Fomite transmission of disease occurs when pathogenic organisms are present in or on an inanimate object that can carry the pathogenic organism from an infected animal or human to another susceptible host.  Fomite transmission then relies on a secondary mode of transmission, e.g., oral or direct contact, for the pathogen to enter the new host.  Essentially anything that comes in contact with an infected animal or individual, or with infected body fluids (e.g., feces, urine, blood, nasal secretions, etc.), can potentially act as a fomite.  Some potential fomites include hands, clothing, foot wear, feeding bowls/buckets, clippers, needles, syringes, collars, leashes, etc. 

Strict adherence to standard practices for hand hygiene and the use of personal protective equipment are particularly critical in preventing the spread of infection via fomites.  In addition, there are a number of other precautions that can be used to reduce the risk of fomite transmission of disease in veterinary practice and animal care settings.

Cleaning and Disinfection: One of the most important means of preventing fomite transmission of disease is through proper cleaning and disinfection.   Prompt clean-up of feces, urine, and other potentially infectious bodily fluids, followed by thorough disinfection of the area, especially common use areas, is always warranted.  The entire hospital, including animal kennels and cages, parking lot areas, animal play areas, waiting room areas, exam rooms, etc., should be thoroughly cleaned and disinfected on a regular basis using EPA-approved cleaning and disinfection agents.  Strict attention should be paid to selecting a product appropriate to the specific use, and to using the recommended dilution and application time for maximum efficacy. 

Any equipment, e.g., stethoscope, thermometer, tracheal tube, ultrasound wand, mask, bandage scissors, brush, muzzle, etc.), that comes in contact with an animal, should be cleaned and disinfected after each use.  For surgical equipment, autoclaving is preferred over cold-sterilization, as autoclaving is more effective at eliminating spore-forming bacteria, such as Clostridium and Bacillus species. 

Protective outerwear and gear, e.g., lab coat and safety goggles, should be cleaned and disinfected after each use.  Outwear and gear should be removed promptly if torn, wet or heavily soiled, and placed in specially designated areas or bins.  Separate collection bins can be used for items known to be contaminated, e.g., soiled laundry.  All reusable items, e.g., fabric smocks, coveralls, lab coats, etc., should be laundered at the hottest tolerable temperature.  Disposable items, e.g., gowns, masks, head covers, booties, etc., should be not be reused.  Disposable items that have been in contact with potentially infectious animals or materials should be discarded in contaminated waste containers.

Having clear, written protocols for the cleaning and disinfection of various hospital areas, kennels and cages, commonly used equipment, and protective outerwear and gear is crucial for developing and adhering to an effective cleaning and disinfection regimen.

Animal Care:  Animals with proven or suspected infectious disease should be housed separately from healthy animals.  A separate area for exercise should be used for animals with known or suspected infectious disease.  Whenever possible, dedicated facilities, equipment and devices should be used for treatments.   In general, boarded animals should be attended to before hospitalized animals.  Healthy and at-risk animals (young, old, immunocompromised, etc.) should be attended to before animals with proven or suspected infectious disease.  This pertains not only to treatments, but also to feeding, exercise and cleaning, i.e., anything that involves potential contact with animals and/or their environment.

Food and water dishes should be removed from cages after feeding, then cleaned, disinfected and thoroughly dried prior to reuse.  Likewise, litter boxes should be thoroughly cleaned, disinfected and dried prior to reuse.  Disposable feeding trays and litter boxes may be used for animals with known or suspect infectious disease. 

Client Management:  Clients should be encouraged to follow hospital protocols for hand hygiene, footwear and protective outerwear.  Clients should be restricted from entering animal wards, treatment rooms, etc. without permission.  If access to a restricted area is granted, clients should be accompanied by a staff member and instructed on the necessity, purpose and use of protective outwear and gear as appropriate to the situation.  Areas that are off-limits to clients should be clearly marked.

There are a number of zoonotic diseases that can be transmitted via fomites, including:
  •   Anthrax (Bacillus anthracis)
  •   Avian influenza
  •   Bordetella bronchoseptica
  •   Brucellosis (Brucella spp.)
  •   Chlamydophila felis
  •   Dermatophilosis (Dermatophilus congolensis)
  •   Giardiasis (Giardia spp.)
  •   Leptospirosis (Leptospira spp.)
  •   Meliodosis (Burkholderia pseudomallei)
  •   Nipah virus
  •   Ornithosis/Psittacosis (Chlamydia psittaci)
  •   Ringworm (Microsporum spp., Trichophyton spp.)
  •   Salmonellosis (Salmonella spp.)

Some of these zoonotic diseases are also foreign animal diseases.  As such, they should be reported to the appropriate state or federal veterinary authorities within 24-48 hours of discovery.  Foreign animal diseases that can be transmitted via fomites include: 
  •   Avian influenza, highly pathogenic (Fowl plague)
  •   Exotic Newcastle disease
  •   Nipah virus
  •   Ornithosis (Chlamydia psittaci)
  •   Viral hemorrhagic disease of rabbits (Calicivirus) 

Many veterinarians practicing in the United States have never seen cases of these foreign animal diseases.  Because many of these diseases have more commonly diagnosed diseases on the list of differentials, they may not be high on our index of suspicion should an animal present with clinical signs consistent with these diseases.  Nevertheless, by adopting and consistently enforcing standard veterinary precautions, infection control practices and biosecurity measures that reduce the fomite transmission of any one of these diseases, we significantly reduce the risk of transmission of multiple diseases spread by the same route of infection, including zoonotic, foreign animal and emerging “as-yet-undefined” diseases, to our patients, staff or clients.

Resources
The Center for Food Security & Public Health. Iowa State University.  Stationary Veterinary Clinic Biological Risk Management.  www.cfsph.iastate.edu/BRM

 


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