Standard Operating Procedures Tier 1 Veterinary Medical Center Infectious Disease

Section Hospital Protocol Date of Issue 12/14/2018 Part Infectious Zoonotic Disease Issued by Administration

Pages 17 Revision Date 04/19/2021

Introduction: It is the standard operating procedure to maintain and control communicable diseases in the hospital.

Kennel-sol solution is used at Tier 1 VMC for disinfection purposes and is effective as: Bactericidal: Proteus vulgaris, Bordetella bronchiseptica, Serratia marcescens, Escherichia coli, Staphylococcus aureus (antibiotic resistant), Fusobacterium necrophorum, Klebsiella pneumoniae (antibiotic resistant), Streptococcus pyogenes, Proteus mirabilis, Salmonella enterica, Salmonella typhimurium, Escherichia coli (antibiotic resistance), Shigella sonnei, Staphylococcus epidermidis (antibiotic resistant), Enterobacter cloacae, Pasteurella multocida, Staphylococcus aureus, Salmonella typhi, Chlamydia psittaci, Shigella flexneri, Enterobacter aerogenes, Streptococcus faecalis (antibiotic resistant), Klebsiella pneumoniae, Streptococcus faecalis

Fungicidal: Trichophyton mentagrophytes, Candida albicans

Virucidal: Canine parvovirus, Canine distemper, Feline leukemia, Feline panleukopenia, Feline picornavirus, Influenza A/Hong Kong, Herpes simplex virus type 1, Herpes simplex virus type 2, Vaccinia, Rubella, Adenovirus type 4, Rabies, Porcine parvovirus, Pseudorabies, Infectious bovine rhinotracheitis, Infectious bronchitis (Avian IBV), Avian Influenza A (H3N2 & H5N1)

Dilution requirements for Tier 1 VMC are 8oz/gallon (240 mls/gallon).

Bleach (Sodium hypochlorite) is used in special instances for disinfection where Kennel- sol is ineffective. Bleach is used to launder all laundry items associated with an infectious disease.

Dilution requirement for Tier 1 VMC are 2oz/gallon (60mL/gallon)

Standard Operating Procedures Tier 1 Veterinary Medical Center Infectious Disease

Follow all SDS recommendations for handling disinfectants/dips/topical medications.

The procedures for infectious disease control is as follows:

General Requirements:

Isolate and prevent spread of communicable diseases.

Infectious diseases seen in the veterinary clinic that pose nosocomial risk: ● Dog: Parvo virus, distemper virus, bordetella bronchiseptica(kennel cough), Methicillin resistant infections ( MRSA, MRSP), rabies virus, leptospirosis bacteria, mange mites, and fleas. lice, coccidia, giardia (reportable in AK), intestinal parasites, campylobacter, tularemia, Brucellosis, o Rare/not common to Alaska but to be aware of: Plague, Leishmaniasis ● Cat: Feline immunodeficiency virus, feline calicivirus, feline leukemia virus, rabies virus, ringworm fungus, mange mites, fleas, toxoplasmosis, worms, panleukopenia, Bartonella henselae (Cat-Scratch Disease), tularemia ● Birds: psittacosis ● Reptile: Salmonella ● Small Mammals: o Rabbits: Pastuerella

Zoonotic disease: Infectious diseases seen in the veterinary clinic that pose a zoonotic risk (transmissible to humans): 1. MRSA/MRSP 2. Rabies Virus 3. Leptospirosis 4. Mange 5. Giardia 6. Intestinal parasites/Worms (various) 7. Campylobacter 8. Tularemia 9. Brucellosis 10. Plague 11. Leishmaniasis 12. Ringworm Fungus 13. Toxoplasmosis 14. Cat Scratch Fever Standard Operating Procedures Tier 1 Veterinary Medical Center Infectious Disease

15. Psittacosis 16. Salmonella

Reportable disease in the state of Alaska Must be reported to State of Alaska Department of Health and Social Services Division of Public Health if you (the human) become infected

1. MRSA/MRSP 2. Rabies Virus 3. Leptospirosis 4. Giardiasis 5. Campylobacteriosis 6. Tularemia 7. Brucellosis 8. Plague 9. Psittacosis 10. Salmonella

