Vet Times The website for the veterinary profession https://www.vettimes.co.uk Clean machine: your guide to brilliant practice hygiene Author : JENNY WRIGHT Categories : Business Date : December 1, 2012 Cleanliness may be associated with godliness, but if a practice is found to be in a poor state it will take more than a wing and a prayer to assuage the authorities and clients. THE STANDARD OF cleanliness within your veterinary practice speaks volumes about you, your staff and your practice s standards. Clean, wellmaintained premises signal to both your clients and your employees that you are efficient, competent and committed to providing the best level of service to the animals you treat. The RCVS guidelines on hygiene state that premises must be in good decorative order, clean and well maintained so as to create an atmosphere of clinical cleanliness and efficiency. It is not required to be perfect. Yet what exactly does this mean? Hygiene is of paramount importance to all of us at the Zetland Veterinary Hospital in Bristol. The process of keeping the premises hygienic involves a great deal more than surface cleaning alone. Infectious disease outbreaks can be devastating. There is a range of potential infectious diseases that can be of concern in the reception and consulting room areas, such as kennel cough and cat flu, as well as antimicrobialresistant bacteria, such as MRSA, and zoonotic diseases that are causing increasing concern in veterinary health care. Therefore, hygiene is something we take very seriously. Clients come to us to look after their pets, so ensuring our practice is as clean as possible is absolutely vital to make sure we carry out our duty of care to the highest possible standards. The Zetland Veterinary Hospital is part of the Premier Veterinary Group (PVG), which has a 1 / 8
number of practices around the UK and is accredited under the RCVS Practice Standards Scheme. PVG is committed to providing the highest level of animal care, so reducing the risk of infection is a key factor in this. Cleaning and disinfection Organisms causing serious and life-threatening diseases can quickly multiply in veterinary practices. They are spread by direct contact, aerosols, contact with bodily fluids or contact with sites within the practice, such as door handles, floors, computer keyboards and examination tables. This can become a public health risk if disseminated into the wider community. Effective infectious disease control methods are, therefore, essential. Many infectious diseases can be prevented or contained through good hygiene practice and education. The most obvious measure is cleaning and disinfection of all equipment and surfaces, and hand washing after each patient, and the same rule applies to equipment taken on to other premises (for example, on home visits), including kennels, bedding, bowls and litter trays. Clear protocols need to be in place regarding cleaning and disinfection of kennel areas in between patients, and bedding is washed thoroughly after each use. Our practice, for example, has a huge stock of bedding due to the amount we get through. Cleaning and disinfection of other sites can be facilitated by the use of waterproof keyboard covers, white boards and impervious seats. Instructions, cleaning schedules and posters should be easily visible and laminated to make them easier to clean. Cleaning schedules should have specific tasks allocated at daily, weekly and monthly intervals as appropriate. Examination tables should also be disinfected between patients. Cleaning and disinfection agents should be available in each room and clearly labelled. Isolation policy We have our own isolation unit at the Zetland where infectious or zoonotic cases are cared for, and we have a very strict policy in this area. Only appropriately trained clinical members of staff are permitted in this ward, and we ensure those at our practice are given familiarisation training throughout the year using our written protocol. We are careful to ensure they have read and signed the COSHH and health and safety guidelines regarding the risks of dangerous pathogens and zoonosis, which are reviewed annually. Practices with their own isolation areas should be equally strict about what goes in and out of the ward. Equipment marked isolation should only be used here, and qualified veterinary nurses, supervised by the head veterinary nurse, must maintain this equipment. Strict guidelines when handling waste must be adhered to infectious waste and waste from the isolation ward should be sealed in leakproof yellow bags or sharps containers and disposed of according to waste disposal 2 / 8
policies. Impermeable dressings should be used to cover discharging wounds. Vets and nurses should wear protective clothing, including masks and overshoes, while the use of a footbath at the door of the isolation ward is recommended. Other practices without the facility of an isolation ward should have in place a standard operating procedure that states how such cases should be dealt with or referred elsewhere. It is vital veterinary practitioners follow procedures so they may meet the duty of care to their own health, as well as that of their staff and patients. They should be aware of certain risk factors, such as animals with wounds that will not heal, or infections that do not respond to antibiotics. Vets should also be alert to postoperative, practiceacquired or secondary infections, and such known or suspected cases should be moved directly to a consultation room to avoid contagion in the waiting area. Wherever we can, we try to schedule procedures for the end of the day and we avoid walking animals through the building, as they could contaminate floors, corridors and other areas of the practice. All practices need to have a clear policy on isolation that is communicated to all employees. It is not always possible for practices to have a truly self-contained isolation unit, but in such cases, the practice must provide separate accommodation for infectious or zoonotic cases. It is not acceptable to merely send the patient home. Regarding dealing with cases of suspected infectious or zoonotic diseases, when such patients are presented to one of our branch practices they are immediately directed to the Zetland Veterinary Hospital and their owners are instructed to take the animal straight there without stopping. If they need emergency treatment or stabilisation at the branch practice, they are immediately taken into a separate examination room, preferably without touching the floors, to facilitate decontamination afterwards. Isolation facilities should contain hand washing facilities, separate drains and separate air space from the rest of the practice to avoid cross-contamination, and ventilation should produce negative air pressure to reduce the risk of this. Personal hygiene and professional behaviour Hands should be washed and disinfected before and after handling any patient or its immediate environment, before gloving, or ahead of any cleaning task. Hand washing facilities should be accessible in all clinical areas. Door handles or any other surface should not be touched before washing. Clinical and reception staff should carry hand washes or alcohol gels and disinfectants with them, even when visiting patients at home. We provide all our clinical employees with simple uniforms that are cleaned regularly, and staff 3 / 8
follow the appropriate guidelines for personal hygiene. Long hair should be tied back, sleeves rolled up, ties avoided and wounds or skin lesions covered with waterproof dressings. Fingernails should be kept short and clean, and jewellery should be kept to a minimum. Human contact can help spread infectious diseases, and practices should ensure staff are trained about and adhere to hygienic practice. Our staff are also particularly vigilant when treating animals from households where there have been infections or with owners who have frequent health care contact. Some animals are more at risk than others, based on where they live and who they live with, so it is definitely worth making notes about their background in such cases. Education I believe education is key to maintaining cleanliness, health and safety. All our staff, including veterinary surgeons, veterinary nurses and receptionists, are properly trained about maintaining high standards of hygiene at the surgery. They are also able to share this knowledge with clients, to help reinforce good practice on hygiene and responsible antibiotic use, including the importance of good compliance. The PVG group lays down clear guidelines for its member practices regarding hygiene, as well as offering veterinary practices a variety of beneficial services through its subsidiary Premier Vet Alliance (PVA), thus enabling smaller practices to compete on a more level footing with larger corporate groups. Few would argue cleanliness is one of the most important factors in maintaining a healthy and successful veterinary practice. As a vet, your main concern is maintaining or restoring the health of the animals in your care, so hygiene is of primary importance. Practice performance also depends on the cooperation of all employees, and your team s attitude to the working environment has a direct impact on the health of your clients. It is vital everyone complies with high standards of hygiene. 4 / 8
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Powered by TCPDF (www.tcpdf.org) There is a range of potential infectious diseases that can be of concern in the reception and consulting room areas, such as kennel cough and cat flu, as well as antimicrobial-resistant bacteria, such as MRSA, and zoonotic diseases that are causing increasing concern in veterinary health care. 8 / 8