BACKGROUND: Expected rates of healthcare‐associated infections (HCAI) have not been established in veterinary hospitals. Baseline rates are critically needed as benchmarks for quality animal care. ...OBJECTIVE: To estimate the occurrence of events related to HCAI identified using a standardized syndromic surveillance system in small animals in critical care cases at referral hospitals. ANIMALS: Weaned dogs and cats (n = 1,951) that were hospitalized in the critical care unit of referral teaching hospitals during a 12‐week period. METHODS: Multicenter, prospective longitudinal study. A survey was completed for all enrolled animals to record basic demographics, information about procedures and treatments that animals received, and to document the occurrence of defined nosocomial syndromes. Data were analyzed to identify risk factors associated with the occurrence of these nosocomial syndromes. RESULTS: Controlling for hospital of admission, 16.3% of dogs (95% confidence intervals CI, 14.3–18.5) and 12% of cats (95% CI, 9.3–15.5) were reported to have had ≥1 nosocomial syndrome occur during hospitalization. Risk factors found to have a positive association with the development of a nosocomial syndrome were longer hospital stays, placement of a urinary catheter, surgical procedures being performed, and the administration of antiulcer medications and antimicrobial drugs excluding those given perioperatively. CONCLUSIONS AND CLINICAL IMPORTANCE: Syndromic surveillance systems can be successfully standardized for use across multiple hospitals to effectively collect data pertinent to HCAI rates and risk factors for occurrence.
Background
Salmonella enterica can significantly impact management of animal facilities. Comprehensive screening is essential for effective control in high‐risk populations. Availability of reliable ...point‐of‐care diagnostic tests would facilitate these efforts.
Hypothesis/Objectives
Compare the ability of commercially available rapid diagnostic assays (2 lateral flow immunoassays LFIs, DNA hybridization DNAH, real‐time PCR qPCR), and culture to detect common serotypes of S. enterica in feces.
Animals
n/a.
Methods
In an experimental study, 112 S. enterica isolates were randomly selected from the 10 most common serotypes recovered at a veterinary hospital. Archived isolates were amplified in broth and standardized inocula (100 colony forming units) were incubated with equine feces in tetrathionate broth (TET). Cultures were tested in a blinded fashion by using LFIs, DNAH, qPCR, and culture.
Results
The LFIs detected 84% and 67% of isolates, respectively, but reactivity varied among serotypes. Both reacted poorly with serotype Cerro (Group K) isolates, and 1 LFI did not react with any serotype Mbandaka (Group C1) or Montevideo (Group C1) isolates. DNAH detected 94% of isolates, whereas culture and qPCR most reliably detected all serotypes. False‐positive results were obtained for 4 negative controls by using DNAH and 1 negative control by using qPCR, but LFIs and culture had no false‐positive results.
Conclusions and Clinical Importance
Culture, qPCR, and DNAH were effective in detecting most Salmonella isolates, but have limited application at point‐of‐care settings. LFIs are appealing as point‐of‐care tests because of low cost and ease of use, but limited detection of some serotypes needs to be evaluated with samples obtained from naturally infected animals.
Salmonella enterica is a common zoonotic pathogen in humans. Transmission typically occurs through consumption of contaminated food products or contact with infected animals, including poultry or ...their environment. The objective of this study was to estimate the frequency of Salmonella contamination in the environment in poultry exhibits at agricultural fairs. Samples were collected from cages, feed, floors and tables in the exhibit and cultured for Salmonella. At least one environmental sample was positive for Salmonella in 10 of 11 fairs (91%), and Salmonella was isolated from 28 of 55 environmental samples (50.9%). Eleven different serotypes were detected. Results of this study demonstrate that environmental surfaces at agricultural fairs can be contaminated with Salmonella and could potentially serve as a route of transmission to bird owners and the general public. Poultry owners and the general public should be educated about the risks of Salmonella infection from the poultry exhibit environment. Agricultural fairs should consider instituting policies and practices to improve hygiene and mitigate the risk of zoonotic salmonellosis.
Distances to common production and marketing supply chain destinations may vary, and this has economic and animal health implications for small-scale food animal operations. Proximity to these ...destinations can affect the economic viability and marketing decisions of small-scale operations and may represent significant barriers to sustainability. Data were collected using a cross-sectional survey conducted by the US Department of Agriculture's (USDA) National Animal Health Monitoring System in 2011 using a stratified systematic sample of 16,000 small-scale (gross annual farm sales between US$10,000 and 499,999) operations from all 50 states. A total of 7925 food-animal operations were asked about the farthest one-way distance (in miles) to slaughter facilities, destinations where they sold animals or products, and feed sources. Across all small-scale operations, 95% of operations reported the farthest distance animals or products were transported for sale was 241 km (150 miles) or less. For distance to slaughter facilities, 95% of operations reported the farthest distance was 145 km (90 miles) or less. For feed shipped by a supplier, 95% of operations reported the farthest distance was 322 km (200 miles) or less. The 95th percentile for distance increased as farm sales increased, indicating larger operations were more likely to travel long distances. The results of this study are an important benchmark for understanding the economic and animal health implications of long transportation distances for operations that are small and/or focused on direct marketing.
