Compendium of Veterinary Standard Precautions for Zoonotic Disease Prevention in Veterinary Personnel: National Association of State Public Health Veterinarians: Veterinary Infection Control Committee 2015

Carl J. WilliamsState Public Health Veterinarian, North Carolina Department of Health and Human Services, Raleigh, NC 27699.

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Joni M. ScheftelState Public Health Veterinarian, Minnesota Department of Health, Saint Paul, MN 55155.

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Brigid L. ElchosDeputy State Veterinarian, Mississippi Board of Animal Health, Jackson, MS 39207.

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Sharon G. HopkinsPublic Health Veterinarian, Public Health, formerly of Public Health—Seattle & King County, Seattle, WA 98104.

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Jay F. LevineDepartment of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606.

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The VSP outlined in this compendium represent routine infection prevention practices designed to minimize transmission of zoonotic pathogens from animals to veterinary personnel. This compendium has been extensively revised and updated since the 2010 version.1 Importantly, the concept of occupational safety and health in veterinary medicine is beginning to achieve equity with employee safety and health in human health care. The NORA states that “[v]eterinary medicine and other animal care personnel are at substantial risk for various occupationally acquired injuries and illnesses, many of which parallel and even exceed those encountered in human healthcare.”2 The NORA had not previously addressed the veterinary medical workforce, but a shift occurred in 2013, when veterinary medical occupational safety and health was included as a component of the NORA.

Preventing transmission of zoonotic diseases from animals to veterinary personnel represents 1 component of a comprehensive safety and health program. This compendium places infection prevention in this context and endorses the concept of conducting workplace risk assessments and using a hierarchy of controls to minimize employee safety and health risks. The hierarchy of controls refers to a range of measures that may be taken to reduce the risk posed by workplace hazards: elimination, substitution, engineering, and administrative procedures and use of PPE.

A thorough review of the human and veterinary medical literature has been conducted and has resulted in updates to a number of recommendations. Of note, hand hygiene recommendations have been updated to embrace use of alcohol-based hand gels as an important strategy for improving overall hand hygiene compliance in veterinary clinical settings.



    Within the context of a comprehensive employee safety and health program, the objectives of the compendium are to address infection prevention and control issues specific to veterinary practice, provide practical, science-based veterinary infection control guidance, and provide a model infection control plan for use in individual veterinary facilities.

    Since 2003, employee safety and health in the veterinary workplace, particularly infection prevention, has garnered increasing attention in the United States and other countries.3–5 The 2003 monkeypox outbreak was a clear example of the risk of zoonotic disease transmission in veterinary practice and led to the development of a novel set of infection control guidelines for veterinarians.6,7 A cohort study8 of potentially exposed veterinary personnel working in veterinary practices in which prairie dogs associated with the outbreak were examined as patients identified occupational risk factors for monkeypox transmission and highlighted the importance of infection control practices.


    Zoonotic diseases are recognized occupational hazards faced by veterinary personnel on a daily basis.9–12 It is known that 868 of 1,415 (61%) known human pathogens and 132 of 175 (75%) emerging diseases that affect humans are zoonotic.13 There are > 50 zoonotic diseases of importance in the United States (Appendix 1).14,15 Documented zoonotic infections in veterinary personnel include the following: salmonellosis,16–19 cryptosporidiosis,20–25 plague,26,27 sporotrichosis,28–32 methicillin-resistant Staphylococcus aureus infection,33–35 psittacosis,36–39 dermatophytosis,40,41 leptospirosis,42–44 bartonellosis,45,46 and Q fever.47–50

    The American Association of Feline Practitioners published feline zoonoses guidelines in 2005 to provide veterinarians with educational information for clients and to highlight infection control procedures for small animal hospitals.51 In 2006, the NASPHV published online the first Compendium of Veterinary Standard Precautions that systematically addressed various infection prevention strategies specifically for veterinary personnel. Results of 2 surveys52,53 published in 2008 identified deficiencies in the awareness and use of personal protective measures among veterinary staff.

