institutions. Perceptions of experts regarding program rigor appeared to be skewed, possibly because of a lack of published data characterizing programs at other institutions. Results may provide a stimulus for hospital administrators to better optimize biosecurity and infection control programs at their hospitals and thereby optimize patient care.

Comparison of Salmonella enterica serotype Infantis isolates from a veterinary teaching hospital

AIMS

To compare Salmonella enterica serotype Infantis isolates obtained from patients or the environment of a veterinary teaching hospital over a period of 9 years following a nosocomial outbreak to determine whether isolates were epidemiologically related or represented unrelated introductions into the hospital environment.

METHODS AND RESULTS

Fifty-six S. Infantis isolates were compared based on their phenotypic (antimicrobial drug [AMD] susceptibility pattern) and genotypic (pulsed-field gel electrophoresis [PFGE] pattern and presence of integrons) characteristics. Epidemiologically unrelated S. Infantis isolates clustered separately from all but two of the hospital isolates, and several isolates from different years and various sources were indistinguishable from each other in cluster analysis of two-enzyme PFGE results. A high percentage of isolates (80.3%) were resistant to at least one AMD, with 67.8% showing resistance to >5 AMD. The majority (74.1%) of isolates tested contained type 1 integrons.

CONCLUSION

Results strongly suggest that there was nosocomial transmission of S. Infantis during the initial outbreak, and that contamination arising from this outbreak persisted across years despite rigorous hygiene and biosecurity precautions and may have led to subsequent nosocomial infections.

SIGNIFICANCE AND IMPACT OF THE STUDY

Evidence of persistence and transmission of Salmonella clones across years, even in the face of rigorous preventive measures, has important implications for other facilities that have experienced outbreaks of Salmonella infections.

Combined Effect of Heat, Essential Oils and Salt on the Fungicidal Activity against Trichophyton mentagrophytes in Foot Bath

This work was originally undertaken to determine the effective conditions of essential oils against Trichophyton mentagrophytes in vitro for the treatment of tinea pedis in a foot bath. Agar blocks implanted with T. mentagrophytes were immersed in 0.1% aqueous agar containing two-fold dilutions of essential oils with or without sodium chloride at 27 degrees C, 37 degrees C and 42 degrees C for 10 and 20 min. The number of surviving mycelia on the agar blocks was determined from the standard curves of the colony diameter and original inocula of the conidia. At the same time, the thermal effect on the cellular morphology was examined using SEM. Most fungal mycelia (99.7%) were killed after treatment at 42 degrees C for 20 min without essential oil. The fungicidal activity of essential oils was markedly enhanced by treating at 42 degrees C for 20 min as compared with that at 27 degrees C, showing 1/4 - 1/32-fold reduction of minimum fungicidal concentration (MFC to kill 99.99%). The order of the fungicidal activity of 11 essential oils was oregano, thyme thymol, cinnamon bark > lemongrass > clove, palmarose, peppermint, lavender > geranium Bourbon, tea tree > thyme geraniol oils. MFCs were further reduced to 1/2 - 1/8 by the addition of 10% sodium chloride. The salt effect was explained, at least partly, by an increase in mycelial adsorption of antifungal constituents in the presence of sodium chloride. Considerable hyphal damage was done at 27 degrees C by the essential oils, but no further alteration in morphology of the hyphae treated at 42 degrees C with or without oil was observed by SEM. The inhibitory effect of heat and oils was also observed against mycelia of T. rubrum and conidia of T. mentagrophytes. Thermotherapy combined with essential oils and salt would be promising to treat tinea pedis in a foot bath.

Evaluation of the efficacy of a peroxygen disinfectant-filled footmat for reduction of bacterial load on footwear in a large animal hospital setting

OBJECTIVE-To compare the efficacy of a peroxygenbased disinfectant used in footbaths with the efficacy of the same disinfectant used in footmats for reducing bacterial contamination of footwear in a large animal hospital. DESIGN-Prospective study. SAMPLE POPULATION-Bacteria recovered from the soles of rubber boots after experimental microbial contamination and exposure to disinfectant solutions or water (water-treated control boots) or no treatment (untreated control boots). PROCEDURES-Investigators contaminated boots by walking through soiled animal bedding. Swab samples were collected from the sole of 1 untreated boot (right or left); the other boot was treated as investigators stepped through a disinfectant-filled footbath, a disinfectant-filled footmat, or water-filled footmat. Samples were collected 10 minutes after each treatment. Differences in numbers of bacteria recovered from treated and untreated boots were analyzed. RESULTS-Mean bacterial counts from peroxygentreated boots were 1.3 to 1.4 log(10) lower (95.4% to 99.8%) than the counts from untreated boots. Results were similar for footmat- and footbath-treated boots. In contrast, there were no statistically detectable differences in mean bacterial counts in samples collected from water-treated or untreated boots. CONCLUSIONS AND CLINICAL RELEVANCE-Results suggest that footmats and footbaths containing peroxygenbased disinfectant are effective in reducing bacterial contamination on the soles of boots when used in conditions representative of large animal hospitals. Similar results were achieved with use of either footmats or footbaths. The use of footbaths and footmats containing effective disinfectants may help decrease the risk for spread of nosocomial infection but should not be expected to sterilize footwear.