Background: Nosocomial salmonellosis is often assumed to occur because infection control and surveillance practices are inadequate, but published evidence is lacking to support the related contention ...that rigorous application of these practices can impact the severity of outbreaks.
Objective: Describe active surveillance, early recognition, and intensive mitigation efforts used in an effort to control an outbreak of nosocomial Salmonella enterica serotype Newport infections without hospital closure.
Animals: Large animals hospitalized at a referral hospital.
Methods: This prospective outbreak investigation was initiated when Salmonella Newport infections were detected among hospitalized animals by active surveillance. Data were analyzed to identify temporal and spatial patterns for epidemic spread of Salmonella in the hospital. Mitigation efforts were aggressively adjusted in response to surveillance data. Genetic relatedness of isolates was investigated by pulsed‐field gel electrophoresis.
Results: Of 145 large animals sampled, 8 (5.6%) were infected with the Salmonella strain associated with this outbreak, and all but 1 shed Salmonella in the absence of or before the onset of disease. This strain was recovered from 14.2% (42/295) of environmental samples (ENV samples), indicating that widespread environmental contamination had occurred. Isolates of Salmonella Newport obtained from infected animals and the environment were genetically indistinguishable, confirming clonal dissemination.
Conclusions and Clinical Importance: Active surveillance allowed early detection of nosocomial Salmonella transmission and hospital contamination. Use of aggressive interventions was followed by cessation of transmission. Active surveillance can allow earlier recognition and mitigation compared with programs by only sampling of clinically affected animals.
OBJECTIVE: Document the clinical features, short‐ and long‐term outcomes and prognostic factors in New World camelids with acquired urethral obstruction. DESIGN: Retrospective case study. METHODS: ...Case data from medical records of 34 New World camelids presenting with acquired urethral obstruction were collected and follow‐up information on discharged patients was obtained. Associations with short‐ and long‐term survival were evaluated using Wilcoxon rank‐sum tests, exact‐logistic regressions and Kaplan‐Meier survival curves. RESULTS: Of the 34 New World camelids 23 were intact males and 11 were castrated; 4 animals were euthanased upon presentation, 7 were treated medically and 23 surgically, including urethrotomy, bladder marsupialisation, tube cystostomy alone or combined with urethrotomy, urethrostomy or penile reefing. Necrosis of the distal penis was found in 4 animals and all were short‐term non‐survivors. Short‐term survival for surgical cases was 65%, and 57% for medical cases. Incomplete urethral obstruction at admission and surgical treatment were associated with increased odds of short‐term survival. Of 14 records available for long‐term follow‐up, 6 animals were alive and 8 were dead (median follow‐up 4.5 years, median survival time 2.5 years). Recurrence of urethral obstruction was associated with long‐term non‐survival. CONCLUSIONS: Surgically treated New World camelids with incomplete urethral obstruction have the best odds of short‐term survival and those with recurrence of urethral obstruction have a poor prognosis for long‐term survival.
Background
Infection control is critical to providing high‐quality patient care. Many veterinary teaching hospitals (VTHs) utilize footbaths or footmats at entrances and key control points throughout ...the facility to decrease trafficking of pathogenic microorganism on contaminated footwear.
Hypothesis/Objectives
To compare efficacy of 4 disinfectants used in footmats for decreasing bacterial contamination of footwear in a large animal hospital.
Animals
A single adult dairy cow was housed in a stall for 4 days to facilitate stall contamination with fecal material.
Methods
Overboots were experimentally contaminated with organic material in a standardized manner. Each boot was randomly assigned to 1 of 5 treatments (no treatment, or exposure to 1 of 4 disinfectants: an accelerated peroxygen AHP, a peroxygen VIRKON, a quaternary ammonium QUAT, and a phenolic disinfectant PHENOLIC) by stepping on a soaked footmat and collecting samples from boot soles. Generalized linear modeling was used to analyze differences in bacterial counts.
Results
Reductions in colony‐forming units (CFUs) on treated boots ranged from no detectable reduction to 0.45 log10 and varied by disinfectant. Percentage reductions in total bacterial counts generally were larger (albeit still modest) for AHP and QUAT disinfectants (range 37–45%) and smallest for the PHENOLIC (no detectable reduction).
Conclusions and Clinical Importance
In general, use of disinfectant footmats was associated with significant reductions in viable bacteria on overboots—albeit with variable efficacy. Footmats may be useful adjuncts to cleaning and disinfection programs for decreasing trafficking of microorganisms throughout VTHs but should not be considered as a sole prevention method.
Summary
Reasons for performing study
Effective decontamination of animal holding environments is critical for providing high quality patient care and maintaining a safe working environment. ...Disinfection of animal holding environments is a significant challenge during times of epidemic disease.
