Biosecurity for Patients and Humans at Wildlife Rehabilitation Clinics

Transcription

1 Biosecurity Biosecurity for Patients and Humans at Wildlife Rehabilitation Clinics Leslie Martin, DVM Biosecurity: process of protecting from disease caused by microorganisms Biosecurity practices Prevention of Zoonotic disease to humans Disease transmission from patient to patient Direct transmission Transmission Bites, scratches Handling animal or infected tissues Indirect transmission Contact with infected urine, feces, blood, tissue samples Fomites (hands, feet, clothes, equipment, cages, etc.) Bites from ectoparasites from infected animals (fleas and ticks) Staff and Volunteer Health Status Special health concerns Immune suppression Chronic disease Organ transplants Chemotherapy Age Pregnancy Zoonotic Diseases Diseases that can be transferred from animals to people Animals may not be clinically ill Still may shed infectious organisms Bodily excretions Respiratory spread Infected tissue, wounds Zoonotic Disease Examples Rabies Tularemia Salmonella LCMV Leptospirosis Hantavirus Campylobacter Baylisascaris 1

2 Other Selected Zoonotic and Vector Borne Diseases Tick borne- Tularemia Lyme disease Flea borne Plague Mosquito borne West Nile Rabies Tularemia Salmonella Hantavirus Leptospirosis LCMV Ringworm Mammals- Examples Parasites Baylisascaris Giardia Ticks or fleas Lyme disease Plague (West coast) More Tularemia Rickettsial diseases Rabies Rabies virus Infects the central nervous system Clinical signs Neurological disease Ultimately death No treatment once clinical signs appear Mammals Neurological signs; Walking in a circle Foaming at the mouth Head tilt Seizuring Behaving aggressively Always consider rabies Pre-exposure vaccinations Rabies Vector Species North Carolina law Raccoons, bats, foxes and skunks Rabies Vector species cannot be legally rehabilitated in NC Any mammal may contract rabies Rabbits, beavers, bobcats, groundhogs And opossums occasionally Bat 16 Bobcat 4 Cat 26 Cow 4 Coyote 2 Dog 4 Equine 3 Fox 89 Raccoon 210 Skunk 71 Totals 429 Rabies Cases NC 2011 Every county had at least 1 case 2

3 What about? Different variants depending on host Skunk, raccoon, canine, fox, bat Mammals usually susceptible to all variants What about owls? Reports of antibody *titers* Rabbits and rodents? Reports of rabid pet rabbits Most common rodent species infected? Woodchuck, occasionally beaver Young Animals Can young animals have rabies? Yes, depending on their exposure Recent cases of young puppies and kittens exposed and infected Too early for them to be vaccinated NC and SC cases Rabies Bite of infected host Virus into open cuts in skin, Onto mucous membranes from saliva Or other potentially infectious material such as neural tissue Aerosol- historical, bat caves Unpasteurized milk and other Compendium of Animal Rabies Prevention and Control, 2008 National Association of State Public Health Veterinarians, Inc. Rabies Biosecurity Recommendations Recommend research this issue for your group Recommend staff are vaccinated What about wildlife patients Bitten by unknown animal? (housing, staff, etc.) Dog bitten by potentially rabid animal Possible human exposure via saliva in wounds NC rabies website Recommend contact NC DHHS Public Health Veterinarians Rabies possible exposure? If you are bitten or scratched by any animal Clean the wound out well with soap and running water for 15 minutes Keep the animal for potential testing Call your physician Call Animal Control Call N.C. DHHS Public Health Veterinarians / 24 hours Document everything Hantavirus Pulmonary Syndrome (HPS) Caused by Hantavirus Pulmonary disease in humans Deaths reported Clinical signs in animals Unknown Contact with rodent feces, urine, or saliva Aerosolized (cleaning rodent areas) Bites (rare) 3

4 What about voles? Other rodents carry strains of hantavirus that cause HPS, but they have not yet been identified. Hantavirus Biosecurity See CDC website for cleaning information Caution Cleaning areas with high rodent activity Cleaning Use CDC recommended precautions Respiratory protection Tularemia (Rabbit Fever) Francisella tularensis Bacterial disease Reportable disease Rabbits and rodents Sheep and other mammals- uncommon Birds, fish, amphibians, reptiles- rare Worldwide In all US states except Hawaii Fatal in 5% of untreated cases Rabbits and rodents Tularemia Most are found dead Often in outbreaks to humans Ticks from infected animals Handling infected animals or their tissue Aerosolization Contaminated dust Lymphocytic Choriomeningitis virus (LCMV) Clinical Signs in humans Febrile Neurologic disease Fetal loss/birth defects Exposure during pregnancy Contact with rodent feces, urine, or saliva Aerosolized (cleaning rodent areas)? Reportable? Recommend- report LCMV - Biosecurity See CDC website for cleaning information Caution Cleaning areas with high rodent activity Cage cleaning urine, feces, saliva Use CDC recommended precautions Respiratory protection 4