    In the United States, the OSHA has promulgated a variety of specific standards that apply to individual workplace hazards. Of note, the OSHA has created a Personal Protective Equipment Standard and a Respiratory Protection Standard, which provide guidelines for workers exposed to contact, droplet, and airborne transmissible infectious agents.54 At the state level, California has developed a General Industry Safety Order that declares “every employer with facilities, operations or services that are within the scope of this standard shall establish, implement, and maintain effective procedures for preventing employee exposure to zoonotic aerosol transmissible pathogens….” This order is inclusive of veterinarians.55

    For situations where the OSHA has not promulgated specific standards, employers are subject to the general duty clause (29 U.S.C. § 654 Sec. 5) and should provide safety and health control measures to ensure a safe work environment. Consistent with the general duty clause, some states, such as Washington, require employers to develop and implement a written accident prevention program to identify and address worksite safety and health hazards.56 This law applies to veterinarians and their staff. A general overview of workers’ rights to a safe workplace under the Occupational Safety and Health Act is available.57

    The NORA was initiated in 1996 to stimulate innovative research and improved workplace practices. There are 10 NORA Sector Councils to guide research in each sector (including but not limited to construction, manufacturing, and HCSA).58 The HCSA sector includes all aspects of human health care. However, veterinary medicine and animal care were never included in any of the original sectors. Owing to a relative similarity between veterinary and human medicine, and following the one-health concept, veterinary medicine and pet care were rolled into the NORA HCSA sector in 2013.2 The NORA HCSA sector now identifies goals for improving the workplace safety of veterinary medical and animal care workers.

    Within the NORA HCSA sector are several goals that apply to both human and veterinary medical providers. These include the following:

    • Promote a culture of safety.

    • Reduce the incidence of musculoskeletal disorders.

    • Reduce or eliminate exposures to and adverse outcomes from hazardous chemicals.

    • Reduce injuries related to sharps.

    Also within the NORA HCSA sector are several goals that apply specifically to veterinary medical providers. These include the following:

    • Minimize or prevent occupational exposure of personnel to zoonotic diseases.

    • Reduce the occurrence of animal-inflicted injuries.

    • Minimize or prevent occupational exposures to respiratory hazards.

    • Reduce potential reproductive hazards.


    This edition of the NASPHV Compendium of Veterinary Standard Precautions provides updated infection prevention recommendations, references, and concepts. However, it should be noted that infection prevention is only 1 component of an employee safety and health program. As indicated in the NORA HCSA goals, worker safety and health extends far beyond preventing zoonotic disease transmission. This compendium provides guidance to minimize transmission of zoonotic pathogens between employees and animal patients. It does not address prevention of disease transmission between patients (nosocomial disease transmission); however, many of the same principles apply.


    In general, provision of a safe work environment is accomplished through the assessment of risks in the workplace and application of a hierarchy of controls to manage those risks. A hierarchy of controls is a systematic method of hazard reduction implemented by employers to control (or eliminate) risks posed by workplace hazards, such as zoonotic diseases (Figure 1).

Figure 1—
Figure 1—

Hierarchy of controls for methods to facilitate infection prevention among veterinary practice employees.

Citation: Journal of the American Veterinary Medical Association 247, 11; 10.2460/javma.247.11.1252

In the context of zoonotic diseases, the aim is to interrupt the disease transmission cycle at 1 or more points. Transmission of disease requires an infectious source (the animal patient), a susceptible host (the veterinary employee), a route of transmission (contact [direct or indirect], aerosol, or vector-borne transmission), and a portal of entry (eg, an open wound or mucous membrane). A successful control measure will reliably interrupt transmission at some point and could be termed infection prevention. Control measures include the following:

  • Elimination or substitution of the hazard—In general, this is the most effective measure, as it requires no action on the part of the employee. The hazard has been identified and eliminated. An example would be exclusion of exotic pets or native wildlife from a clinic because of the disease risk; such animals would include macaques and skunks that are associated with a risk of herpes B virus or rabies virus transmission.

  • Engineering controls—A veterinary clinic is designed to facilitate infection prevention best practices. An example would be placement of sinks for handwashing in convenient locations.

  • Administrative controls—Clinic policies are adopted that mandate appropriate infection prevention practices. Administrative controls are generally not considered as effective as elimination or engineering controls because they require rigorous adherence to the policy by all employees. Examples would be the requirement for handwashing between patient contacts, no recapping of needles, and rabies vaccination of staff.

  • PPE—This control measure is generally considered the least effective and the last line of defense because it requires the most action from the employee. The use of PPE requires routine adherence to and appropriate use of a variety of equipment and is dependent on employee training. Personal protective equipment is frequently and appropriately used in veterinary practice when engineering and administrative control options are limited. An example would be wearing a mask and face shield while performing dental procedures.

