OBJECTIVES: The objectives of the Compendium are to raise awareness of the scope of zoonotic disease risk in veterinary medicine; address infection control issues specific to veterinary practice; provide practical, science-based veterinary infection control guidance; and provide a model infection control plan for use in individual veterinary facilities. BACKGROUND: In the 2003 African monkeypox infection outbreak in the United States, 18 of 71 (25.4%) infected individuals were veterinary personnel. This incident highlighted the risk of exposure to exotic zoonotic pathogens and the need for infection control precautions in veterinary medicine. However, zoonotic diseases are occupational hazards faced by veterinary personnel on a daily basis. Approximately 868 of 1,415 (61%) known human pathogens are zoonotic, and approximately 132 of 175 (75%) emerging diseases that affect humans are zoonotic. There are more than 50 zoonotic diseases of importance in the United States. Documented zoonotic infections in veterinary personnel include the following: salmonellosis, cryptosporidiosis, plague, sporotrichosis, methicillin-resistant Staphylococcus aureus, psittacosis, dermatophytosis, leptospirosis, and Q fever. Veterinary Standard Precautions are guidelines for commonsense infection control practices. They are intended to be used consistently by veterinary personnel--regardless of the clinical presentation or the presumed diagnosis of animals in their care--whenever personnel may be exposed to potentially infectious materials including feces, body fluids, vomitus, exudates, and nonintact skin. Veterinary Standard Precautions are based on human standard precautions, which are the cornerstone of infection control in human health-care settings. However, the VSP also include strategies to reduce the potential for animal bites and other trauma that may result in exposure to zoonotic pathogens. During their careers, approximately two-thirds of veterinarians report a major animal-related injury resulting in lost work time or hospitalization. Dog and cat bites, scratches from cats, kicks, and crush injuries account for most occupational injuries among veterinary personnel. Approximately 3% to 18% of dog bites and 28% to 80% of cat bites become infected, depending on the location of the bite and other factors. Most infected dog- and cat-bite wounds contain mixed aerobic and anaerobic bacteria. The most commonly isolated aerobes are Pasteurella multocida (from cat bites), Pasteurella canis (from dog bites), streptococci, staphylococci, Moraxella spp, and Neisseria weaveri; the most commonly isolated anaerobes are various species of Fusobacterium, Bacteroides, Porphyromonas, and Prevotella. Rarely, bite and scratch wounds may result in serious systemic infections caused by invasive pathogens such as Capnocytophaga canimorsus, Bergeyella zoohelcum, CDC group NO-1, and Bartonella spp. Needlestick injuries are among the most frequent accidents in the veterinary workplace; the most commonly reported needlestick injury is inadvertent injection of a vaccine. In a 1995 survey of 701 veterinarians, accidental self-injection of rabies virus vaccine was reported by 27% of respondents; among large-animal practice respondents, 23% had accidentally self-injected vaccines containing live Brucella organisms. Inadvertent self-injection of vaccines, antimicrobials, and anesthetic agents by veterinary personnel may result in adverse events that range from local irritation to serious systemic reactions. Additionally, needle punctures sustained during procedures such as fine-needle aspiration are potential sources of zoonotic pathogens. CONSIDERATIONS: Elimination of all risks associated with zoonotic pathogens in veterinary practice is clearly not possible. This Compendium provides reasonable guidance for minimizing disease and injury among veterinary personnel in clinical settings. Although the VSP are intended to be adaptable to individual practice needs and circumstances, any modifications should adhere to basic principles of infection control and comply with federal, state, and local regulations. The VSP focus on personal protective equipment and actions; however, comprehensive infection control planning should also include consideration of work-environment control measures such as exposure avoidance (eg, refusal to provide care for species for which a practice is not equipped); engineering controls (eg, convenient placement of sharps containers or providing an employee break room), and administrative controls (eg, employee training). Employers should demonstrate and promote safe work habits. The cost of implementing these guidelines compares favorably with the potential financial consequences of inadequate infection control, including sick leave or hospitalization of personnel, loss of credibility, and litigation. Training is an essential part of VSP implementation and it is most effective if each employee is made aware of the relevance of infection control policies to their own health and the health of others. Veterinarians are accessible, expert sources of information regarding zoonotic diseases and should be prepared to inform clients of risks specific to their community. Client education about issues such as the importance of rabies vaccination for animals, internal and external parasite control, and bite prevention will also help protect veterinary staff from exposure to zoonotic diseases.
Dr. Scheftel, NASPHV VICC, Acute Disease Investigation and Control Section, Minnesota Department of Health, 625 N Robert St, Saint Paul, MN 55155