Methicillin resistant bacteria o Methicillin resistant infections are diagnosed by the culture of infected skin. o Definition: ▪ Bacterium that is methicillin resistant “after exposure to multiple or sub therapeutic doses of antibiotics, the bacteria can become resistant to multiple antibiotics” http://dermvettacoma.com/mrsa/ ▪ MR infections are a general threat to those individuals whom are immunosuppressed, elderly, and babies. ▪ MRSA ● Staphylococcal aureus is the natural floral bacterium of humans and can live in low numbers in dog carriers. MRSA develops when the human form of SA becomes drug resistant on the human host. When cultured from the dog, this is generally indicative that a human host is infected or is a carrier of MRSA.

▪ MRSP Standard Operating Procedures Tier 1 Veterinary Medical Center Infectious Disease

● Staphylococcal pseudo-intermedius is the natural floral bacterium of dogs. MRSP can develop when the dog form of SP becomes drug resistant. ● Not generally contagious to humans however humans can become carriers or a reservoir for MRSP bacterium and can inadvertently spread the bacterium.

● Prevention Measures/PPE required: ○ Wear gloves ○ Wash hands ○ Wear a gown or have a spare pair of scrubs to change into after handling patient ○ Disinfect area with Kennel-Sol. Make sure there is 10 minutes contact time and wipe clean with non-reusable paper towels ○ Limit number of personnel handling case ○ Isolate patient while in hospital

● Hospitalization Measures: ○ Pens/pencils, stethoscopes, thermometers and other equipment should be kept for use with the affected patient only and disposed of or disinfected after use ○ Bedding should be disposed of. If re-use is essential it should be laundered at 60oC. Great care should be exercised to avoid contaminating other bedding during cleaning, but separate laundering isn’t necessary. ○ Owners should not be discouraged from visiting hospitalised patients. However, they should be informed of the potential risks, wear protective clothing and thoroughly wash their hands as outlined above. Contact should be restricted to their animal. ○ If an MRSA positive animal dies, all lesions and body orifices should be covered. The body should be placed in a sealed, impervious bag as soon as possible and be disposed of by cremation.

Rabies virus o Overview: ▪ Rabies virus is transmitted through direct contact (such as through broken skin or mucous membranes in the eyes, nose, or Standard Operating Procedures Tier 1 Veterinary Medical Center Infectious Disease

mouth) with saliva or brain/nervous system tissue from an infected animal. ▪ Usually transmitted by the bite of a rabid animal. It is also possible, but rare, for people to get rabies from non-bite exposures, which can include scratches, abrasions, or open wounds that are exposed to saliva or other potentially infectious material from a rabid animal. ▪ Other types of contact, such as petting a rabid animal or contact with the blood, urine or feces of a rabid animal, are not associated with risk for infection and are not considered to be exposures of concern for rabies. ▪ Only mammals can be affected by the rabies virus ▪ 90% of reported cases of rabies in animals occur in wildlife (racoons, skunks, bats, foxes) ▪ Most pets get rabies from having contact with wildlife ▪ Foxes, especially in the North Slope and Southwest regions, are the most common transmitters of rabies in Alaska. Rabies can cause death within days of symptoms, so be sure to seek medical attention as soon as possible if you suspect exposure. ▪ Alaska has enzootic regions of the state for rabies (meaning rabies is always present) ● Recognition ○ Vaccination status of animal should be determined upon arrival at Tier 1 VMC ○ General sickness of patient ○ Problems swallowing ○ Hypersalivation ○ Biting at everything (air/randomly etc.) ○ Trouble moving or paralysis ○ Travel history ● Prevention Measures/PPE required: ○ Utilize the rabies-pole to move patient within hospital ○ Fluid-proof barrier gloves ○ Wash hands after handling ○ Safety glasses ○ Gown ○ Disinfect area with Kennel-Sol. Make sure there is 10 minutes contact time and wipe clean with non-reusable paper towels Standard Operating Procedures Tier 1 Veterinary Medical Center Infectious Disease

○ Limit number of personnel handling case (ideally to those individuals who have received/are current on the Pre-Exposure Rabies Vaccination Series) ○ Isolate patient while in hospital