5 Leptospirosis In our area, wildlife reservoir Bacteria = Leptospira spp Clinical signs in humans Renal disease Flu-like symptoms Abortion Clinical signs in animals May not have signs Leptospirosis Clinic concerns Aerosolizing urine Rodent cages Other mammal cages Mucosal exposure Splash of urine into eyes Direct contact with urine onto broken skin Contact physician to discuss NC DHHS epidemiologists Parasites Baylisascaris - the raccoon roundworm Ingestion of infective eggs Food item contamination Eggs are very hardy Larval migrans, aberrant migration Tapeworms Ingestion of eggs Food item contamination Rodentolepis nana - from rodents- GI signs Recommend; Refer to CDC website Discuss with NC DHHS veterinarians Flea and Tick-borne Tularemia- direct exposure or via fleas Rickettsial Rickettsia prowazekii, Epidemic Typhus Human reservoir, Flying squirrels in Southeast Re-emerging disease; lice and fleas Severe, sometimes fatal Febrile illness, neuro, flu-like Recommend; Discuss with Infectious Disease physicians Reptiles and Amphibians Salmonella Mycobacteria Campylobacter Yersinia Salmonella Caused by salmonella spp bacteria Many different types of salmonella Clinical signs in humans GI disease Fecal-oral Skin contact-oral 5

6 Salmonella Sources Normal for reptiles, amphibians Small turtles (<4 inch carapace) Banned by FDA Ctr Vet Med Birds Pine siskins highly susceptible Mammals (many) Rodents, rabbits, raccoons, etc. Special concerns Proper handling, hand sanitation Young children and immunocompromised Birds Avian influenza Salmonella Goldfinch, other Chlamydophila Campylobacter Chlamydophila (West Nile- mosquito) Avian Influenza Essentially an avian disease Can cause severe illness Respiratory, neurological, GI Low path < 75% dead High path > 75% dead Direct (feces, aerosol, etc.) Fomites Some strains have potential to affect people Direct contact/respiratory No clear human to human Salmonella Passerines, and others Associated with flocks at feeders, fields Fecal shedding Concurrent trichomonas Goldfinch, pine siskin, other finch Recommend; Contact physician Campylobacter Surveillance of Avian Influenza, Campylobacter Spp., and Salmonella Spp. in Canada Geese (Branta canadensis) in Greensboro, NC Prevalence of avian influenza = 0% Prevalence of Campylobacter = 5.50% Prevalence of Salmonella = 2.12% Fecal oral Causes GI disease in humans Birds can be asymptomatic! Reportable disease Chlamydophila Bacterial disease Carriers- mainly psittacines, and pigeons Sometimes passerines Human signs- flu-like, endocarditis, hepatitis, neurological, pneumonia - dander, dried feces, dust Recommend; Discuss with NC DHHS Consider Respiratory protection (ventilation, mask) Special concerns; Immunocompromised people - State Veterinarian s Office 6

7 West Nile Virus Spread through infected mosquitoes Susceptible corvid, owl Mosquito control important Contact State for further information CDC Website Diseases Epidemiology Specific information on cleaning up after rodents Other Resources Compendium of Measures to Prevent Disease Associated with Animals Public Settings, 2011, CDC Compendium of Veterinary Standard Precautions for Zoonotic Disease Prevention in Veterinary Personnel, National Association of State Public Health Veterinarians, 2010 Association of Avian Veterinarians Proceedings, 2007, Biosecurity and the Challenges Facing Wildlife Care Facilities, J. Whittington, DVM, S. Etter, BS NC Dept Health and Human Services Veterinarians= NC Dept Health and Human Services = Biosecurity- Intake to Release Protect staff and public Protect hospitalized patients Protect newly arrived patients Protect environment Protect resident educational animals Preventative Health Goal: Keep humans and patients healthy Special health concerns Pregnancy, compromised immune system Recommend; Discuss health issues with physician Share zoonotic disease information Specific species you work with, and what potential zoonoses See physician immediately if you are unwell Intake All animals arriving may have infectious disease Ideal- isolate all new intakes Practical- Isolate if clearly infectious 7

