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Companion animal practice – hand hygiene

Rosanne Jepson discusses the challenges related to AMS in companion animal practice in regards to hand hygiene.
And the second issue that I was going to discuss very briefly today is the topic of hand hygiene. So we’ll start by thinking about what healthcare-associated infections are, and a definition that’s widely used is that these are an infection that occurs in a patient during the process of hospital care which was not present or incubating at the time of admission. And this includes infections acquired in the healthcare facility but appearing after discharge and also can include occupational infections among healthcare workers within that facility as well. And so this is something which is a huge issue in human medicine but is perhaps under considered in veterinary medicine. It’s important in human medicine because it plays a role in transmission of infections.
It can lead to increase in both morbidity and mortality of human patients and can lead to both longer periods of hospitalisation and also increased costs. So we’ve known for a long time that hand hygiene is very important in the prevention of spread of infections within hospitals, and we can track this back to some work that was done back in the 1840s. And so this was work looking at mortality associated with childbirth, and there were some pioneering work done comparing the mortality rate of mothers between– those being looked after by medical students and those being looked after by midwives. And the difference in mortality rates between these two groups was initially 18% versus 2%.
And the work that was done essentially demonstrated students were splitting their time both between the maternity wards and also the mortuary and the post-mortem room, whereas the midwives were just involved within the maternity wards. And what happened when they instituted a form of hand disinfection on leaving the mortuary or the post-mortem room was that the mortality rate of the medical students for those women in childbirth then actually fell to the same level as the midwives– so very early evidence about the importance of hand hygiene.
And so if we look online, there are a huge number of different resources available to us about the important method of hand hygiene, whether we’re using soap and water or whether we’re using some of the alcohol-based hand rubs. And in human medicine, there are very clear guidelines in terms of when hand hygiene should be performed. So in the diagram on the right-hand side, we can see important five-step process before touching a patient, before performing any kind of clean or aseptic procedure, after any exposure to body fluids, after touching a patient, and then also after touching patients or their surroundings.
And so I think in veterinary medicine, we could certainly step up in this regards and think about how our hand hygiene when we’re dealing with our patients compares to the targets that they’re aiming for in human medicine. There are particular healthcare-associated infections that are of concern in human medicine. So these particularly relate to development of urinary tract infections, surgical site infections, catheter-related bloodstream infections, ventilator-associated pneumonia, and many of these may have relevance in veterinary medicine, obviously depending on the type of hospital that you’re working in, but these are certainly within the referral setting or issues that we know that we face.
And so I would say that hand hygiene very much has a role in veterinary medicine and that we need to look closer at the potential for hospital or healthcare-associated infections within our veterinary patients. These are going to be of particular concern, I think, in the hospitalised environment, and we need to recognise that the whole of a hospital environment may be a potential source for infection.
The risk is not well quantified in veterinary medicine, and part of the process for trying to better engage with this will be identifying patients and auditing patients which may have healthcare-associated infections, recognising that they could exist and that they could occur and thinking about the types of personal protective equipment, policies and guidelines that we have in place. So this would be, for example, the types of barrier nursing that we’re using and also the facilities that are available within an individual practise for hand hygiene.
So the challenges really are that we need to consider whether our practises have appropriate policies for PPE or protective clothing or barrier nursing, whether the practise has an appropriate policy for hand hygiene, whether the individuals that are working within the hospital environment understand the times at which that they should be wearing barrier nursing equipment, when they should be performing hand hygiene, and thinking about how we actually ascertain that there is continuity and adherence to these recommendations. And so those are the two aspects or challenges that I’m going to talk about in this session. And in the next session, I’m going to just talk about some of the ways that we have tried to approach these two issues.

In this video, Rosanne Jepson, discusses the importance of good hand hygiene in companion animal practice as part of antimicrobial stewardship. Further to step 1.11, where the challenges to achieveing good antimicrobial guidelines were discussed, this video focuses on the challenges to implementing good hand hygiene.

It’s really important to have good hand hygiene in veterinary practice to prevent the transmission of HCAIs, or healthcare associated infections. While HCAIs are much more commonly discussed in human practice, they are also prevalent in veterinary practice.

What are the current hand hygiene policies and guidelines in your practice? How are they enforced?

We will later discuss the potential ways of overcoming these challenges. Before you get to that step in week 2, have a think about how these challenges are mitigated in your practice. Use the comments section to discuss and share ideas with your fellow learners.

Please find a downloadable copy of the powerpoint slides used in the video in the downloads section below.

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Antimicrobial Stewardship in Veterinary Practice

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