● If a rabies suspect animal dies or is euthanized: ○ Don gloves, mask, face-shield/safety glasses before assisting DVM with decapitation and packaging to send specimen to the State of Alaska Lab ■ Please contact the Section of Epidemiology for authorization prior to submitting specimens for rabies testing. Call (907) 269- 8000, or after hours call (800) 478-0084. ■ http://dhss.alaska.gov/dph/Labs/Pages/publications/default.aspx

● The body should be placed in a sealed, impervious bag as soon as possible and be disposed of by cremation. ● Disinfection protocol as indicated previously for all areas that came in contact with the patient. ● Resources: ○ https://www.cdc.gov/rabies/index.html ○ http://dhss.alaska.gov/dph/Epi/id/Pages/rabies/default.aspx ○ https://ehs.oregonstate.edu/sites/ehs.oregonstate.edu/files/pdf/rabies- prevention-program-12-14.pdf

Leptospirosis bacterium o Overview: ▪ Caused by the bacterium of genus Leptospira. an aerobic gram- negative spirochete. ▪ Lepto is spread through the urine and rarely other bodily fluids of infected animals in water or soil of which can remain present for weeks to months. The bacterium can enter the body from open skin and mucous membranes. ▪ Animals may become infected by direct transmission of the spirochete (direct contact with infected urine, blood, ingestion of infected tissues, bite wound, and venereal or placental transfer) ▪ Indirect transmission includes exposure to water, soil, food, or fomites contaminated by infected urine. ▪ Leptospirosis enters the body by penetrating mucous membranes or through abraded or water-softened skin, enter the bloodstream, and multiply/spread rapidly (leptospiremic phase lasting 7- 10 days) Standard Operating Procedures Tier 1 Veterinary Medical Center Infectious Disease

▪ Chronically infected carrier animals may shed the bacteria for months to years ▪ After shedding into the environment, the organism can survive for weeks to months in water/moist soils. ▪ Leptospirosis is a reportable disease in many states of the United States (human confirmed cases) - AK has a 2 day reporting window that your personal healthcare provider will coordinate. ● Risk Factors for Pets ○ Outdoor activities ○ Exposure to wildlife or livestock ○ Exposure to moist environments or standing water ● Prevention Measures/PPE required ○ Fluid-proof barrier gloves ○ Wash hands after handling ○ Safety glasses/face shields ○ Water Resistant Gown ○ Hair cap/bouffant cap if concerned about contact/spray

● Hospital Procedure ○ A cage card that says “lepto suspect” is placed on the front of the cage — preferably a cage away from other animals. The cage does not need to be in the isolation ward, just away from the heaviest foot traffic ○ A tape border is placed on the floor in front of the cage to delineate a buffer around the patient. ○ Disinfect surfaces and supplies (thermometers, stethoscopes, pens etc) with Bleach solution (1:10) ○ Limit number of personnel handling case ○ Urine containment highly recommended by way of placing a urinary catheter and closed collection system ○ Walk patient in designated walk area (separate from general walk area and chemotherapy walk area) ○ Disposable bedding is preferred, as any laundry that comes in contact with that patient will potentially be destroyed. Any non disposable laundry is washed twice in bleach solution without coming in contact with any other hospital laundry. Standard Operating Procedures Tier 1 Veterinary Medical Center Infectious Disease

○ A dedicated sharps container with a “lepto suspect” label and the patient's full name is kept within the tape border of the cage. ○ A biohazard red bag for all other waste (also labeled “lepto suspect" and including the patient’s full name) is placed within the taped-off area. ○ If treating multiple patients, treat the lepto suspect last. ○ Wash and disinfect your hands after any contact with the patient or items associated with the patient. ○ Urine is mixed 10:1 with bleach before disposal, and allowed to sit for 10 minutes. ○ Owners who visit their pet are required to wear gloves and gowns for the first 48 hours and then just gloves until the pet is discharged ○ If the patient dies or is euthanized while hospitalized, the body should be placed in a sealed, impervious bag as soon as possible and be disposed of by cremation. Resources: http://dhss.alaska.gov/HIT/Meaningfuluse/Documents/Conditionsl%20reportable%20to %20Public%20Health%202018.pdf https://www.cdc.gov/leptospirosis/pets/prevention/index.html#:~:text=If%20you%20ar e%20cleaning%20surfaces,follow%20up%20with%20your%20veterinarian. Leptospirosis Isolation Protocol (atdove.org) Merrill, Linda; Small Animal Internal Medicine for Veterinary Technicians and Nurses, Wiley-Blackwell, 2012, pp. 357-358

