In my first article in the December/January 2019/20 issue, I questioned the standards and attitudes to biosecurity in the veterinary profession and provided some examples. I highlighted the indirect language being used to control disease, how the profession’s biosecurity standards are viewed by others and how easy it is to spread disease. What evidence is there to back my assertions?
This article will show a number of examples of poor biosecurity and lack of awareness of the potentials for disease spread or control. Reflection on how the medical profession are reacting to the current coronavirus outbreak is enlightening and should provide us with a warning which we must heed.
Challenge 1 – blood sampling protocols
In the last article, I described a young vet who was about to reuse a needle while doing my annual cattle health scheme test. At an assessment I carried out for two vets, one was blood sampling while the other was TB testing. I noticed that there were 12 blood samples and four used needles in the container. I challenged this finding to be regaled with the “fact” that if you withdraw the needle before the tube is full, the vacuum will “clean” the inside of the needle. I explained the folly of this concept.
How have these two vets, graduated from different veterinary schools, both come to their respective opinions? What were they taught at university? If biosecurity was taught, why was the lesson not learned? Who is auditing this aspect of their professional work? Have they picked this up from colleagues in the profession? Anecdotal evidence from laboratories suggests this is not an uncommon practice. Why is it so?
Challenge 2 – hygiene and cleanliness
How clean is the vehicle you take to farms? Would you eat your dinner off the inside? If not, why not? Given the minimal amount of fomite it takes to transmit disease and potentially the transfer of antibiotic and anthelmintic resistance, are you placing your farm clients at risk?
Figure 1 shows the inside of a car. Consider the picture before reading further. What are the issues? There are five issues here. First is the unacceptable state of the container the boots are kept in. Second, apart from being too small, it is beside a towel and a roll of paper towels. Third, there is the latch on a box lying in the boot’s container. Fourth is the new measuring jug, unused, the new FAM30 container and new buckets. Lastly, we also need to be aware that this scenario could also be a pointer that someone is not coping and needs some help.
Figure 2 shows the state of PPE which a vet arrived at an assessment with, heavily contaminated with faeces. How has this, in the light of our professional training and knowledge, become acceptable and why do our colleagues not appear to pick up on this?
Challenge 3 – are you letting your colleagues down?
Figure 3 shows the state of a carrier for TB equipment. The outside is covered with some fairly fresh and some dry faeces. This indicates that the container was brought back to the surgery on more than one occasion, put back in storage and left for someone else to clean.
What does this say about that vet’s attitude to their job, their colleagues, their place of work and their profession and its role in society? Why would any farmer allow this onto their farm? Would a farmer challenge this? Why shouldn’t they challenge it? It is not acceptable.
Challenge 4 – how do you clean a bucket?
Figure 4 shows a very tidy and clean boot with the exception of, again, the boot container. The vet concerned was challenged about the contamination on the outside of the container. The response was “how are you supposed to clean it?”
Challenge 5 – antibiotic storage and handling
On an assessment, I witnessed a bottle of antibiotic on a wall and two syringes. The vet being assessed was challenged as to why, an hour into the assessment, he hadn’t noticed it nor challenged the farmer about it. As a young vet, he was very reluctant to speak out about it. Why are young graduates unwilling to speak out about issues that are clearly wrong and part of a growing threat to humanity? How do we engender a change in approach? Where would this vet stand in the situation where this is a “big” client of the practice? Would partners and senior managers support that vet? If not, I would like to know why not.
There was a picture of a medicine storage cabinet in a veterinary magazine a few months ago. It had faeces on the outside of bottles, on the shelves and on cardboard outers. It was included in the article as an example of a medicine cabinet. What message does this send to colleagues, farmers and stockmen when this is considered a good example?
Challenge 6 – the fitting dog, are you prepared?
You are faced with a dog with a history of mild aggression for a few days and now taking fits. On exploring its history, you discover it came into the country about two months ago from an unknown source. What is your differential diagnosis? Do you consider rabies? Well, you should. What do you do next? Good question!
You should contact APHA and report suspicion of rabies. You will be asked to isolate the dog. How many of you are aware of how to isolate a rabies suspect? How many of you have a practice protocol for isolating a rabies suspect or any other infectious disease? What disinfectant do you use? What are the health and safety implications for the practice staff? How do you handle that dog?
Challenge 7 – personal biosecurity
We all use stethoscopes every day. We are all used to seeing pictures of vets and vet nurses with stethoscopes hanging round their necks. This is the image we portray. Is it right? The stethoscope is in contact with all manner of animals with all manner of infections, with variations in antibiotic resistance, yet we just launch it round our neck when we have finished using it. Then we go home to our families, some with young children and when hugging them, place them in contact with the same area of our neck as the stethoscope. Sensible?
Consider MRSA and multidrug-resistant Pseudomonas aeruginosa. It is common in dogs and humans. Do you handle animals with these infections without disinfecting equipment, tables, keyboards or hands between animals?
My mother recalls when taking us children to the doctor that when you entered the consulting room the doctors were always making the point that you could see them finish washing and drying their hands before examining you. Do you see that with doctors today? Do you as vets do that? If not, why not?
Challenge 8 – are we really playing our part in society?
The above challenges are a small sample of many issues I could quote in support of the contention that vets do not really understand biosecurity. Society faces challenges from disease and antibiotic and anthelmintic resistance. There are many issues associated with these challenges and as a profession closely working on them it is beholden on us to use and demonstrate clearly the use of all the armoury we have. Biosecurity, whatever that really means, needs to be at the forefront of it.
I believe there needs to be a very comprehensive rethink of what we are teaching students, what our “biosecurity” standards ought to be, what our stance is on our relationship with colleagues with regard to this, our relationship with the society and industries we deal with and how we can improve the understanding and implementation of “biosecurity”. Perhaps a return to old fashioned cleanliness and hygiene might not be out of order.
Challenge 9 – can it be done?
I leave you with a picture of the back of a vet’s vehicle which is absolutely immaculate (Figure 5). Is there any reason why the whole profession cannot meet a reasonable standard of hygiene and cleanliness such as this?