8 Recommendations for Working with Rescuers Considerations for setting clinic policies Rescuers should not bring toys, pacifiers into intake area Plan for rescuers to wash up Prepare standard advice for rescuers Prepare standard protocol for asking questions of rescuers; Were you bitten, scratched? Did you find a flying squirrel nest in your wall? You do not have to re-invent the wheel! Hand Washing When to wash your hands After handling any animal, cage or dishes Before eating, drinking At the end of your shift Recommend No food/ drink at clinic areas Recommend avoid touching face, hair Recommend to wear gloves when washing animal dishes, cages and laundry Make it Simple Inform and educate Awareness of safety protocols Make it easy to comply Turtle Bathroom- for dirty turtle water People Bathroom No samples or cleaning of cages or dishes Recommend policy against eating or drinking in clinic Instead designate areas Other Personal Protective Equipment Leather gloves and goggles for raptors Specialty gloves - not 100% protective! Puncture proof, kevlar, etc. Goggles for herons, egrets and the like Masks - surgical, N95, respirators Bonnets/ caps, Bunny suits, faceshields Lab coats, scrubs, dedicated work clothes Shoe covers, boots, foot baths Extend Biosecurity to All Possible exposures; rescuers, staff, volunteers, maintenance help Information on zoonotic disease for all staff, volunteers Recommend; set policies for tetanus vaccination, rabies vaccination What about the x-ray technician, etc? Rescuers- Safety Document Recommend handouts by CDC or Public Health 8

9 In Case of Injury Recommend policy; volunteers do not handle patients Unless trained by staff Signed off on by staff If injured, recommend; Report to supervisor Fill out incident report No matter how small or insignificant! Seek medical attention ASAP Contact Animal Control and DHHS Public Health Veterinarians for bites and possible rabies exposures Biosecurity - Cost/ Benefit Analysis Minimum Protocols Gloves, masks Hand soap Paper towels Disinfectant Cleaning supplies Dishes, cages Detergent and disinfectant, bleach Ideal In clinic washer/dryer For clinic laundry Disposable PPE Especially for isolation Coveralls, lab coats Shoe covers/ booties Bonnets Clinic-only scrubs for all staff and volunteers Autoclave scrubs Appropriate Attire Staff and Volunteers Clothing Dedicated if possible Shoes Closed-toe Dedicated shoes Shoe disinfectant by the door Washing clothes Hot water and detergent Dry on high heat If bring home Soiled clothingtransport in plastic bag Next load not kids pajamas Laundry Ideal to have scrubs professionally laundered or in clinic In clinic- separate bins for clean/ dirty Use gloves to handle Not clean till dry Biosecurity Flow of Traffic Traffic flow: personnel Healthy sick Baby adult Limit visitation of other health facilities Where do you go after working with wildlife Avoid susceptible humans and animals Avoid pediatric ICU If in doubt, go home, change and shower Forms and posters are available for Printing and posting. 9

10 The Wet Paint Theory Imagine the bottom of whatever dish or object you have is covered in paint Wherever the container is placed, it leaves a mark of paint This is the contamination from this object You d like to have NO paint anywhere in the clinic! Holding Rooms Intake examination Collect samples, look for infectious disease Holding room or Isolation If no isolation is available, but suspect infectious disease Separate by susceptible species Pros and cons - stress of housing with other species Resident educational animals Holding Rooms and Medical Waste Ventilation is important Recommended air changes per hour Isolation with negative air pressure relative to other rooms Recommend; Review OSHA guidelines regarding medical waste Check for local and NC requirements Sharps and disposal Chemicals- anesthetics, radiology, cleaners Biosecurity and Record Keeping Learn from problems in the past Disease outbreaks or incidents Management techniques Something s wrong, what is new? Biosecurity Cleaning and Disinfection All equipment, food dishes and working areas Exam table and instruments (after each use) General procedure Wash with disinfecting soap Rinse thoroughly Disinfect for recommended time minimum Biosecurity Cleaning and Disinfection Removal of debris Feed Rodent control/insect control Remove material before bringing dishes to kitchen Place in dirty bin Water Turtle bathroom 10

11 Biosecurity - Feed and Food Prep Food closet Airtight lids Food prepped only in kitchen Food for carnivores or omnivores? May get exposure to zoonotic diseases from prey items Cross Contamination Prevention Wash hands Hand sanitizer Use trays to carry new and old dishes Each cage Food dishes Feeding implements Perishable food properly handled Biosecurity Disease Surveillance Training- know normal from abnormal Monitor animals over time Fecals on arrival Fecals 2 weeks before changing to new cage Prophylactic treatment for parasites in mammals ISOLATE SICK ANIMALS! Source of contamination Limit staff exposure Consider necropsy By knowledgeable veterinarian Thank You! Tufts University Wildlife Clinic Wildlife Center of Virginia New England Wildlife Michael Martin, DVM, MPVM, Dip. ACPV CDC NC DHHS Veterinarians 11