Resumen de Awareness, perceived relevance, and acceptance of large animal hospital surveillance and infection control practices by referring veterinarians and clients
Objective�To assess awareness, perceived relevance, and acceptance of surveillance and infection control practices at a large animal referral hospital among referring veterinarians and clients who sent horses to the facility for veterinary care.
Design�Survey.
Sample�57 referring veterinarians and 594 clients.
Procedures�A 15-question survey targeting Salmonella enterica as an important pathogen of interest in horses was sent to clients who sent = 1 horse to the University of Florida Large Animal Hospital for veterinary care during July 1, 2007, through July 1, 2011, and to veterinarians who had referred horses to the same hospital prior to July 1, 2011. Responses were summarized with descriptive statistics. The ?2 test and the Wilcoxon rank sum test were used to examine associations among variables of interest.
Results�Survey response rates were low (57/467 [12%] for veterinarians and 594/3,095 [19%] for clients). Significantly more (35/56 [63%]) veterinarians than clients (227/585 [39%]) were aware that the hospital operates a surveillance and infection control program. Most veterinarians (56/57 [98%]) and clients (554/574 [97%]) indicated that sampling and testing of horses to detect Salmonella shedding in feces at admission and during hospitalization was justified. In addition, on a scale of 1 (not important) to 10 (very important), veterinarians and clients indicated it was very important (median score, 10 [interquartile range, 8 to 10] for both groups) that a referral hospital operates a surveillance and infection control program.
Conclusions and Clinical Relevance�Survey results indicated that awareness of hospital surveillance and infection control practices was higher among veterinarians than clients, and these practices were considered relevant and well-accepted among participant veterinarians and clients.
In the past 20 years, several large animal veterinary referral hospitals have established surveillance and infection control programs.1�6 The goals of such programs are to support high standards of veterinary care, reduce the risk of outbreaks of hospital-acquired infections (eg, salmonellosis) in patients, and minimize the risk of zoonotic infections in hospital personnel. Guidelines for developing, implementing, and evaluating surveillance and infection control programs that are tailored to the needs and limitations of veterinary hospitals have been published.1,7�11 During an outbreak of nosocomial Salmonella infections in a large animal hospital in 2006,12 active surveillance for Salmonella enterica allowed early detection of the outbreak strain and may have minimized the consequences of that outbreak. Disease transmission was limited to 8 animals, and 7 of those animals shed Salmonella in the absence of clinical signs or before the onset of disease.
Veterinary hospitals are required to deliver accessible, high-quality veterinary care services at reasonable costs to clients. During 2007 through 2009, a weak economy and decreasing caseload and frequency of horses shedding Salmonella at admission or during hospitalization as well as a low number of nosocomial Salmonella infections (ie, = 1 case every month and = 3 every year) created a need to assess the frequency of sample collection and testing, a key surveillance element, at the University of Florida Large Animal Hospital. From 2002 to 2008, fecal samples from equine inpatients at the study hospital were collected and tested at the time of admission and 3 times weekly. Beginning in 2009, the frequency of collection and testing was reduced to admission and once weekly. At the same time, environmental sample collection and testing was reduced from monthly to every other month (or more often if required). Hospital administrators and infection control personnel discussed further reductions in sample collection and testing to save hospitalization costs, such as limiting testing for early detection of Salmonella shedding to patients with diarrhea detected at admission or during hospitalization. This recommendation was not implemented because surveillance data indicated that between 2007 and 2010 at the study hospital, 52 of 67 adult equine inpatients with colic that tested positive for Salmonella did not have diarrhea at admission or during hospitalization. A subpopulation such as this creates an infection control hazard because failure to detect Salmonella shedding can delay implementation of infection control measures required to mitigate disease transmission during hospitalization.
Although veterinary hospital administrators, clinicians, and staff recognize that disease surveillance and infection control practices are important components in the delivery of high-quality veterinary care services, to our knowledge, the degree of awareness and perceived relevance of hospital infection control practices by stakeholders (ie, clients and referring veterinarians) have not been evaluated. Feedback from these stakeholders can be an important source of information to help hospital administrators to make informed decisions for optimal management of hospital operations. The objective of the study reported here was to investigate the degree of awareness, perceived relevance, and acceptance of hospital infection control practices among referring veterinarians and clients who sent horses to a veterinary referral hospital for treatment.
