Bad Habits Breed Germs, Resistance

An infection control plan is highly important for any practice, but management of those plans is often overlooked.

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Reducing the spread of infection is a two-tiered strategy requiring proper hygiene and accurate diagnosis.

While every practice needs an infection control plan, experts say management of those protocols is too often lax.

“Antibiotic resistance is a big topic and hygiene is a huge issue that needs to be improved on,” says Joshua Daniels, DVM, Ph.D, a clinical microbiologist at Ohio State University. “Proper hand washing and disinfection of surfaces along with other measures can’t be assumed as known and must be discussed.”

The U.S. Centers for Disease Control and Prevention and the American Veterinary Medical Assn. periodically survey veterinarians about infection control practices within the clinic. These surveys help authorities better understand practices routinely used by veterinarians.

“CDC infection control policies and those made by the National Assn. of State Public Health Veterinarians (NASPHV) detail proper hand-washing procedures, the use of gloves, cleaning and precautions in general,” Dr. Daniels says. “These may seem obvious, but it’s clear that employee education and reminders are necessary.”

Click here for NASPHV recommendations. (Click on “What’s New.”) They  cover respiratory protection, protective outerwear, isolating infected animals, autoclaving methods and infectious material disposal.

First of All, Get it Right

Making sure to treat an animal for what it actually has can help fight antibiotic-resistant bacteria such as staphylococcus and enterococci.

“The bacteria the patient is harnessed with is stronger than ever before and you can’t rely on cephalexin to take care of it anymore,” Daniels says. “We’re dealing with more resistant bugs now. Although we can add a human drug to our armamentarium from time to time, we don’t have medications that can eliminate bacterial infections the way they did in the past.”

One concern is diagnostic labs used by veterinarians.

“Human and commercial labs may not have veterinary microbiologists on staff who understand the normal types of bacteria you might see,” Daniels says, “so the results lead vets to use antimicrobial agents that are inappropriate because the bacteria found at the tested site are normal.”

Recurring urinary tract infections and dermatologic problems are the main arenas in which antibiotic resistance is found, Daniels says. These conditions can help spread infection hospital-wide.

“We are seeing a lot of resistant dermatological infections that cannot be overcome easily,” says Gregory C. Griffeth, DVM, Dipl. ACVD, an associate at the Allergy & Dermatology Veterinary Referral Center in Portland, Ore.

“Certain staph infections have increased in resistance in more recent years, and the potential for spreading is great. Veterinarians should be aware of this and educate staff on the implications of not taking hygienic precautions,” Dr. Griffeth says. “A patient’s health can be significantly compromised if it is already immune-suppressed, and you don’t want your hospital to be a vector for this.”

Secondary bacterial infections that stem from chronic renal failure or diabetes are difficult to control as well because the underlying disease is hard to manage.

Looking to Future

Antibiotic resistance and the spread of infection are getting more attention from researchers.

Mark Rutherford, Ph.D., an associate professor in the veterinary and biosciences department at the University of Minnesota, and Sheila Torres, DVM, Ph.D., an assistant professor, are looking at canine atopic dermatitis and secondary infections. They hope to unveil the role of natural antibiotics, proteins made by the immune system that inhibit bacterial growth.

The research is sponsored in part by Morris Animal Foundation of Denver.

“Absence of cationic antimicrobial peptides contributes to the increase of secondary infections in humans,” Rutherford says. “We are looking to identify defensin and protease inhibitor peptide genes to determine if antimicrobial peptides are expressed in normal canine skin. The findings of the study are expected to provide a tool for future studies by examining the association between antimicrobial gene expression and cutaneous immunity in dogs.”

Rutherford says that despite their immune importance, knowledge  of canine defensins and their expression is limited.

“We’re using reverse-transcription-polymerase chain reaction to test for the expression of several antimicrobial peptides in the skin of five normal dogs,” Rutherford says. “Screening identified 65 putative antimicrobial in the genes in five different body sites.”

Rutherford says the research is expected to determine whether the cationic antimicrobial peptides can be used to fight bacteria resistant to antibiotics.

Watch for Patterns

“When veterinarians experience recurring infections in patients, they need to consider possible patterns,” Daniels says. “(Consider) previous exposure to resistant genes, contamination in the environment, the population number of microorganisms and the sustainability of the population of microorganisms compared with other bacteria in the animals’ environment that has not been treated with antibiotics.”

Prudent use of antibiotics and proper documentation of the antibiotic types, doses and duration used in patients are important if resistance becomes a chronic problem in the practice.

“Remain vigilant about educating employees on proper hygiene in all aspects of practice,” Daniels says. “Prevention is essential in steering clear of infection spread, while avoiding casual antibiotic use. Detailing some precautionary steps to clients will help prevent recurring infection outside of the clinic.” 

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