24 April 2020
Infection Control in the Veterinary Profession for Covid-19
With the ever-changing situation on the global coronavirus pandemic, we want to give you a veterinary specific update on Covid-19 in practice and how to reduce transmission through effective infection control.
In this blog we highlight how Covid-19 is affecting veterinary practices and their staff, answer some of the commonly asked questions about the use of Personal Protective Equipment, and share our top tips on disinfection around the workplace!
How is Covid-19 affecting working vet practices and nursing staff?
The RCVS have set guidelines on what type of work can be performed during the Covid-19 lockdown period. In order to comply with government guidance, the amount of staff in practice should be reduced and face-to face interactions with clients should be kept to a minimum.
For veterinary practices, this means seeing clients and patients in the practice only if it is an emergency or a particular type of case that needs to be managed within a hospital environment. Any routine appointments or procedures that can wait without affecting animal welfare should be postponed until government guidelines have been lifted. This is to limit the number of clients and patients within the practice, and reduce the amount of staff required to care for these patients which in turn reduces exposure too.
The British Veterinary Association (BVA) have released some Small Animal Guidelines on whether practices should perform routine appointments like vaccinations, neutering, microchipping. If the veterinarian feels that patient welfare may be/become compromised, that any care can be provided with appropriate risk assessments of themselves and the team, and social distancing with clients can be maintained, then some work is permitted. Please see the BVA colour coded priority chart and guidelines here.
Reducing Face-to-Face Client Interactions
To reduce the number of clients within the practice, where possible, try and perform telephone triage prior to any patient admission. Sometimes the veterinary surgeon may be able to advise on care or prescribe medication remotely (RCVS guidance on remote prescriptions can be found here).
If a client is required to visit the practice with their pet, it is vital to confirm if there is anyone in their household that has tested positive or has suspected Covid-19 to ensure correct PPE can be utilised (see more about this further on). There should only be one client per animal, and ideally the patient history is taken on the phone prior to examining them. The examination can be performed in the car or car park, or in the waiting room.
The use of Personal Protective Equipment (PPE)
Gloves – Gloves should be worn when meeting clients or examining a patient. These should be disposed of as hazardous waste (from a household where there are confirmed Covid-19 cases) or as offensive waste. Gloves do not replace the use of effective hand hygiene, and hand hygiene practices should still be performed before and after wearing them. Here is a quick reminder on hand hygiene:
When cleaning your hands, don’t forget to cover all 4 sides to your hands and fingers, fingertips and allowing adequate contact time to be effective:
If using a hand wash, remember that this takes 40-60 seconds
If using an alcohol hand rub, remember that this needs a contact time of 20-30 seconds
If there is any patient gross contamination on your hands, perform a hand wash instead of using an alcohol hand rub
Uniforms – These should only be worn at work, and ideally laundered there too. Do not wear your uniform or scrubs to and from work. It is also recommended to shower as soon as you get home.
Face masks – these should be worn if working with an infected client. As long as social distancing is maintained between staff then face masks do not need to be worn. Avoid taking them on and off throughout the day and clean your hands if you do touch your mask.
What type of disinfectant should be used to clean surfaces in practice?
Most veterinary marketed disinfectants are able to kill viruses. In order to adhere to the viricidal EN14675 standards of the European Chemical Agency (ECHA), they must be able to kill the hardest “non-enveloped virus ECBO virus”. The Covid-19 virus is an enveloped virus, so it is actually easier to kill.
According to the American Animal Hospital Association (AAHA), a number of disinfection mistakes are:
● Not measuring the disinfectants for dilution, which can make a solution too weak to work
● Not allow enough contact time for the disinfectant to work
● Once diluted, some disinfectants have a shelf life which may be 24 hours, weeks or months!
● Don’t “top up” solutions when running low – it may over dilute or create an inactivated mixture
● Don’t use a spray bottle; instead, use a wet cloth and bucket of disinfectant
Our Top Tips
As veterinary nurses, disease transmission between patients and also disease transmission between us and the patient is always front of mind. However, with the Covid-19 pandemic, we need to also consider and prioritise the potential risk of disease transmission between clients and staff – not just through direct contact but also through the environment.
There is evidence to suggest that the Covid-19 virus may persist in the environment on different surfaces for anything from a few hours to a few days. This means thorough cleaning of hard surfaces should be performed throughout the day, and where there is a changeover of staff shifts.
Here are some of our top tips on improving environmental infection control within your practice:
1. Wipe down or wash items often that may be considered a travelling fomite:
○ Clipboards that move around the practice
○ Practice leads and harnesses for walking patients
○ Stationery – try to keep your own pen for the day!
○ Leave handbags and lunch bags in lockers
○ Disinfect mobile phones throughout the day
2. Between consults, the consult rooms and reception should have all hand touched surfaces wiped (doors, handles) between appointments.
3. If taking cash payments from clients, wear gloves before and after handling the money and do not count it on a clinical surface. When taking card payments, wipe the keypad with a damp cloth between clients.
4. Wipe down high-touch surfaces, equipment and machines that are touched frequently throughout the day:
○ High-touch areas include doors, door handles, cupboards, light switches, microwave, refrigerator, stair banisters, sink taps
○ Equipment and machines include telephones, keyboards, computer screens, otoscopes, anaesthetic monitoring machines and vaporisers, laboratory machines (anything with buttons and knobs!)
○ A lot of commonly used disinfectants used in the veterinary industry are for cleaning hard surfaces and instruments, and may not be suitable for using on screens. Alcohol wipes can be used on most screens, but refer to the manufacturer’s manual for appropriate products.
5. Clean the cleaning equipment – disinfect the vacuum heads, mop handles, dustpans and brushes.
These cleaning tasks can be entered into a checklist to ensure they are done daily (as a minimum) but may need to be done hourly depending on the frequency of clients entering the practice.
As you can see, many of the environmental infection control measures will add only a few extra minutes to the normal end of day cleaning protocols, but it has a huge impact on reducing transmission of Covid-19.