The VSP are derived from standard precautions applicable to human medicine, which are the cornerstone of infection prevention in human health-care settings.59 In addition, the VSP also include strategies to reduce the potential for animal bites and other trauma that may result in exposure to zoonotic pathogens. During their careers, approximately two-thirds of veterinarians report a major animal-related injury that resulted in lost work time or hospitalization.9,10,60–62 The most common occupational injuries among veterinary personnel include animal bites and scratches, kick and crush injuries, and needlesticks.63–72

The VSP described in this document should be used consistently by veterinary personnel—regardless of the clinical condition or the presumed diagnosis of animals in their care—whenever personnel may be exposed to potentially infectious materials including feces, blood, body fluids, vomitus, exudates, work surfaces contaminated with these items, and nonintact skin. Although the VSP are intended to be adaptable to individual practice needs and circumstances, any modifications should adhere to basic principles of infection prevention and comply with federal, state, and local regulations.

Although it may not be possible to eliminate all zoonotic disease hazards, employers should conduct a workplace risk assessment and implement appropriate control measures where possible. Adherence to a well-developed employee safety and health program will minimize the risk of injury and illness. This compendium provides reasonable guidance for minimizing 1 type of workplace hazard—zoonotic disease transmission—among veterinary personnel in clinical settings through the application of the VSP.


Pathogens are transmitted via 3 major routes: contact, aerosol, and vector-borne. Some agents may be transmitted by multiple routes of infection.59 Infection prevention or control refers to policies and procedures used to minimize the risk of spreading pathogens through any of these routes of transmission.


    Contact transmission occurs when pathogens from animals or their environments enter a human host through ingestion or through cutaneous, percutaneous, or mucous membrane exposure. Many zoonotic pathogens are transmitted from animals to people by hand-to-mouth contact either directly from animals or indirectly through the environment. Direct transmission may occur during examination, treatment, and handling of animals. Indirect transmission involves contact with a contaminated intermediate—objects such as cages, equipment, workplace surfaces, and soiled laundry. The role of the clinic or work environment in transmission of disease can be very important.16,19,73–75


    Droplet transmission occurs when droplets created by coughing, sneezing, and vocalization are deposited on the mucous membranes. These droplets are typically large, can generally travel only approximately 1 to 2 m (3 to 6 feet), and do not remain suspended in the air. Procedures such as lancing abscesses or dentistry can also produce droplets. Examples of zoonotic pathogens that are transmitted by droplets include avian influenza virus and Rhodococcus equi. Risk of pathogen transmission increases with proximity to the source and duration of exposure.

    Airborne transmission occurs when small droplets or particles that are created remain suspended in the air for extended periods and are inhaled. These small droplets or particles can be disseminated by air currents in a room or through a facility. They may be generated through medical procedures such as suction and bronchoscopy and during cleaning, particularly with high-pressure sprayers. Certain airborne pathogens may remain infective over long distances depending on particle size, the nature of the pathogen, and environmental factors.59,76 Two zoonotic pathogens transmitted over long distances are Coxiella burnetii and Mycobacterium bovis.77–81


    Vector-borne transmission occurs when vectors such as mosquitoes, fleas, and ticks transmit pathogens. Animals may bring flea and tick vectors into contact with veterinary personnel. Working in outdoor settings may increase the risk of exposure to arthropods.



    Consistent, thorough hand hygiene is the single most important measure veterinary personnel can take to reduce the risk of zoonotic disease transmission. Most common pathogens are transmitted by hand-to-mouth contact either directly from animals or indirectly through the environment.82–84 Hand hygiene includes handwashing with soap and water, the use of alcohol-based hand rubs, and appropriate use of gloves. Adequate hand hygiene may include washing the forearms when contamination extends beyond the wrist.

    Hand hygiene should be performed after contact with feces, body fluids, vomitus, or exudates; after contact with articles contaminated by these substances; after contact with environmental surfaces in animal areas; and after removing gloves. Hand hygiene should be consistently performed between examinations of individual animals or animal groups (eg, litters of puppies or kittens, groups of cattle).

