Management of infec-ous diseases in a high volume se4ng Holly Putnam, DVM College of Veterinary Medicine Cornell University Per-nence • • • • HQHVSN clinics Wellness clinics Shelters Private prac-ces Animal demographics • • • • • Owned Shelter Feral Pediatric Immune-‐compromised Unique situa-on • • • • • Large number of animals Limited medical history Close proximity Shared equipment Limited -me Sound like a recipe for disaster? Significance • High Quality – Medicine – Surgery • Responsibility – Professional – Ethical Significance • • • • • Individual animal morbidity Individual animal mortality In-‐home disease transmission Shelter-‐wide disease outbreaks Free-‐roaming cat morbidity & mortality Significance “As is typical for any surgery, standard procedures for controlling poten4al infec4ous diseases should be prac4ced.” ASV spay-‐neuter program guidelines Infec-ous pathogens Viral • FHV-‐1 • Calici virus • Feline Panleukopenia • Canine parvovirus • CIRDC • Canine Influenza • Canine Distemper Bacterial • Bordetella • Mycoplasma • Chlamydophila • Strep zoo • Gastrointes-nal • Brucella • Leptospirosis Infec-ous pathogens Internal parasites • Nematodes • Giardia • Tritrichomonas • Isospora • Cryptosporidium • Toxoplasma External parasites • Fleas • Ticks • Lice • Ear mites • Cheyle-ella • Sarcop-c mange • Dermatophytes Symptoms Sneezing Coughing Nasal discharge Ocular discharge Increased respiratory effort Diarrhea Vomi-ng Dehydra-on Fever Lethargy Anorexia Poor body condi-on Haw’s syndrome Pruritus Alopecia O--s Infec-ous pathogens Shedding periods • Symptoma-c • Asymptoma-c – Subclinical infec-ons – Clinically recovered • Infec-ve period Shedding periods Feline respiratory • FHV-‐1: 3 weeks • Calici virus: 30 days – life • Mycoplasma: 90 days • Bordetella: 90+ days Canine respiratory • CIRDC: 2 weeks • Canine distemper: 90 days • Canine influenza: 10 days • Mycoplasma: 90 days • Bordetella: 90+ days Shedding periods GI viral GI parasites • Canine parvovirus: 10 days • Nematodes: weeks-‐months • Feline panleukopenia: 6 wks • Protozoal: weeks -‐ months Prevalence • Regional • Vary by Popula-ons – Vaccina-on status – Age – Owned animals – Shelter animals Prevalence • • • • • Study by Tupler, Levy, et al. 2012 Open admission municipal shelter in Florida 50 dogs with diarrhea, 50 dogs without diarrhea Samples taken 24hrs ager admission Pathogen prevalence of asymptoma-c dogs: – Giardia 16% – Ascarids 8% – Parvovirus 2% – Cryptosporidium spp 2% Prevalence • • • • • Study by Sabshin, Levy, et al. 2012 Open admission municipal shelter in Florida 50 cats with diarrhea, 50 cats without Samples taken 24hrs ager intake Pathogen prevalence of asymptoma-c cats: – Clostridium 50% – Cryptosporidium 20% – Giardia 8% – Panleukopenia 4% – Calicivirus 2% Modes of transmission • • • • • • Fecal-‐oral Droplet Airborne Direct contact Vector FOMITES!!! Fomites Fomites Hands Clothes Blankets Towels Liker boxes Laryngeal scope Tracheal tube Anesthe-c tubing Pulse ox sensors Eye lubricant Surgical prep materials Surfaces Nutrical Thermometers Dosing syringes Flea combs Warming devices Toys Food & water bowls Hands • Gloves • Washing • Topical an-microbial Priori4ze based on suscep4bility • Pediatrics • Immuno-‐ compromised • Clinically ill Hands Clothes • • • • • Towels Aprons Fresh scrub tops Lint rollers No snuggling Priori4ze based on symptoms Feces Urine Pruritus Alopecia Ectoparasites Blood Nasal discharge Clothes Equipment • Anything in contact with the animal • Anything in contact with contaminated object • Cleaning • Disinfec-on • Between every animal Housing considera-ons • • • • Suscep-bility Source Symptoms Stress Stress • Rise in cor-sol • Immuno-‐suppression • Las-ng effects? Housing considera-ons • • • • • • Separate by risk Pediatrics Owned animals Feral Shelter animals Clinically ill Housing considera-ons Upper units • Pediatrics • Immune-‐compromised • Cats Lower units • Respiratory symptoms • GI symptoms • Adult animals Cage covers • Respiratory symptoms • Stressed animals • Pediatrics (warmth) Environmentally resistant pathogens • Unenveloped viruses • Protozoal oocysts • Dermatophytes Unenveloped viruses • • • • • Canine parvovirus Feline panleukopenia Canine adenovirus Lack lipid bilayer envelope Resistant – Desicca-on – Heat – Detergents oocysts • • • • Giardia Coccidia Toxoplasma Wall and cytoplasmic proteins confer resistance Dermatophytes • Microsporum canis • Microsporum gypseum • Spores are highly resistant – Desicca-on – Detergents – Heat Cleaning and Disinfec-on Contact items Hands Clothes Towels Blankets Surfaces Liker boxes Laryngeal scopes Tracheal tubes Anesthe-c tubing Pulse Ox Thermometers Dosing syringes Warming devices Flea combs Food & water bowls Toys Cleaning & Disinfec-on Principles 1) Mechanical removal of organic material 2) Applica-on of disinfectant 3) Contact -me Mechanical removal “Remember, there’s no such thing as sterile poop.” Anne Marie McPartlin Cornell Shelter Medicine program LVT Bleach Bleach Pros • Efficacy – Unenveloped viruses – Dermatophytes • Cost-‐effec-ve Cons • Contact -me: 10 minutes • Inac-vated by organic material • Respiratory irritant • Caus-c • Requires rinsing • Stable for 24 hours Quaternary Ammonium • • • • • Roccal KennelSol A33 Parvosol D256 Quarternary ammonium Pros • Some detergent ac-vity • Some efficacy with organic maker • Cost-‐effec-ve Cons • Poor efficacy – Unenveloped viruses – Oocysts – Dermatophytes • Contact -me: 10 minutes • Requires rinsing • Stable for 24 hours Potassium Peroxymonosulfate • Trifectant • Virkon-‐S Potassium Peroxymonosulfate Pros • Efficacy – Unenveloped viruses – Oocysts • Detergent ac-vity • Some ac-vity in with organic maker • No rinsing required • Stable for up to 7 days Cons • Poor efficacy: dermatophytes • Contact -me: 10 minutes • Expensive Calcium hypochlorate • Wysiwash • Pool shock Calcium hypochlorite Pros • Efficacy – Unenveloped viruses • Contact -me: 2-‐4 minutes • Variety of dispensing mechanisms • Cost-‐effec-ve Cons • Requires a specific dispensing mechanism • Precipitates form in hard water Accelerated hydrogen peroxide • Accel TB Accelerate hydrogen peroxide Pros • Efficacy – Unenveloped viruses – Dermatophytes • Detergent ac-vity • Efficacious with organic maker • Contact -me: 1-‐5 minutes • No rinsing requried • Stable for 3 years Cons • Expensive • No proven efficacy against dermatophytes • Contact -me: 10 minutes for dermatophytes Comparison chart Disinfectant 5.25% Household Bleach (Sodium Hypochlorite) Quaternary Ammonium (Quats) Accelerated Hydrogen Peroxide Potassium Peroxymonosulfate Common names (Clorox, many others) Roccal, KennelSol, A33, Parvosol, D256 Accel TB Trifectant, Virkon-S Effective Against Parvovirus? Yes Dilute 1:32 Not reliably Yes Yes Effective Against Panleukopenia? Yes Dilute 1:32 Not reliably Yes Yes Effective Against Ringworm? Yes Dilute 1:10 No Labeled as effective but not confirmed with independent studies Not reliably Effective Against Calicivirus? Yes Dilute 1:32 No Yes Yes Inactivated by Organic Material? Yes Mildly inactivated No Less inactivation than bleach or quats Stability When Prepared 24 hours if protected from light 24 hours Ready to use 0.5% solution has a 3 year shelf life 7 days when mixed from powder Minimum Contact Time 10 minutes 10 minutes 1-5 minutes (bacteria, virus) 10 minutes (ringworm) 10 minutes Detergent Activity? No Mild but rinsing is critical Yes Yes Rinse Required? Yes Yes No No Cost Comparison Cheap More expensive than Bleach Most expensive More expensive than Bleach or Quats Notes Highly corrosive to metal Ready to use liquid can be applied in a variety of ways Cost comparison Product • Bleach • Quaternary ammonium • Potassium peroximonosulfate • Calcium hypochlorate • Accelerated hydrogen peroxide Cost per gallon • $0.08 • $0.30 • $0.65 • $0.02 • $2.28 Mechanical removal • Significant impact • Ringworm – Study by Karin Moriello – Compared several household cleaners and disinfectants – All found to be equally effec-ve against M. canis with 10 minutes contact -me – AND mechanical removal Disinfectants for items in contact with mucus membranes chlorhexadine • Bactericidal • Ineffec-ve against viruses • Contact -me: 2 minutes • Residual ac-vity • Mucus membrane irritant Povoiodine • Bactericidal • Viricidal • Contact -me: 2 minutes • No residual ac-vity • Tissue irritant • Staining Laundry • • • • Bleach and hot water: ½ cup – 1 cup per load Consider using detergent as well Dry on high heat Consider fomite poten-al – Traffic flow – Dirty laundry in clean areas – Transport of clean laundry with dirty hands & clothes Personal protec-ve equipment • • • • • Gloves Goggles Apron Respirator: pregnant women Change of clothes – Fomite source – Personal pets Protocols • • • • Wriken documents Developed by a veterinarian Techniques for preven-on of disease transmission Founda-on for staff training Protocols • Allow for quick response • Implemented by non-‐veterinary staff members • Ensures animal and staff safety Resources Aspca.org Humanealliance.org Maddiesfund.org Maddie’s Infec-ous Control Manual for Animal Shelter Resources: www.cfsph.iastate.edu • Infec-ous Disease Management in Animal Shelters, Miller & Hurley 2009 • Shelter Medicine for Veterinarians and Staff, Miller & Zawistowski, 2013 • • • • References • ASV Spay Neuter Program Guidelines, • “Efficacy of eight commercial disinfectants against Microsporum canis and Trichophyton spp. infec4ve spores on an experimentally contaminated tex4le surface”, Moriella, et al. Veterinary Dermatology Dec 2013 • “Enteropathogens iden-fied in cats entering a Florida shelter with normal feces or diarrhea, Sabshin, Levy, et al. JAVMA 2012 • “Enteropathogens iden-fied in dogs entering a Florida animal shelter with normal feces or diarrhea”, Tupler, Levi, et al. JAVMA. 2012 • Georgi’s Parasitology for Veterinarians, Bowman 1999 • Infec-ous Disease Management in Animal Shelters, Miller and Hurley • Moriella • Shelter Medicine for Veterinarians and Staff, 2nd edi-on, Miller and Zawistowski
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