OSU Small Animal Hospital Infectious Disease Control Policy and Procedures Patient Flow and Hospital Zones

Infectious Disease Policy (Small Animal Services) 1. 2. Importance of Infectious Disease Control: Hospital Zones Special Considerations General Hospital Zone Special Considerations Intensive Care Ward Special Considerations Oncology Ward Special Considerations Diagnostic Imaging Special Considerations Isolation Ward Special Considerations Surgery Suites and Ancillary Areas

3. Passage of Staff and Students Between Zones 4. Potential Zoonoses

1. Importance of Infectious Disease Control 1.1. Control of the passage of infectious and/or contagious organisms from staff to patients and patient to patient is critical to patient care. Many of the patients at the OSU SA VTH are critically ill or potentially immune suppressed, all feasible measures should be taken by all staff and students to avoid the possibility of nosocomial infection in hospital patients 1.2. Some animal patients are presented with organisms that respresent a significant health risk to students and staff handling the animal. Protocols for the handling and management of animals with potential zoonoses are described in section 3. 2. Hospital Zones 2.1. The OSU VTH may be viewed as containing six specific zones, each of which has requires different approaches to the transmission and management of infectious disease organisms. 2.2. The six zones include 2.2.1. General Hospital Zone 2.2.2. Intensive Care Unit 2.2.3. Oncology Ward 2.2.4. Diagnostic Imaging 2.2.5. Isolation Ward 2.2.6. Sterile Surgical Suite 2.3. Hospital Reception, the consultation rooms, general treatment area, all corridors, endoscopy suite, cardiology suite, fluoroscopy suite, the dog ward, large dog ward and cat ward represent one zone of the hospital, referred to as the General Hospital Zone. Animals accommodated in this zone are assumed to be at low risk for contracting or transmitting organisms to or from other patients. 2.3.1. Animals with immune compromise or immune suppression should not be accommodated in these ward areas if feasible. 2.3.2. Patients and staff will often transit this zone to other regions of the hospital. Patients with potentially contagious diseases should be moved through this zone in a manner and at times that minimize contact with other animals and staff. Animals with open or draining wounds should be transported through the general hospital zone area on a gurney whenever possible. Following use to transport an animal with an open or draining

wound, the gurney should be cleaned with a quaternary ammonium compound disinfectant before use with any other patients. 2.3.3. If animals with potentially contagious disorders require movement for diagnostic imaging or the general hospital zone for diagnostics or treatment, these procedures should be carried out at the end of the day to minimize contact with other patients, staff and visitors. 2.3.4. Animal patients that are referred with a possible diagnosis of a contagious organism (non-healing wounds, draining tracts, severe diarrheal diseases in young animals) should be examined in Consultation room one or Exam room one only. Following use of this room for a patient with a presumptive diagnosis of a contagious organism, the room shall be closed to other patients until thoroughly cleaned and disinfected as per standard hospital protocols. 2.4. The Intensive Care Unit represents a separate zone of the Hospital 2.4.1. Animals housed in the Intensive Care Unit (ICU) are considered to be at higher risk of contracting nosocomial infections, due to greater potential for immune suppression in these patients. 2.4.2. Students and staff should avoid transiting the ICU area unless it is directly essential to patient management within the ICU. ICU technicians should remain within the ICU area and not assist with patients in the general hospital zone or diagnostic imaging unless this is critical to patient care. Students and staff should avoid congregating in the ICU area. 2.4.3. Owners of animals housed within the ICU may visit patients at the end of the day. If the patient is being barrier nursed, the owner will be provided with and must utilize protective gowns, glove and face mask. 2.4.4. The supervising clinician or student managing an ICU case should remain present with the owner while a visit is carried out. Owners may not interact with other animals within the ICU. 2.5. The Oncology Ward represents a separate zone for infectious disease control. 2.5.1. Animals housed within the oncology ward should be considered at high risk for immune suppression and contracting nosocomial infections. 2.5.2. Staff, clinicians and students should minimize entry into the oncology ward. The oncology ward should only be entered for direct manipulation of patients and the administration of chemotherapeutic drugs. For occupational safety as well as infectious control purposes, gloves and disposable gowns should be worn while handling animals in the oncology ward, these items should be disposed of in the biohazard bins in the oncology ward.