Objectives
The purpose of this study was to evaluate the disinfectant efficacy of 3 strategies for high‐volume directed mist application of accelerated hydrogen peroxide and peroxymonosulfate disinfectants; 4.25% accelerated hydrogen peroxide (Accel®; AHP) at a 1:16 dilution and single and double applications of 2% peroxymonosulfate solution (Virkon‐S®; VIR‐1 and VIR‐2) for decontamination of a large animal hospital environment.
Study design
Experiment.
Methods
After cleaning and disinfection of the hospital environment, transparencies experimentally contaminated with known concentrations of Staphylococcus aureus, Salmonella enterica and Pseudomonas aeruginosa were placed on vertical surfaces. Disinfectant solution was applied by directed mist application and, after 30 min of contact time, transparencies were collected and individually placed into tubes containing 10 ml Dey‐Engley broth. The process was repeated for each disinfectant. Tenfold dilutions of each sample were plated onto tryptic soy blood agar with 5% sheep blood. Bacterial counts from transparencies exposed to disinfectants were compared with counts from control transparencies (unexposed to disinfectants) to evaluate reduction in colony forming units.
Results
The least squares mean reduction (log10) in colony forming units (CFUs) for S. aureus and P. aeruginosa was 1.5–2.5 logs and approximately 0.8–1.0 logs for S. enterica. Reductions were generally largest for VIR‐2 and smallest for AHP, although these differences were not all statistically significant and the magnitude of differences may not be clinically relevant.
Conclusions
For the organisms evaluated, all 3 disinfectants applied as a directed mist were effective at reducing CFUs in a veterinary hospital environment. Effective disinfection using this method of application is dependent on adequate cleaning prior to application, and use of adequate volumes of disinfectant.
REASONS FOR PERFORMING STUDY: Salmonella enterica is the most commonly reported cause of outbreaks of nosocomial infections in large animal veterinary teaching hospitals and the closure of equine ...hospitals. Rapid detection may facilitate effective control practices in equine populations. Shipping and laboratory testing typically require ≥48 h to obtain results. Lateral flow immunoassays developed for use in food‐safety microbiology provide an alternative that has not been evaluated for use with faeces or environmental samples. OBJECTIVES: We aimed to identify enrichment methods that would allow commercially available rapid Salmonella detection systems (lateral flow immunoassays) to be used in clinical practice with equine faecal and environmental samples, providing test results in 18–24 h. STUDY DESIGN: In vitro experiment. METHODS: Equine faecal and environmental samples were inoculated with known quantities of S. enterica serotype Typhimurium and cultured using 2 different enrichment techniques for faeces and 4 enrichment techniques for environmental samples. Samples were tested blindly using 2 different lateral flow immunoassays and plated on agar media for confirmatory testing. RESULTS: In general, commercial lateral flow immunoassays resulted in fewer false‐negative test results with enrichment of 1 g faecal samples in tetrathionate for 18 h, while all environmental sample enrichment techniques resulted in similar detection rates. The limit of detection from spiked samples, ∼4 colony‐forming units/g, was similar for all methods evaluated. CONCLUSIONS: The lateral flow immunoassays evaluated could reliably detect S. enterica within 18 h, indicating that they may be useful for rapid point‐of‐care testing in equine practice applications. Additional evaluation is needed using samples from naturally infected cases and the environment to gain an accurate estimate of test sensitivity and specificity and to substantiate further the true value of these tests in clinical practice.
REASONS FOR PERFORMING STUDY: Methods that can be used to estimate rates of healthcare‐associated infections and other nosocomial events have not been well established for use in equine hospitals. ...Traditional laboratory‐based surveillance is expensive and cannot be applied in all of these settings. OBJECTIVES: To evaluate the use of a syndromic surveillance system for estimating rates of occurrence of healthcare‐associated infections among hospitalised equine cases. STUDY DESIGN: Multicentre, prospective longitudinal study. METHODS: This study included weaned equids (n = 297) that were admitted for gastrointestinal disorders at one of 5 participating veterinary referral hospitals during a 12‐week period in 2006. A survey form was completed by the primary clinician to summarise basic case information, procedures and treatments the horse received, and whether one or more of 7 predefined nosocomial syndromes were recognised at any point during hospitalisation. Adjusted rates of nosocomial events were estimated using Poisson regression. Risk factors associated with the risk of developing a nosocomial event were analysed using multivariable logistic regression. RESULTS: Among the study population, 95 nosocomial events were reported to have occurred in 65 horses. Controlling for differences among hospitals, 19.7% (95% confidence interval, 14.5–26.7) of the study population was reported to have had at least one nosocomial event recognised during hospitalisation. The most commonly reported nosocomial syndromes that were unrelated to the reason for hospitalisation were surgical site inflammation and i.v. catheter site inflammation. CONCLUSIONS: Syndromic surveillance systems can be standardised successfully for use across multiple hospitals without interfering with established organisational structures, in order to provide useful estimates of rates related to healthcare‐associated infections.
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