I have my vehicle set up to make infection control and biosecurity at the forefront of
my mind, and simple to achieve.
So I have gloves in my eye line, to remind me to put them on straight away.
Alcohol hand rub is easily accessible, so I use it before leaving every property.
Sharps disposal and clinical waste are secure and accessible.
There is a complete set of PPE made up in a separate tub.
I also have disinfectant within reach, so I can disinfect my gear before I leave the
property.
So let me take you through my approach when I first arrive at a property.
At the time the client calls to book an appointment, the team member who takes the call asks if
the horse has been well, what its current vaccination status in, and any relevant history,
so I know this before I arrive.
When I'm dealing with an apparently healthy horse, I automatically run through a mental
checklist in my head.
What's the horse's history?
What am I seeing and detecting right now?
What does the horse look like on distant exam?
The horse's demeanour, signs of clinical disease, whether it has a fever, and what my level
of contact will be with blood and body fluids.
I then ask the owner for a detailed recent history on the horse.
And some of this includes whether the horse has recently displayed any changes to eating,
drinking, or behaviour.
Or, has displayed any signs of illness, such as a fever, respiratory signs, or neurological
symptoms.
What's its current vaccination status?
Specifically around Hendra virus, and is it up to date?
If the horse has traveled from an area known to have had cases of Hendra virus infection,
and are any other horses on the property sick?
Then I take a tiered approach to selecting my PPE.
Healthy horse, with a non-invasive procedure, I need tier 1 PPE.
A healthy horse, undergoing invasive procedures where I may have contact with blood or bodily
fluids, I need tier 2.
And a sick horse, I need tier 3 PPE.
I choose tier 1 PPE for examining a healthy horse.
I wear disposable gloves to examine every horse because often I have no or limited water
to wash.
And wearing my gloves makes me think about not contaminating my face or phone.
I'm almost always coming into contact with blood or body fluids, even if it's just saliva
when I check the mucus membranes.
I'm always careful to cover any cuts or abrasions, and I always wash my hands or use alcohol
hand rub after removing my PPE.
When I'm examining an apparently healthy horse, I'm mitigating against zoonotic diseases,
both known and emerging, that pose a risk to human health.
Some of these include emerging zoonoses like psittacosis of equine origin, multi-resistant
organisms, Salmonella infection, Hendra virus infection, Australian bat lyssavirus, which
has caused disease in horses, and also more common diseases, such as ringworm.
I choose tier 2 PPE for contact with an apparently healthy horse on which I'm performing an invasive
procedure.
If I'm going to have contact with non- intact skin, mucus membranes, or blood and body fluids,
then I wear gloves.
I always wear gloves.
Eye or face protection, such as safety glasses or goggles, or a face shield if I think I
could be splashed in the face.
And a gown or coveralls to cover my clothing.
If I'm going to do a procedure that may generate infectious aerosols, especially from the respiratory
tract, then I wear gloves, a disposable P2 respirator, eye or face protection, and a
gown or overalls to cover my clothing.
I choose tier 2 PPE for invasive procedures on a healthy horse to mitigate zoonoses such
as Hendra virus, multi-drug resistant organisms, psittacosis of equine origin, especially with
exposure to placentas and foetal fluids, or any other emerging zoonoses that we don't
know about.
I choose tier 3 PPE if I'm dealing with a sick horse.
However, then I break this down into two categories in my head.
So if Hendra is part of the differential diagnoses, I don a complete set of PPE.
The AVA EVA 2011 video Suit Up takes you through PPE for Hendra virus.
If Hendra virus is not part of the differential diagnoses, but I could be exposed to other
zoonoses or there are biosecurity risks, then PPE will depend on my level of contact with
blood and body fluids and what infections diseases I'm considering and how these spread.
So this might include things like gloves, eye or face protection - that is safety glasses
or goggles or a face shield if blood and body fluids can splash on my face - a disposable
P2 respirator if I could inhale infections aerosols, shoe covers or rubber boots, and
overalls.
If I'm treating a horse with diarrhea or known Salmonella infection, I will also wear disposable
overalls and rubber boots.
By learning and following these steps in the use of PPE, you're protecting yourself and
others from the spread of disease.