The Hazards of Puppies & Kittens with Diarrhea
Maureen Anderson, DVM, DVSc, PhD, DACVIM, Guelph, Ontario, Canada
The Case
Check-In
Princess, a 12-week-old golden retriever puppy, was administered her first series of vaccines at a local veterinary practice approximately 4 weeks ago. She was scheduled to receive the next series in 2 days, but her owner, Mrs. Smith, called the practice and rescheduled the appointment for today.
Mrs. Smith and Princess arrive at the practice. Princess receives a lot of attention, including petting and hugging, from several team members and other clients. Most team members and clients do not wash their hands or use hand sanitizer after handling her in the reception area.
Without warning, Princess has explosive, bloody diarrhea across one of the reception area benches and the floor. Mrs. Smith then mentions that Princess has not quite been herself for the past few days and has had diarrhea “a couple of times.”
What Next?
Every team member has different roles and responsibilities. Here is what each team member should and should not do to help control the spread of infection when handling such a case.
Client Service Representatives, Veterinary Nurses & Nursing Assistants
DO: Immediately move Princess to an examination or isolation room, if possible. Containing any potential pathogens is top priority. Use a blanket or disposable puppy pad to pick Princess up and carry her to the room.
DO NOT: Encourage Mrs. Smith to take Princess outdoors to finish defecating. At this point, the cause of the diarrhea is unknown, and if an infectious agent is involved, the areas commonly used by other dogs will be contaminated, increasing the risk for transmission.
Veterinarians, Veterinary Nurses & Nursing Assistants
DO: Minimize movement in and out of the examination room. Ask a “clean” team member to stay outside the room and retrieve needed supplies.
DO: Ask a “clean” team member to escort the clients out of the practice once all the paperwork and permission forms are complete. Clients should not be taken to the reception/waiting area because their clothing and hands are possibly contaminated.
DO: Perform any procedures (eg, sample collection, catheter placement) in Princess’ examination room. When all procedures are complete, wrap Princess in a clean blanket or puppy pad. Leave all contaminated materials in the “dirty” room to deal with later. (See Disposal of Contaminated Items.)
DO: Carry the puppy directly to an isolation kennel or a kennel that is separated as much as possible from other animals and high-traffic areas. An isolation kennel is ideal but requires more effort to monitor because it should be physically separated from other parts of the practice. In both cases, follow procedural isolation techniques, which require excellent communication between team members (eg, signs to ensure only designated team members handle Princess) and compliance with practice protocols.
DO NOT: Repeatedly enter and exit the room to retrieve treatment and diagnostic testing supplies while wearing potentially contaminated clothing and without handwashing.
DO NOT: Carry Princess to the main treatment room to perform diagnostic testing and then to an easily accessible kennel for monitoring. Moving Princess and any potentially contaminated materials through the practice can spread infectious pathogens into a high-traffic area.
Disposal of Contaminated Items
Disposable items and those that cannot be effectively disinfected should be placed directly in the garbage, double-bagged, and removed from the examination room.
Reusable items should be cleaned in the examination room and disinfected before being removed.
Laundry should be handled as contaminated:
Remove gross contamination.
Take bagged laundry directly to the washer.
Wash in hot water with added bleach.
Dry with hot air.
Client Service Representatives, Veterinary Nurses & Nursing Assistants
DO: Follow a 2-step process to clean and disinfect the soiled areas. Commonly used disinfectants (eg, quaternary ammonium compounds, bleach) have decreased activity in organic material such as diarrhea, so contaminated surfaces must be cleaned thoroughly before disinfection. Once the area is visibly contamination-free, apply enough disinfectant to keep the surface wet for the time recommended on the product label—usually 10 to 15 minutes—and then wipe dry. If disinfection is performed properly, the affected area should be ready for use as soon as the surface is dry.1,2
DO: Perform a second round of careful disinfection, if concerns remain. This will be more effective than simply closing the soiled area for a period of time. Most practices have a disinfectant for routine daily use, but an enhanced protocol that uses another product (eg, bleach) that is effective against a wider range of pathogens (eg, nonenveloped viruses [parvovirus]) should also be in place. Use a 1:25 to 1:50 solution of household bleach (4% to 5.25%).2 Absorbent fabric items (eg, reception-area bench cushions) often cannot be effectively cleaned and disinfected and may need to be replaced.