Ringworm fungus o Overview ▪ Approximately 40 different species of fungi can cause ringworm; the scientific names for the types of fungi that cause ringworm are Trichophyton, Microsporum, and Epidermophyton Standard Operating Procedures Tier 1 Veterinary Medical Center Infectious Disease

▪ Dogs, cats, puppies, kittens, cows, goats, pigs, and horses can pass ringworm to people. ▪ All bedding materials, combs, clippers, cages or any other objects with which an infected animal comes into contact become potential sources of infection ▪ Other sources of infection include soil and rodents. ● PPE ○ Gloves ○ Long sleeves/gowns ○ Wash hands between patients ○ Remove gown/long-sleeve clothing item before handling another patient ● Hospital Procedures ○ Individuals with weakened immune systems should ideally not handle the patient if ringworm is suspected ○ Limit contact points/personnel/locations where patient resides (ideally keep the pt in the exam room for treatments) ○ The spores of this fungus can be killed with common disinfectants like diluted chlorine bleach (2oz per gallon water) ○ Remove organic material from area where patient resided into a sealable impervious bag, soak area for 10 minutes with a bleach solution, wipe down area with single-use paper towels, and place soiled paper towels into same sealable impervious bag as the organic material, seal the bag and take to the dumpster immediately ○ Bag and seal non-disposable laundry and label as ‘ringworm’ if you are unable to launder immediately ○ Any non disposable laundry is washed twice in bleach solution without coming in contact with any other hospital laundry. ○ Follow all SDS recommendations when handling disinfectants/shampoos/dips/topical treatments ○ If the patient dies or is euthanized while hospitalized, the body should be placed in a sealed, impervious bag as soon as possible and be disposed of by cremation.

● Resources ○ People at Risk for Ringworm | Ringworm | Types of Diseases | Fungal Diseases | CDC Standard Operating Procedures Tier 1 Veterinary Medical Center Infectious Disease

○ Dermatology Clinic for Animals Ringworm in Tacoma, WA - Dermatology Clinic for Animals (dermvettacoma.com)

Mange mites o Overview Of the mange mites that are transiently infectious to humans, scabies and cheyletiella (walking dandruff) are most prevalent. ▪ These are mites that burrow under the skin of the host. Scabies can also live in the environment for up to 21 days. ▪ These mites are transient in humans, which remain only symptomatic for up to 3 weeks and will have spontaneous resolution. ▪ Cheyletiellosis affects dogs and cats as well as rabbits and humans ▪ Canine scabies is highly contagious. Dogs, coyotes, foxes, (humans, cats and other mammals can be transiently infected) ▪ Transmission occurs through direct contact with a carrier animal, or when a mite falls off the skin of a carrier and survives in the environment long enough for it to infest a new host animal. ▪ At 50 - 59 F, mites can survive between four to 21 days in the environment without a host. At room temperature (68 - 77 F), mites can survive for two to six days. ▪ Human symptoms can typically take 4-8 weeks to develop after they are infested; however they can still spread scabies during this time ● PPE ○ Gloves ○ Long sleeves/gowns ○ Wash hands between patients ○ Remove gown/long-sleeve clothing item before handling another patient ○ Hair cover/bouffant cap ○ Face-shield if concerned about splashing during bathing/topical medication application ● Hospital Procedures Standard Operating Procedures Tier 1 Veterinary Medical Center Infectious Disease

