Infection Control
What is an infection control program and why do we have one in our hospital?
Because we run a state-of-the-art hospital, we are responsible for providing the best veterinary care possible to our patients. Minimizing the risk of infections in our patients during hospitalization is essential, as it is in any veterinary hospital and even on farms. While we have always had infection control protocols, we are proud to announce our enhanced Infection Control Program, which we believe provides even more protection for our valuable patients.
The concept of infection control is certainly not new. Infection control programs at human hospitals have been used as the role model in many medical fields. Barrier nursing methods and improved hygiene have been successfully implemented in many veterinary hospitals. The main goal of our Infection Control Program is to develop an early warning system for detection of disease causing organisms and help prevent the potential spread of disease. This surveillance system entails performing bacterial cultures on samples from patients, animal housing areas, and personnel who have direct contact with patients. A primary concern is for infectious enteric pathogens (disease producing bacteria of the intestinal tract), such as Salmonella.
If I see evidence of the Infection Control Program, such as footbaths, gowns, roped-off areas, does that mean there is a Salmonella outbreak at the University of Florida?
No. If there were a Salmonella outbreak, we would close the hospital. While we understand that our measures may appear imposing, we want our clients to feel secure, not concerned by our bold, proactive approach. The program is designed to protect our valuable patients. “An ounce of prevention equals a pound of cure” has never been truer than in the case of this growing concern for all veterinary hospitals.
What is Salmonella?
Salmonella is a type of bacteria that can cause intestinal disease (eg, diarrhea) in horses, cattle, sheep, goats, llamas, dogs, cats, birds, and humans just to name a few.
Can horses have Salmonella and not be sick?
Yes. Published studies have found that as many as 20 percent of healthy horses shed Salmonella bacteria in their manure. It is possible that a horse with Salmonella in its feces may show clinical signs if the organisms multiply and increase in number. This “over-growth” in a hospital setting usually occurs in times of stress (such as during transportation, illness, and summer months). Nevertheless, in a hospital we must assume that all horses shedding Salmonella pose a potential risk to other patients and to people until proven otherwise. A component of our Infection Control Program is typing of the particular strain of Salmonella, as some strains are known to be more likely to produce disease.
Can people be infected with Salmonella from animals?
Yes. Any human is at risk. People should avoid contact with infected animals and their environments (such as stalls). Young children and immune-compromised people may have less functional immune systems than other people and may be more likely to become ill if infected with Salmonella. Consequently, it is essential to prevent them from being exposed to animals or humans with Salmonella.
How do horses get Salmonella?
Horses may acquire the bacteria from other horses and other animals. Transmission is by the fecal-oral route, which means manure from one animal (not necessarily a horse) was ingested by another. Horses may pick up Salmonella from the pasture, feed, or water sources when the feces of other animals (including birds and other horses) are in these sources.
What are the signs of Salmonella in horses?
Signs may vary. While one animal may seem apparently normal, another may have severe illness that could lead to death. Horses sick with Salmonella may be referred to as having “salmonellosis.” Diarrhea, which can range from “cow-pie” manure to “watery” diarrhea, is a common sign. Horses may exhibit signs of colic (especially before they “break” with diarrhea), tenesmus (straining to defecate) and shock. Sometimes Salmonella can get into the circulatory system (the blood stream) and go to many different organs, including the liver, lungs, joints, lining of the spinal cord and brain, and others. This can cause many different problems and clinical signs. If there are questions regarding these signs, please contact your veterinarian.
What are the signs of Salmonella in other animals, including humans?
These may vary from being apparently normal to showing severe gastrointestinal disease, such as abdominal pain, diarrhea, vomiting and cramps. Consult your physician if you have these signs.
How is Salmonella diagnosed?
The most common diagnostic test is culturing a manure sample in a laboratory. Blood and other tissues can also be sampled. Culture results may take 2 to 5 days from when the sample is received at the laboratory. Fecal cultures can be negative in horses with salmonellosis, but it has been shown that culturing serial samples increases the probability of finding Salmonella when it is present. The usual protocol is once per day for five days.
What is the treatment for Salmonella?
Treatment varies with the severity of salmonellosis, ranging from no treatment to intensive medical care in a referral hospital. Treatment may include intravenous fluid therapy (for the shock and to replace fluid losses from diarrhea), antibiotics (to protect against infection while its immune system responds), non-steroidal anti-inflammatory drugs (e.g. Banamine® to reduce signs of shock), and plasma (to provide protein to replace fluid losses in the diarrhea and to reduce signs of shock, etc).
What is the prognosis (expected outcome) of Salmonella?
The prognosis varies with the case. Some horses may have Salmonella and never show clinical signs. Others can become sick and require intensive therapy. Some sick horses may die suddenly despite intensive therapy.
Should I have an infection control program on my farm?
Yes. Many of the principles in place at the University of Florida Large Animal Veterinary Medical Center would apply to infection control at other hospitals and even on farms. While a farm-program need not be as extensive as that in a hospital, some method of isolating new additions and ill horses is advisable. New horses introduced to a barn should be isolated for approximately 2 to 3 weeks to minimize the chance of spread of disease. This time also allows monitoring of the new horses manure to ensure that it is not soft or watery. New horses (even if they are isolated correctly) may still have Salmonella in their intestine and may later shed it if stressed for a number of reasons.
Ideally, horses identified by fecal culture to be shedding Salmonella should be isolated from the rest of the horse population (i.e., horse, foal, pony, donkey, mule - any equine) and possibly other animal populations. General guidelines are to isolate the horses for six to 12 months. Isolation means that the horse has its own separate area and equipment. Manure and straw from the horses stall should be disposed in a landfill facility and not spread on the pasture.
Humans should exercise great care to minimize exposure. Horses may shed Salmonella for a variable time; unfortunately we cannot predict how long this will be. Hygiene is important for people managing the isolated horse. Frequent hand washing is critical, while gloves and protective clothing are recommended. Do not let other animals (e.g. dogs and cats), children, or the elderly have contact with the isolated horse.
As isolation for this length of time is often impractical, most owners and trainers find facilities in which a horse can be isolated for one to three months and then have their veterinarian submit a manure sample for culture once daily for 5 days. If these cultures are negative for Salmonella, then there is a lower likelihood that the horse is actively shedding, and it is probably (although this can no be guaranteed) a low risk to bring the horse out of isolation. If the horses’ fecal culture proves to be positive, it should remain in isolation and be re-tested the following month.
LA Medical Center Infection Control
Surveillance and Infection Control
Equine General Barn Ward Isolation
Equine Isolation Unit
Bovine and Other Non-Equine Species
Equine Herpes Virus -1 Surveillance and Infection Control
For more information, please contact:
Abel Ekiri , LAH Infection Control Officer at
(352) 392-2212 ext 5655 or Cell(352) 258-1886
E-mail address: ekiria@vetmed.ufl.edu