    Either plain or antimicrobial soaps are appropriate for routine handwashing, which removes loosely adherent transient flora from the hands.85 Transient flora reside in the uppermost layers of the stratum corneum; are acquired through contact with animals, people, or the environment; and are most frequently associated with infection transmission. Transient flora may be removed by the mechanical friction or detergent properties of soap and water or killed by antiseptic agents. In contrast, resident flora are of low pathogenicity, are permanent residents of the deeper layers of the skin, and are not susceptible to mechanical removal; if the goal is to reduce their numbers, such as when scrubbing for a surgical procedure, an antiseptic agent must be used.85 Several antiseptic products with variable efficacy against different classes of microorganisms are available (Appendix 2).82,84,86

    Hand soaps may be susceptible to bacterial overgrowth and have been associated with nosocomial infections.87 To prevent creation of a bacterial reservoir or cross-contamination, no additional soap should be added to liquid soap dispensers before they are empty (ie, they should not be topped off); once completely empty, refillable dispensers should be cleaned and dried, then refilled with liquid soap or sealed soap refills.82 Water temperature has little effect on the removal of microorganisms from hands, but warm (as opposed to cold) water improves compliance.88 Moisturizing soaps and lotions can preserve skin integrity and encourage adherence to hand hygiene protocols among veterinary staff. Dry, cracked skin is painful, indicates compromised skin integrity, and is more likely to be colonized with staphylococci and gram-negative organisms.82 When hand lotions are used, personal containers are recommended over use of shared dispensers to prevent contamination.

    Staff members who have animal contact should not wear artificial nails and should keep fingernails short.82,89 Wearing rings and other jewelry reduces the effectiveness of hand hygiene; as a result, the skin underneath rings and other jewelry can become more heavily colonized with organisms.82 Additionally, the use of community or shared towels should be avoided. Disposable towels should be used for the drying of hands.82,90

    Alcohol-based hand rubs are fast-acting, broad-spectrum germicides that kill microorganisms by denaturing microbial proteins.85 They lack residual activity, but can be combined with other antiseptic products (eg, chlorhexidine or triclosan) to enhance persistence (Appendix 2). Hand rubs are generally well tolerated owing to the addition of emollients. Hand rubs, when properly applied for 30 seconds to hands that are not visibly soiled, are highly effective against bacteria, many fungi, and enveloped viruses.82,91–93 Hand rubs are less effective against bacterial spores, protozoal parasites, and some nonenveloped viruses.82,94,95 In the field, when running water is not available and hands are visibly soiled, use of a moist wipe to remove organic material prior to application of an alcohol-based hand rub may increase the effectiveness of hand hygiene. Use of moist wipes alone is not recommended.82 The CDC recommends hand rubs containing 60% to 95% ethyl alcohol (ethanol) or isopropyl alcohol (isopropanol) for use in health-care settings.82 Hand antisepsis products containing other disinfectants may be susceptible to bacterial overgrowth and have been associated with nosocomial infections.96–99

    Hand hygiene performed with an alcohol-based hand rub requires approximately a third of the time required to perform handwashing with soap and water.85 For this reason and because hand rubs are well tolerated and easily accessible, they are gaining acceptance in veterinary medicine as an important strategy for improving overall hand hygiene in clinical settings.100,101 Strategic placement of hand rub dispensers increases access to hand hygiene where soap and running water are not immediately available, such as in examination rooms and outdoor stalls.101 However, it is important to train staff that the visible presence of organic matter (eg, blood or feces) on hands will greatly decrease the efficacy of alcohol-based hand rubs.

    The importance of hand hygiene cannot be overemphasized. Personal adherence to hand hygiene protocols can be negatively influenced by several factors including inaccessible hand hygiene supplies, skin irritation, high workload, and insufficient time.102 Compliance with hand hygiene protocols among veterinary personnel can be improved when adherence is made as simple and convenient as possible, with regular training uniquely tailored to individual workplaces and delivered in innovative ways, and, most importantly, when senior team members consistently display good hand hygiene practices.103,104

    Correct handwashing procedure:

    • Wet hands with running water.

    • Place soap in palms.

    • Rub hands together to make a lather.

    • Scrub hands thoroughly for 20 seconds.

    • Rinse soap off hands.

    • Dry hands with a disposable towel.

    • Turn off faucet using the disposable towel to avoid hand contact.

    Correct use of hand rubs:

    • Place alcohol-based hand rub in palms.

    • Apply to all surfaces of hands.

    • Rub hands together until dry.


    The following sections highlight a variety of PPE intended to prevent the transmission of zoonotic infectious agents to veterinary employees. However, the personal protective value of PPE is realized only if there is a collective culture that supports the use of PPE and if the necessary gloves, face shields, respirators, gowns, and other supplies are readily accessible when needed.