2.5.3. Disposable gowns should be disposed of if contaminated with urine, feces, blood or chemotherapeutic agent as per the Oncology Service SOPs. Disposable gowns from the oncology ward should not be worn into the General Hospital Zone, to minimize potential introduction of infectious organisms into the oncology ward. 2.5.4. Oncology cases will typically be day-stay visits, thus owner visitation is unlikely. Critically ill oncology cases will be moved to the ICU, where owner visitation may occur as described (2.4.3 above). 2.6. Diagnostic Imaging 2.6.1. Diagnostic Imaging is a core service of the OSU VTH, and as such it is inevitable that students, clinicians and staff from the Large and Small Animal services will mingle in this area. Diagnostic Imaging should be considered a transitional area for infectious disease control, and viewed as potentially contaminated. 2.6.2. Animals hospitalized in the General Hospital zone may enter the Diagnostic Imaging zone without need for additional precautions. 2.6.3. Animals hospitalized in the ICU or Oncology zones requiring diagnostic imaging should, where possible, be taken to the Diagnostic Imaging zone at the end of the day, when staff and patient movement is at the lowest. 2.6.4. The staff of the Diagnostic Imaging zone should receive prior notice regarding patients that are at risk for infectious complications or contracting nosocomial disease, to allow suitable disinfection/cleaning of the imaging room to be used. 2.6.5. Movement of animals from the Isolation Ward zone to Diagnostic Imaging should be carried out at the end of the day, unless urgently required for patient care. 2.6.6. The staff of the Diagnostic Imaging zone should receive prior notice regarding patients that are housed in the Isolation Ward zone to allow suitable disinfection/cleaning of the imaging room used before other patient procedures are carried out. 2.7. Isolation Ward Zone 2.7.1. The Isolation Ward is a single purpose isolation facility for the hospital care of canine and feline patients with presumed contagious diseases. 2.7.2. Animals housed in the Isolation Ward should be considered a significant potential source of infectious organisms that may affect other patients within the hospital. Great care should be taken to avoid contact between animals in the isolation ward and animals in the remainder of the hospital.

2.7.3. All examinations and, where feasible, all treatments for animals hospitalized in the isolation ward should be carried out within this area. An adequate supply of bandaging, intravenous fluid, catheterization and diagnostic sampling materials will be maintained within this ward. 2.7.4. Medications for use on individual patients in the isolation ward should be dispensed prior to entry into the isolation ward environment. Bulk bottles of medications should not be transferred to the isolation ward from the general hospital environment or from the isolation ward back into the general hospital zone. 2.7.5. Patients admitted to the isolation zone should enter the building via the rear door entrance to avoid contamination of the general hospital environment. 2.7.6. Disposable gowns, gloves and shoe covers are provided in the isolation zone; these protective items must be used when treating animals within the Isolation Zone, and must be disposed of in the bins within the isolation ward. 2.7.7. Disposable gowns should be disposed of if contaminated with urine, feces, or blood. Disposable gowns from the isolation ward should remain within the isolation zone and must not be worn into the General Hospital Zone, to minimize potential introduction of infectious organisms into the General Hospital Zone area. 2.7.8. Owners may visit patients hospitalized in the Isolation Zone at the end of the day. Owners will be provided with and must use suitable protective items such as gowns, gloves and shoe covers. Owners of animals in the Isolation Zone must enter and exit the hospital via the rear entrance, and should not be allowed access to the remainder of the hospital at the end of their visit. Students and/or clinical staff responsible for patients in the Isolation Zone should accompany owners during the visit to ensure compliance. 2.8. Sterile Surgical Core 2.8.1. The sterile corridor area of Surgery is specifically and highly isolated from the remainder of the hospital traffic. Specific protocols for entry to the sterile surgical core are provided in the Surgical Service SOP manual. 2.8.2. No individual shall enter the sterile corridor under any circumstances without donning appropriate protective clothing. 3. Passage of Staff, Students and Patients Between Zones 3.1. Students responsible for the care of patients in the Isolation Zone shall not also be responsible for care of patients within the ICU or Oncology zones, but may be responsible for care of patients in the General Hospital zone.