○ Limit contact points/personnel/locations where patient resides (ideally keep the pt in the exam room for treatments) ○ Remove organic material from area where patient resided into a sealable impervious bag, soak area for 10 minutes with a bleach solution (2oz/gal), wipe down area with single-use paper towels, and place soiled paper towels into same sealable impervious bag as the organic material, seal the bag and take to the dumpster immediately ○ Launder all non-disposable items in hot water and bleach immediately to prevent the mites from living in the environment. ● Resources ○ Dermatology Clinic for Animals Sarcoptic Mange in Tacoma, WA - Dermatology Clinic for Animals (dermvettacoma.com) ○ Dermatology Clinic for Animals Cheyletiellosis in Tacoma, WA - Dermatology Clinic for Animals (dermvettacoma.com) ○ Sarcoptic Mange (Scabies) in Dogs - Veterinary Partner - VIN ○ Mange in Dogs and Cats - Integumentary System - Merck Veterinary Manual (merckvetmanual.com)

Giardiasis ○ Overview ■ Infection is common in dogs, cats, ruminants, and pigs ■ Is seen worldwide in most domestic and wild mammals, many birds, and people ■ Is found on surfaces or in soil, food, or water that has been contaminated with feces from infected humans or animals. ■ Transmission occurs by the fecal-oral route, either by direct contact with an infected host or through a contaminated environment. ■ Giardia cysts are infectious immediately after excretion and are very resistant ■ Cyst shedding may be continual over several days and weeks but is often intermittent, especially in the chronic phase of infection. ■ The cyst is the infective stage and can survive for several weeks in the environment, whereas trophozoites cannot ■ Flagellate protozoa (trophozoites) of the genus Giardia inhabit the mucosal surfaces of the small intestine, where they attach to the brush border, absorb nutrients, and multiply Standard Operating Procedures Tier 1 Veterinary Medical Center Infectious Disease

■ The prepatent period is generally 3–10 days (prepatent = the period between infection with a parasite and the demonstration of the parasite in the body)

● PPE/Hospital Procedure ○ Wear gloves when handling patient, feces, bedding ○ Wash hands after handling patient, feces, bedding ○ Decontaminate area with kennel-sol solution ○ Feces should be removed as soon as possible ○ Prompt and frequent removal of feces limits environmental contamination, as does subsequent disinfection ○ Infected dogs and cats should be bathed to remove cysts from the hair coat. ○ Cysts are inactivated by most quaternary ammonium compounds, steam, and boiling water (wash bedding in hot water w/ bleach) ○ To increase the efficacy of disinfectants, solutions should be left for 5–20 min before being rinsed off contaminated surfaces. ○ Cysts are susceptible to desiccation, and areas should be allowed to dry thoroughly after cleaning ○ Disinfection of grass yards or runs is impossible, and these areas should be considered contaminated for at least a month after infected dogs last had access ○ Giardia cysts are killed in the environment by freezing temperatures and by direct sunlight ○ Organic matter such as dirt or stool is protective to the cyst and therefore should be removed prior to disinfection ● Resources ○ Overview of Giardiasis - Digestive System - Merck Veterinary Manual (merckvetmanual.com) ○ Giardia in Pets - Veterinary Partner - VIN ○ Conditions Reportable Alaska.pdf

Standard Operating Procedures Tier 1 Veterinary Medical Center Infectious Disease

Alimentary Tract Parasites (Zoonotic) ○ Tapeworms (Dipylidium caninum, Echinococcus, Taenia) ○ Roundworms/Ascarid Nematodes (Toxocara canis, Toxascaris leonina, and Toxocara cati) ○ Hookworms (Ancylostoma caninum, Uncinaria stenocephala) ○ Strongyloidiasis (Strongyloides sercoralis/planiceps and S. felis/tumefaciens) ○ Trematodes/Flukes (Alaria) ● PPE/Hospital Procedure ○ Wear gloves when handling patient, feces, bedding ○ Wash hands after handling patient, feces, bedding ○ Feces should be removed as soon as possible ○ Prompt and frequent removal of feces limits environmental contamination, as does subsequent disinfection ○ Infected dogs and cats should be bathed to remove oocytes/proglottids from the hair coat ○ Remove all organic debri before disinfecting the area with Kennel-Sol. Make sure there is 10 minutes contact time and wipe clean with non- reusable paper towels ● Resources ○ Gastrointestinal Parasites of Dogs - Dog Owners - Merck Veterinary Manual (merckvetmanual.com) ○ Merrill, Linda; Small Animal Internal Medicine for Veterinary Technicians and Nurses, Wiley-Blackwell, 2012, pp. 213-216 ○ www.veterinarypartner.com