    Personal protective equipment is equipment worn to minimize exposure to serious workplace injuries and illnesses. As stated by OSHA, “when engineering, work practice, and administrative controls are not feasible or do not provide sufficient protection, employers must provide PPE to their workers and ensure its proper use. Employers are also required to train each worker required to use PPE to know:

    • When it is necessary

    • What kind is necessary

    • How to properly put it on, adjust, wear, and take it off

    • The limitations of the equipment

    • Proper care, maintenance, useful life, and disposal of the equipment.”105,106

      1. Gloves

        Gloves reduce the risk of pathogen transmission by providing a barrier that can be efficiently removed when soiled.107,108 Gloves should be worn routinely when contact with feces, body fluids, vomitus, exudates, and nonintact skin is likely. They should be worn when performing dental or obstetric procedures, resuscitations, and necropsies and when handling diagnostic specimens (eg, urine, feces, aspirates, or swabs). Gloves should also be used when cleaning cages, litter boxes, and contaminated equipment and environmental surfaces in animal areas and when handling dirty laundry. Gloves should also be worn when personnel have wounds or other compromised skin integrity of the hands. Gloves are not necessary when examining, handling, vaccinating, or obtaining a blood sample from most healthy animals, provided good hand hygiene is practiced.

        Gloves should be changed between examinations of individual animals or animal groups, between dirty and clean procedures performed on a single patient, and whenever torn. Gloves should never be washed and then reused for another procedure.109,110 Gloves should be removed immediately after use and before beginning other activities. During removal, care should be taken to avoid skin contact with the outer glove surface. Wearing gloves (including palpation sleeves) does not preclude the need for hand hygiene. Hand-washing should be performed or alcohol-based hand rubs should be used immediately after glove removal because gloves may have undetected microperforations or hands may be contaminated during glove removal.111,112

        Gloves are available in a variety of materials, such as latex, nitrile, and vinyl. Choice of gloves depends on their intended use; a range of sizes should be available to encourage use. Some personnel exposed to latex may experience allergic reactions. Further information regarding prevention of allergic reactions to natural rubber latex in the workplace is provided by the National Institute for Occupational Safety and Health.113,114

      2. Facial Protection

        Facial protection prevents exposure of the mucous membranes of the eyes, nose, and mouth to infectious materials. Facial protection should be used whenever exposure to splashes or sprays is likely to occur (eg, when lancing abscesses, flushing wounds, or suctioning and when performing dentistry, obstetric procedures, or necropsies).59,115–118 A face shield or goggles worn with a surgical mask provide adequate facial protection during most veterinary procedures that generate potentially infectious sprays and splashes.

      3. Respiratory Tract Infection

        Respiratory tract protection is designed to protect the airways of employees from infectious agents. In veterinary medicine, molded N95 and N99 particulate respirators are the most commonly used equipment option when respiratory tract protection is needed. Employers and employees must understand and distinguish between respirators and surgical masks, which are designed for very different functions. Respirators are designed and certified to prevent inhalation of small airborne contaminants. Surgical masks are designed to protect the patient and do not provide the same level of protection for the wearer as a respirator.119

        Pathogens such as C burnetii, Brucella spp, and Chlamydophila psittaci are known to present an occupational risk to veterinary staff; use of respiratory tract protection is recommended when exposure to these and other airborne pathogens is likely.120–122 Additionally, respiratory tract protection is warranted for procedures that are likely to generate aerosols, such as the use of power tools during necropsy.123

        Respirator use requires compliance with OSHA's respiratory tract protection standard (29 CFR 1910.134), and employers must address the following elements to fulfill the respiratory tract protection program criteria124:

        • Develop a written respiratory tract protection program.

        • Select the appropriate respirator for use.

        • Identify a physician to perform medical evaluations and provide a medical determination for each employee.

        • Perform fit testing.

        • Provide education on proper respirator use including donning and doffing, cleaning, disinfection, maintenance, storage, and repairs.

        Given the strict requirements of the respiratory tract protection standard, it may be desirable to identify other means, such as engineering or administrative controls, to address risk from specific airborne pathogens. Nonetheless, in certain situations, use of respiratory tract protection may be the only feasible means of addressing the risk.