3.2. Students on surgical rotations may be responsible for the care of surgical patients in the ICU, General Hospital or Oncology zones, but shall not be responsible for patients hospitalized in the Isolation zone. 3.3. Wherever possible, students and staff shall minimize movement into and between the ICU zone and the General Hospital zone. Movement of staff and students between the isolation zone and the ICU should be avoided. 3.4. Staff and students exiting the Isolation zone must ensure that they have removed and disposed of all outer garments, shoe covers, leashes etc from the Isolation zone before entering the general hospital zone treatment areas. Hands should be washed before leaving the Isolation zone. Stethoscopes, thermometers, reflex hammers and all other items used in diagnostic assessment of patients in the Isolation zone should be thoroughly cleaned and swabbed with 70% alcohol before use on patients in the other hospital zones. 3.5. The Isolation zone is visible via windows at the end of the large dog ward and from the adjoining corridor. Quick checks of patients mental state can be made through these windows without requiring entry into the isolation ward. 3.6. Students and staff from Large Animal Medical or Surgical services shall not enter the Small Animal ICU or Oncology zones while wearing overalls or protective overboots that have been worn in the Large Animal hospital wards. Passage of students and staff between the Large and Small Animal Hospitals should be minimized. 3.7. Students and staff from the Small Animal hospital delivering prescriptions to the hospital pharmacy or diagnostic samples to the Veterinary Diagnostic Laboratory should travel via the front of the hospital, avoiding passage through the Large Animal hospital general corridors. 4. Potential Zoonoses 4.1. Certain patients presenting to the OSU VTH Small Animal Hospital will present with conditions caused by infectious organisms that are potentially transmissible to human caretakers. These are referred to as zoonotic diseases. 4.2. Four major groups of potential zoonoses may be encountered in the OSU VTH Small Animal Hospital. 4.2.1. Dermatophytic Fungal Organisms, such as Microsporum canis. 4.2.2. Bacterial Pathogens such as Leptospirosis, Salmonell, Methicillin resistant Staphylococcus. 4.2.3. Gastrointestinal Pathogens, such as Salmonella. 4.2.4. Viral Pathogens such as Rabies virus.

4.3. If a potential zoonosis becomes part of the differential diagnosis list for any patient at the OSU VTH Small Animal hospital, all reasonable steps must be taken to inform staff, involved students and the patients owner of this possibility. 4.4. Patients with a suspected zoonosis may be admitted to the general hospital zone, but they will be barrier nursed. Cage tags indicating the presence of a potential zoonosis will be prominently displayed. 4.5. Staff and students interacting with patients with potentially zoonotic diseases must wear disposable gowns, gloves and face masks while interacting with the patient and carrying out any procedures. 4.6. If an animal with a potential zoonosis requires diagnostic imaging services, the staff of diagnostic imaging will receive adequate warning of the potential zoonosis to allow donning of protective clothing and cleaning of the imaging area as deemed appropriate. 4.7. Students and staff who are or may be pregnant or immune suppressed will not be required to provide patient care to animals with potential zoonotic diseases. 4.8. If a potential zoonosis is definitively diagnosed in a patient, all involved staff, students and the patients owner must be informed of this diagnosis as soon as if feasible. This diagnosis will be entered into the animals permanent medical record on the problem list page.