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Infection Control Practices Employed Within Small Animal Veterinary Practices - a Systematic Review

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Infection Control Practices Employed Within Small Animal Veterinary Practices - a Systematic Review DR. ANGELA NATALIE WILLEMSEN (Orcid ID : 0000-0003-2198-9500) Article type : Review Corresponding author mail id:- [email protected] Infection control practices employed within small animal veterinary practices - A systematic review Infection control in veterinary practices Angela Willemsen1, Rowland Cobbold2, Justine Gibson2, Kathryn Wilks3, Sheleigh Lawler1, Simon Reid1 1The University of Queensland, School of Public Health, Herston, Queensland, Australia 21The University of Queensland, School of Veterinary Science, Gatton, Australia 3 Infectious Diseases and Medical Microbiology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia Acknowledgements I am grateful to the authors of the literature included in this review who responded to requests for additional information. This is the author manuscript accepted for publication and has undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/ZPH.12589 This article is protected by copyright. All rights reserved Summary Background Effective infection control (IC) provides a safe environment for staff, clients and animals of veterinary practices by reducing the risk of nosocomial and zoonotic infections, which are associated with increased hospital stays, costs, morbidity and mortality. An equally important issue arising from nosocomial infection is the loss of trust between the client and the veterinary practice that has potential negative impacts on the veterinary practice in terms of economic risk and the wellbeing of staff. Furthermore, an emerging and significant threat, in this context, is antimicrobial resistance. The aim of this systematic review was to critically review published reports that documented current IC practices and evaluated interventions to improve IC practices. Methods A systematic literature search using ten databases to identify papers published over a 20 year period (February 1996 to February 2016) was conducted for studies that met the inclusion criteria. Included studies were assessed using the PRISMA and STROBE-Vet statements. Results and Discussion A total of 14 of 1615 identified studies met our inclusion criteria. Infection control practices included; hand hygiene, sharps handling, environmental cleaning, personal protective equipment and personnel vaccination. Descriptive studies were the predominant research design for assessing IC compliance. Only three studies were interventions. Compliance with IC protocols was poor and only marginally increased with multi-modal educational campaigns. There was significant variation in the implementation of IC by veterinary staff. Workplaces that had IC policies, management support and a staff member supporting their implementation were more likely to embrace good IC. Infection control data in veterinary practices was inconsistently reported and collected. Clearly defining IC and determining prevalence of these practices within the veterinary field is important given the limited research in this area. Further, developing and implementing educational campaigns for this sector is needed. Keywords Companion / small animals Hand hygiene This article is protected by copyright. All rights reserved Infection control Nosocomial Personal protective equipment Sharps management Veterinary Impacts Infection control within small veterinary practices is an important way of minimising the risk of nosocomial (hospital acquired) infections and zoonotic diseases. Employing adequate infection control practices will reduce the need for antimicrobial use, which contributes to the reduction of antimicrobial resistance, an issue in animal and human health. The included studies suggest that strategies such as adequate management support, appropriate policy documents and a dedicated staff member monitoring and implementing recommended practices may improve IC practices. Introduction The aim of Infection control (IC) is to reduce the risk of transmission of pathogens by disrupting access to either the source, transmission mode or the host, in human and animal health contexts. It includes practices such as hand hygiene, disinfection, sharps management, vaccination, and isolation (National Health and Medical Research Council, 2010). The progress of human health care has seen good IC become an expectation of the general community with improving hand hygiene a sign of best practice (Grayson, Ryan, Havers, & Olsen, 2017). In contrast, basic IC has not been applied systematically by the veterinary profession (J. Stull, 2016; J. W. Stull & Weese, 2015; Weese, 2011). An established culture of casual indifference toward basic hygiene practices has been well documented within veterinary practices (Attard et al., 2012; Morley, 2013) despite facing similar challenges as human health care facilities(Alder & Easton, 2005). Within small animal veterinary practices, there is a lack of regular IC plans and dedicated IC staff to monitor and implement protocols. Infection control is needed in veterinary practice as poor IC poses a risk to animals as well as humans. Nosocomial outbreaks due to methicillin resistant Staphylococcus pseudintermedius (Grönthal et al., 2014), and feline calicivirus (Australian Veterinary Association, 2016; Reynolds et al., 2009) are well recognised. Pathogens such as Salmonella spp. have been linked with nosocomial outbreaks (Walther, This article is protected by copyright. All rights reserved Tedin, & Lübke-Becker, 2017) as well as presenting a zoonotic risk to both staff and clients (J. W. Stull & Weese, 2015; H. Wright et al., 2005). Antimicrobial resistance (AMR) has been irrefutably linked with infection control. Hand hygiene can help with reducing nosocomial infections and thus reduce the need for antimicrobial use, which reduces the emergence and spread of AMR (World Health Organization, 2015). AMR is a global issue that requires a coordinated effort between human and veterinary practitioners as it impacts on both human and animal health (Prescott, 2008). The World Health Organisation has highlighted the need for interventions in the veterinary sector to support a global strategy (World Health Organization, 2015, 2016). Objectives The aim of this systematic review was to determine personal and environmental IC practices used in small animal veterinary workplaces worldwide. The two objectives were: to determine the range of approaches to IC practices, and secondly, to identify the efficacy of IC interventions to improve IC practices. Methods Protocols The Preferred Reporting Items for Systematic reviews and meta-Analyses (PRISMA) Statement for reporting Systematic Reviews checklist (Liberati, Altman, Tetzlaff, & Mulrow, 2009) was utilised to structure this systematic review. The STROBE-Vet statement checklist was used to comprehensively assess the studies for quality (Sargeant et al., 2016). Information sources Details of the search terms and electronic databases used for this review are provided in Table 1. Each database has different search functions so alternate search terms were required to capture a workable number of studies. Boolean operators were utilised in all searches. Data searches commenced in February 2016 and concluded in December 2016. A follow up search performed in August 2018 identified no additional studies for inclusion. Additional studies were identified by hand searching the bibliography of included studies. Endnote X7.4 (1988-2015 Thomson Reuters) was used to store all studies and documents retrieved. The population of interest included veterinarians and veterinary staff from generalist and specialist small animal practices. Peer reviewed primary research studies that examined clinical practice or management of IC practices were included. This article is protected by copyright. All rights reserved Eligibility criteria Studies were eligible for inclusion if they involved behavioural IC practices of staff employed in veterinary clinics identified through reading of titles, abstracts and text scanning. These IC practices included hand hygiene, environmental cleaning, personal vaccination and the use of personal protective equipment. Two investigators (AW, SR) independently screened the title and abstract from the searches. Any disagreements were settled by discussion. Small animal responses had to be greater than 50% overall to be included in this systematic review. A summary of inclusion and exclusion criteria are listed in Table 2. Study selection Data collection process and data items For each study that met the selection criteria for inclusion the following data were extracted: first author and year of publication, type of study, IC practice examined, if an intervention was included, numbers of participants, response rate and outcome. Attempts were made to obtain copies of questionnaires and intervention materials from the corresponding authors of the included studies. Risk of bias Risk of bias was assessed using “The STROBE-Vet statement checklist”(Sargeant et al., 2016). The “Strengthening the Reporting of Observational Studies in Epidemiology-Vet (STROBE-Vet)” assessment tool assists in evaluating observational studies in “veterinary medicine related to health, production, welfare, and food safety” (Liberati et al., 2009). Results Study selection The study selection process is shown in Figure 1. A total of 1509 studies were identified from database searches, and a further
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