      4. Protective Outerwear

        Protective outerwear includes laboratory coats, smocks, aprons, coveralls, nonsterile gowns, footwear, and head covers. The purpose of protective outerwear is to limit the transfer of pathogens between the wearer and the patient, and its importance in infection control is often underappreciated.125–127


    1. Patient Intake

      Waiting rooms should be a clean and safe environment for clients, animals, and veterinary personnel. Staff training regarding waiting room protocol for reception area personnel should include instruction to pose basic questions to incoming clients about the reason for the visit and to observe every pet for behavioral cues and outward signs of illness. Animals that are fearful, are aggressive, or have a known exposure to an infectious agent should bypass the waiting room and be placed directly into an examination or isolation room, as should those with the following so-called red flag signs: neurologic signs, diarrhea, respiratory tract signs, fever, infected wounds, or chronic infection. Consider providing alcohol-based hand rub dispensers in the waiting room and at the desks where clients check in and out.

    2. Animal Handling and Injury Prevention

      Proper handling and restraint of animals decrease the possibility of staff receiving bites, scratches, needlesticks, and other animal-related injuries, which are associated with risk for zoonotic infections. Most injuries among veterinary personnel occur during animal handling or treatment.132 Preventive measures include reliance on experienced veterinary personnel rather than owners to restrain animals and the use of muzzles, bite-resistant gloves, and sedation or anesthesia as necessary.133 Veterinary personnel should be trained to remain alert for changes in a patient's behavior. Aggressive or fearful tendencies and bite history should be recorded in the patient's record, communicated to personnel, and indicated with signage on cages and enclosures. Those working with large animals are at risk for kick and crush injuries. Proper livestock-handling equipment should be used, and an escape route should be kept in mind at all times.9,10 Veterinarians have the right to refuse services if large animal–handling facilities are not available or are not adequate to ensure their safety and the safety of those assisting them. Similarly, veterinarians have the right to refuse to provide services for clients with exotic species or wildlife that cannot be handled safely because of physical infrastructure or clinician or staff training limitations.

      Preplanning, adequate equipment, and clear communication with coworkers while working with animals are key to preventing animal-related injuries. First aid supplies, including eyewash, should be readily available, and personnel should know where the supplies are located and how to use them. Incident response procedures should be displayed prominently.

    3. Examination of Animals

      Animals with potentially infectious diseases should be examined in a dedicated examination or isolation room and should remain there until initial diagnostic procedures and treatments have been performed. Contact with animals suspected of having an infectious disease should be limited to essential personnel who should wear protective outerwear and use gloves and other protective equipment appropriate for the situation.

      The examination room used for this purpose should remain out of service until properly cleaned and disinfected. Every examination room should have an easily accessible source of running water, a soap dispenser, and paper towels. In addition, it is recommended that alcohol-based hand rubs be available in the examination room.

    4. Injection, Venipuncture, and Aspiration Procedures

    5. Dentistry

      Dental procedures can generate splashes, sprays, and large droplets that are potentially infectious. Veterinary personnel and anyone in range of direct splashes or sprays should wear protective outerwear, a head cover, gloves, and facial protection. Dental procedures should be performed in a dedicated space—ideally a dental suite—with separate, dedicated equipment and appropriate ventilation.139 Environmental surfaces can be easily contaminated during dental procedures. These surfaces should be cleaned and disinfected between patients and at the end of daily work activities.140

    6. Resuscitation

      The urgent nature of resuscitation increases the likelihood that breaches in infection control will occur. Standard emergency protocols and regular staff training regarding resuscitation are very important to minimize risk and reduce exposures. Barrier precautions, such as the use of gloves and facial protection, should be implemented to prevent exposure to zoonotic infectious agents that may be present. Never blow into the nose or mouth of an animal or into an endotracheal tube; instead, intubate the animal and use a manual resuscitator, anesthesia machine, or ventilator.

    7. Obstetrics

      Zoonotic agents, including Brucella spp, C burnetii, and Listeria monocytogenes, may be found in high concentrations in the birthing fluids of aborting or parturient animals and in stillborn fetuses and infected neonates. Gloves or sleeves, facial protection, and impermeable protective outerwear should be used routinely to prevent exposure to potentially infective materials.141 Respiratory tract protection should be used when investigating abortions attributable to C burnetii infection (Q fever) or when other airborne pathogens are known or suspected risks.142

    8. Necropsy

      Necropsy is a high-risk procedure because of the possibility of injury and potential contact with infectious agents in body tissues, body fluids, and aerosols.117,120 Nonessential persons should not be present during necropsy procedures. Veterinary personnel should routinely wear gloves, facial protection, and impermeable protective outerwear. In addition, eye protection and respiratory tract protection used in the context of a respiratory tract protection program should be employed when band saws or other power equipment is used or there is a high probability of exposure to a zoonotic pathogen. Cut-proof gloves should be used to prevent sharps-associated injuries.