Effectiveness of using a mat filled with a peroxygen disinfectant to minimize shoe sole contamination in a veterinary hospital

OBJECTIVE

To determine the effectiveness of using a disinfectant mat filled with a peroxygen compound to prevent mechanical transmission of bacteria via contaminated footwear between the food animal ward and common breezeway of a veterinary teaching hospital.

DESIGN

Observational study.

SAMPLE POPULATION

Shoe soles of individuals entering and exiting from the ward.

PROCEDURES

A mat filled with peroxygen disinfectant was placed at the entrance to the food animal ward, and participants wiped each shoe twice on the mat surface (n = 16) or walked on the mat surface but did not wipe their shoes (17) before entering and exiting from the ward. Swab specimens were collected from the shoe soles of participants before and after mat use and submitted for bacterial culture.

RESULTS

For both study days, as participants entered the ward, median number of aerobic bacteria isolated from shoe swab specimens collected prior to use of the disinfectant mat was not significantly different from median number isolated after use of the disinfectant mat. However, as participants exited the ward, median number of aerobic bacteria isolated from shoe swab specimens collected prior to use of the disinfectant mat was significantly higher than median number isolated after use of the disinfectant mat.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggest that placing a mat filled with a peroxygen disinfectant at the exit from the food animal ward of a veterinary teaching hospital may help reduce mechanical transmission of bacteria on the footwear of individuals leaving the ward.

Evaluation of the effects of footwear hygiene protocols on nonspecific bacterial contamination of floor surfaces in an equine hospital

OBJECTIVE

To evaluate the effects of footwear hygiene protocols on bacterial contamination of floor surfaces in an equine hospital.

DESIGN

Field trial.

PROCEDURES

Footwear hygiene protocols evaluated included use of rubber overboots with footbaths and footmats containing a quaternary ammonium disinfectant, rubber overboots with footbaths and footmats containing a peroxygen disinfectant, and no restrictions on footwear type but mandatory use of footbaths and footmats containing a peroxygen disinfectant. Nonspecific aerobic bacterial counts were determined via 2 procedures for sample collection and bacterial enumeration (contact plates vs swabbing combined with use of spread plates), and the effects of each footwear hygiene protocol were compared.

RESULTS

There were no consistent findings suggesting that any of the protocols were associated with differences in numbers of bacteria recovered from floor surfaces. Although there were detectable differences in numbers of bacteria recovered in association with different footwear hygiene protocols, differences in least square mean bacterial counts did not appear to be clinically relevant (ie, were < 1 log10).

CONCLUSIONS AND CLINICAL RELEVANCE

Although cleaning and disinfection of footwear are important aids in reducing the risk of nosocomial transmission of infectious agents in veterinary hospitals, the numbers of aerobic bacteria recovered from floor surfaces were not affected by use of rubber overboots or the types of disinfectant used in this study. Further study is warranted to evaluate the usefulness of footwear hygiene practices relative to their efficacy for reducing transmission of specific pathogens or decreasing nosocomial disease risk.

Efficacy of directed misting application of a peroxygen disinfectant for environmental decontamination of a veterinary hospital

OBJECTIVE

To evaluate effectiveness of 4% peroxymonosulfate disinfectant applied as a mist to surfaces in a large animal hospital as measured by recovery of Staphylococcus aureus and Salmonella enterica serovar Typhimurium.

DESIGN

Field trial.

SAMPLE POPULATION

Polyester transparencies inoculated with bacteria.

PROCEDURE

Polyester transparencies were inoculated with S aureus or S Typhimurium and placed in various locations in the hospital. After mist application of the peroxygen disinfectant, viable bacterial numbers were quantified and compared with growth from control transparencies to assess reduction in bacterial count.

RESULTS

When applied as a mist directed at environmental surfaces contaminated with a geometric mean of 4.03 x 10(7) CFUs of S aureus (95% confidence interval [CI], 3.95 x 10(7) to 4.11 x 10(7)) or 6.17 x 10(6) CFUs of S Typhimurium (95% Cl, 5.55 x 10(6) to 6.86 x 10(6)), 4% peroxymonosulfate reduced the geometric mean number of viable S aureus by 3.04 x 10(7) CFUs (95% Cl, 8.6 x 10(5) to 1.7 x 10(6)) and S Typhimurium by 3.97 x 10(6) CFUs (95% Cl, 8.6 x 10(5) to 3.5 x 10(6)).

CONCLUSIONS AND CLINICAL RELEVANCE

Environmental disinfection with directed mist application of a 4% peroxymonosulfate solution was successful in reducing counts of bacterial CFUs by > 99.9999%. Directed mist application with this peroxygen disinfectant as evaluated in this study appeared to be an effective and efficient means of environmental disinfection in a large animal veterinary hospital and would be less disruptive than more traditional approaches to intensive environmental cleaning and disinfection.