Bartonella spp. (Formerly classified as Haemobartonella) ○ Overview ■ Cat-scratch disease (CSD) is a bacterial infection spread by cats. ■ The disease spreads when an infected cat licks a person’s open wound, or bites or scratches a person hard enough to break the surface of the skin. ■ CSD is caused by a bacterium called Bartonella henselae. About 40% of cats carry B. henselae at some time in their lives, although most cats with this infection show NO signs of illness. ■ There are 24 Bartonella species, 14 of which can infect humans and five of which are harbored by cats. ■ Cats can get infected with B. henselae from flea bites and flea dirt (droppings) getting into their wounds. By scratching and biting at Standard Operating Procedures Tier 1 Veterinary Medical Center Infectious Disease

the fleas, cats pick up the infected flea dirt under their nails and between their teeth.

● PPE/Preventative Measures ○ Wash hands immediately after a cat scratch or bite with soap and water for five minutes ○ Avoid contact with flea excrement ○ Follow flea protocol for decontamination of area if fleas are suspected or confirmed

● Resources ○ Cat-Scratch Disease | Healthy Pets, Healthy People | CDC ○ Hemotropic Mycoplasmas - Circulatory System - Merck Veterinary Manual (merckvetmanual.com) ○ Merrill, Linda; Small Animal Internal Medicine for Veterinary Technicians and Nurses, Wiley-Blackwell, 2012, pp. 349 - 350 ○ Bartonella and Cat Scratch Fever - Veterinary Partner - VIN

Brucellosis ○ Overview ■ Occurs in dogs, pigs, horses, cattle, goats, sheep ■ Brucellosis is infection with the bacteria Brucella canis ■ In dogs, it leads to miscarriage, infection of the sexual organs in males, and infertility ■ Brucellosis can be contracted sexually but it can also be contracted by inhalation (sniffing contaminated urine or fetal membranes), through the eyes, or orally (licking contaminated urine or urogenital secretions or chewing up fetal membranes). ■ When a female dog aborts a pregnancy because of a Brucella infection, she continues to secrete fluids packed with Brucella bacteria for four to six weeks ■ Brucella organisms are able to survive in the environment for months if conditions are moist, cool, and dark ■ Spread of infection is controlled through isolation of infected dogs ■ Brucellosis must be reported to the health department in the state of Alaska ■ Inhaling the bacteria while dressing game can lead to infection. Commonly infected wild animals include: bison, elk, caribou, moose and wild hogs (feral swine). Standard Operating Procedures Tier 1 Veterinary Medical Center Infectious Disease

■ In humans: Signs and symptoms of brucellosis may include fever, joint pain and fatigue. The infection can usually be treated with antibiotics. ● PPE/Preventative Measures ○ Wear single-use protective examination gloves during assistance with whelping including the handling of newborn puppies, placentas, fetal membranes, or exposure to urine or vaginal secretions. ○ Extreme caution should be taken when handling any aborted materials including dead or partially developed puppies, their fetal membranes and placentas. ○ Appropriate use of personal protective equipment beyond just wearing gloves (respiratory and ocular protection) may be required to prevent human infection during cleaning and disinfection and animal handling in brucellosis positive kennels during quarantine and isolation situations. ○ Gowns ○ Goggles/Face shields ○ Caution should be taken when collecting and handling blood, serum, fluids or tissues for laboratory analysis by the veterinarian, paraprofessional staff, the client, and laboratory personnel if brucellosis is suspected. ○ Remove all organic material prior to decontamination of areas and use a bleach solution (1:10) and allow 10 minutes of contact time before wiping clean with disposable towels. ○ If the patient dies or is euthanized while hospitalized, the body should be placed in a sealed, impervious bag as soon as possible and be disposed of by cremation. ● Resources ○ Brucellosis in Dogs - Dog Owners - Merck Veterinary Manual (merckvetmanual.com) ○ Brucellosis in Dogs - Veterinary Partner - VIN ○ brucella_canis_prevention.pdf (usda.gov) ○ Conditions Reportable Alaska.pdf ○ Transmission | Brucellosis | CDC