    9. Diagnostic Specimen Handling

      Samples of feces, urine, or vomitus; aspirate specimens; and swabs collected from the general patient population should be handled as though they contain infectious organisms. The sample containers should bear clear and detailed labeling and be stored in a designated refrigerator. Protective outerwear and disposable gloves should be worn when these specimens are handled. Discard gloves and wash hands before subsequently touching clean items such as telephones, medical records, or computer keyboards.143 Specimens shipped for diagnostic testing must be packaged and labeled according to applicable regulations.144

    10. Wound Care and Abscess Treatment

      Many zoonotic pathogens can be associated with wound infections and abscesses.145 Veterinary personnel should wear protective outerwear and gloves for debridement, treatment, and bandaging of wounds; facial protection should be worn when abscesses are lanced and wounds are lavaged. Hand hygiene should be performed after gloves are discarded and following removal of outerwear. Animals with infected wounds should be prevented from contaminating environmental surfaces, including floors. Used bandage materials and equipment such as bandage scissors and clipper blades should be considered contaminated and handled accordingly. Leftover bandaging material should be sterilized (autoclaved or gas sterilized) prior to storage for reuse because unused bandaging material may become contaminated with methicillin-resistant S aureus and other wound pathogens during wound care.a


    The veterinary clinic environment can potentially serve as a source of pathogens for staff and patients. Controlling this potential reservoir of infection is increasingly recognized as an important component of infection control and prevention. Surfaces in a clinic can become contaminated with methicillin-resistant S aureus, Salmonella spp, and other pathogens; once introduced onto a surface, some pathogens may persist for months in the facility and serve as a source of infection for animals, their owners, and veterinary employees.16,146–148 Additionally, equipment (eg, stethoscopes) can become contaminated with pathogens following physical examination.149,150 Guidelines have been developed for hospital layout and design that address infection control issues and provide for ease of cleaning and disinfection of environmental surfaces.151

    1. Cleaning and Disinfection of Equipment and Surfaces

      Regular cleaning and disinfection of equipment and surfaces is critical for environmental control of pathogens. Equipment and surfaces must be cleaned with water and detergent before they are disinfected because organic material decreases the effectiveness of most disinfectants.151–153 An EPA-registered disinfectant should be used according to label instructions, with attention to storage conditions, proper dilution, and contact time. When selecting a disinfectant, ensure that users will be able to accommodate all label requirements, including appropriate contact time. Quaternary ammonium compounds and hypochlorites are the most common disinfectants used on environmental surfaces in veterinary practices; however, hydrogen peroxide–based oxidizing agents are also effective against a wide range of veterinary microbes (Appendix 3).152

      Equipment and surfaces should be cleaned and disinfected between uses or whenever visibly soiled. Special attention should be paid to surface areas with high contact rates (eg, examination tables, door knobs, cage latches, faucet handles, and sinks).154 A written checklist should be developed for each area of the facility (eg, waiting room, examination rooms, treatment area, surgery suite, and kennels) that specifies the frequency of cleaning, disinfection procedures, products to be used, and the staff responsible. At a minimum, staff should perform hand hygiene after they have finished cleaning and before beginning other tasks.

      Surfaces in areas where animals are housed, examined, or treated should be made of nonporous, easily cleaned materials. Generation of dust that may contain pathogens can be minimized by use of vacuums with high-efficiency particulate air filters, wet mopping, dust mopping, or electrostatic sweeping. Surfaces may be lightly sprayed with water prior to mopping or sweeping to minimize dust generation (wet mopping). Use of high-pressure sprayers and similar devices that can disseminate infectious particles should be avoided. However, if procedures that may generate infectious aerosols are undertaken, appropriate PPE should be worn.

      Cleaning products and disinfectants may contain components harmful to human health. It is incumbent on employers to provide appropriate training as required by OSHA. This training must detail all physical, chemical, and biological hazards in the workplace, and each cleaning and disinfectant products’ label and safety data sheet should be easily accessible.155

      Routine dishwashing is sufficient to clean food and water bowls used for most hospitalized patients. Toys, litter boxes, and other miscellaneous items should be discarded or cleaned and disinfected between patient uses. Litter boxes should be cleaned or disposed of at least daily by a nonpregnant staff member.