DO NOT: Spray or pour disinfectant on the diarrhea, let the diarrhea sit for 5 minutes, wipe or mop it up, spray again, wipe up residual contamination, and close the area to team members, clients, and patients for 24 to 48 hours. This is not an effective means of cleaning and disinfecting the area.
All Team Members
DO: Wear an additional layer of clothing (eg, laboratory coat, smock) that can be removed easily, or change into clean scrubs and place contaminated clothing directly in the laundry.
DO: Perform good hand hygiene, which in these scenarios is essential but should also be part of the practice’s daily infection-control procedures. Hand sanitizer is quick and easy to use and can be effective, but certain viruses (eg, parvovirus) are resistant to alcohol, so wash hands with soap and water whenever possible.
DO NOT: Overlook the importance of hand hygiene and changing contaminated clothing. Hands and clothing can easily transmit pathogens to patients, clients, food, and beverages.
Examination
The veterinarian determines Princess is mildly dehydrated and admits her for fluid therapy and diagnostic testing, including blood work and fecal analysis. The veterinary nurse collects samples and places the IV catheter in the examination room before taking Princess directly to the isolation kennel for IV fluid therapy.
Discharge
At the end of the day, Princess is bright and responsive. Fecal test results are pending, but blood test results show only mild abnormalities, so the veterinarian decides to send Princess home.
Before discharge, team members discuss at-home infection-control precautions with the client. Precautions include isolating Princess from other dogs and high-risk individuals (eg, young children, the elderly, immunocompromised persons), properly cleaning and disinfecting areas in the home contaminated by feces, and practicing good hand hygiene.
Discussion
Noninfectious “events” and infectious organisms can cause diarrhea in puppies and kittens. Noninfectious causes (eg, dietary changes or indiscretion, stress, toxin ingestion) are not transmissible. Infectious diarrhea is caused by nonzoonotic organisms (eg, parvovirus, distemper, coronavirus), zoonotic pathogens (eg, bacteria [primarily Salmonella spp], some parasites (eg, Ancylostoma spp). In fact, in one study, more than 77% of both diarrheic and nondiarrheic puppies were found to be shedding one or more enteropathogens.3
Veterinary practices should have an infection-control protocol in place to ensure all team members are familiar with the actions required when animals present with diarrhea. (See Table 1.)
Potential Control Points & Actions for this Case
When confirming an appointment, particularly for high-risk animals (eg, puppies, kittens), ask the client about any additional concerns (eg, recent diarrhea episodes, coughing, sneezing).
| | Arrival at the practice |
Knowing Princess has diarrhea, the appropriate team member takes the client and the patient directly to an examination or isolation room.
If the patient has diarrhea in the practice, as Princess did, clean and disinfect the affected areas using the 2-step process.
Have hand sanitizer in the reception area, and make sure clients are aware it is available for their use and protection.
| | Patient examination |
Team members must wear appropriate attire (eg, gown or laboratory coat, gloves) that can be changed and laundered.
Team members must also exercise proper hand hygiene (ie, hand sanitizer, soap and water handwashing) immediately after handling any animal.
| | Movement through the practice |
Minimize movement to prevent direct contact with other patients and limit envronmental contamination.
| | After client and patient departure |
Immediately clean and disinfect potentially contaminated reuseable items (eg, stethoscopes) and dispose of potentially contaminated consumable items.
Clean and disinfect contaminated surfaces (eg, examination tables, floors, reception-area benches or chairs).
|
Conclusion
Everyone loves puppies and kittens, and most clients enjoy other people taking delight in their pets. In the end, however, puppies and kittens can be fuzzy little biohazards.