Friday, July 26, 2013

Vets, zoonoses and infection control

A calf with a fever. 
Imagine examining a pyrexic calf. Opening and examining the oral cavity without the benefit of gloves or a mask. It happens all of the time, but three days after Dr Navneet Dhand examined this particular calf, it was diagnosed with rabies. 

He wrote about the episode, and some lessons learned, in a recent article in The Conversation which you can read here.

That was in 1996. Dr Dhand is now an epidemiology guru, and his research team has presented some findings which should jolt the profession out of its complacency - notably that veterinarians, as a profession, are woefully inadequate when it comes to infection control.

I wrote about this recently in The Veterinarian Magazine, but this story needs to be told and retold.

A study published by Dowd et al. in Preventative Veterinary Medicine, found that 44.9 per cent of vets had contracted a zoonotic disease through their work, yet only 40-60 per cent perceived occupational exposure to zoonosis likely or highly likely.

Principal investigator Dr Dhand didn't mince his words: 

“Not using appropriate protection when necessary is just like having unprotected sex with a stranger and thinking that it will be alright.”

Well, it isn't. According to the study, Australian veterinarians didn't use appropriate PPE most of the time when we should have known better, for example, when investigating neurological and respiratory cases. This is an even bigger concern as two of the most dangerous zoonoses - Hendra and Lyssavirus - can present in this way.

Only 75 per cent of veterinarians use adequate PPE (such as masks, gowns and gloves) when performing post-mortems, dental procedures and surgery. Gross.

Other findings included:

34.8 per cent of veterinary hospitals did not have isolation units for animals with contagious or infectious diseases;
* 21.1 per cent of practices do not have staff eating areas separate from animals;
* 60 per cent of workplaces do not make adequate use of national industry standard infection control kits designed to protect staff against infection.

Probably the most concerning finding is that despite a high risk of contracting a zoonotic disease, half of us considered our risk as low. The thing is, if you think your risk is low, you tend not to take precautions. 

There are some excellent resources to help vets improve their infection control practices.

Aside from some misconceptions about our personal risk, why are veterinarians not great at infection control? Is it because that dog on the table can't say "hey mate, you ain't coming near my anal glands without gloves?" or do we think we're all invincible? 

[And if you really need a jolt, check out the Australian Story episode about occupational exposure to Hendra virus in a veterinary hospital here].


Dowd K, Taylor M, Toribio J, Hooker C and Dhand N (2013) Zoonotic disease risk perceptions and infection control practices of Australian Veterinarians: Call for change in work culture. Preventative Veterinary Medicine