    2. Isolation of Animals with Infectious Diseases

      Animals with suspected or confirmed communicable diseases should be identified prior to arrival if possible and be examined, cared for, and housed in designated isolation rooms (small animals) or areas (large animals) to protect other patients and veterinary personnel. Isolation procedures should be prominently posted.116 Isolation rooms or areas should be identified with signage, access should be limited, and a sign-in log should be used.

      Only the equipment and materials needed for the care and treatment of the patient should be kept in an isolation room or area, and isolation supplies should not be removed for use elsewhere. Whenever possible, use of disposable articles such as bowls, litter pans, and gowns is recommended. Equipment that must be removed from the isolation room or area should be disassembled, cleaned, and disinfected prior to removal to prevent contamination of other areas of the hospital. Potentially contaminated materials should be bagged before transport within the facility and disinfected or disposed of in accordance with state rules governing disposal of medical waste.116,156

      Limited data are available regarding the effectiveness of footbaths and foot mats for infection control in private veterinary practices.157–159 Footbaths and foot mats are difficult to maintain properly, which limits their efficacy. Disposable, impermeable shoe or boot coverings made of plastic should be considered for use in isolation rooms. All PPE used when attending animals in isolation should be donned immediately prior to and doffed following care for the animal in an effort to limit movement of infectious organisms within the facility.

    3. Handling of Laundry

      Although soiled laundry may be contaminated with pathogens, the risk of disease transmission is negligible when soiled items are handled correctly.160 Personnel should check pockets for sharps before items are removed and laundered. Gloves and protective outerwear should be worn when handling soiled laundry. Bedding and other laundry should be machine washed with any standard laundry detergent and machine dried at the highest temperature suitable for the material.161 To prevent cross-contamination, separate storage and transport bins should be used for clean and dirty laundry. When soiled clothing is laundered at home, it should be transported in a sealed plastic bag, kept separate from household laundry, emptied from the bag directly into a washing machine, and thoroughly machine dried after completion of the wash cycle.162–164

    4. Spill Response and Decontamination

      Spills and splashes of potentially infective substances should be immediately contained with absorbent material (eg, paper towels, sawdust, or cat litter). Personnel should wear PPE sufficient to protect against potentially infective substances in the spill and the cleaning or disinfectant agent selected for use. The safety data sheet for each EPA-registered disinfectant will indicate appropriate PPE for use with the product.165 The spilled fluids and absorbent material should be collected and sealed in a leak-proof plastic bag, and the area should be cleaned and disinfected. An EPA-registered disinfectant should be used with attention to storage conditions, label instructions, and contact time. Animals and people who are not involved in the cleanup should be kept away from the area until disinfection is completed. Creating a spill response kit with instructions in advance may expedite cleanup processes and enhance worker safety.

    5. Medical Waste

      Medical waste is regulated at the state level, and employers should become familiar with the applicable laws in their state.166 Medical waste is defined by the EPA as “any solid waste that is generated in the diagnosis, treatment, or immunization of human beings or animals, in research pertaining thereto, or in the production or testing of biologicals.”167 Sharps and regulated medical waste are generally considered subsets of medical waste, and proper management of them is also based on state medical waste laws.

    6. Rodent and Vector Control

      Field veterinarians and any accompanying support personnel are likely to have the greatest risk of exposure to arthropod vectors that may transmit zoonotic pathogens. However, the risk of illness for any particular infection is not uniform across the United States.168,169 Regardless of the geographic location of the field work, permethrin-treated clothing has been demonstrated to be highly effective at reducing tick bites and would be recommended for those veterinarians and assistants with occupational exposures.170 Animals may act as mechanical carriers for ticks, and it is important to check patients as they enter a clinic to limit introduction of arthropod vectors into the indoor work environment.171

      Integrated pest management is the recommended approach to the control of rodents and vectors in veterinary medical buildings. Integrated pest management is a comprehensive approach to pest control based on an understanding of the life cycle and ecological niche of the pest. Pest populations are controlled largely by creating unfavorable environments; by removing the air, moisture, food, or shelter that pests need to survive; or by blocking access to buildings.172,173 Pesticides and rodent traps may be used as part of a comprehensive plan that includes environmental control measures as follow:

      • Sealing of potential entry and exit points into buildings with caulk, steel wool, or metal lath.

      • Storage of food and garbage in metal or thick-plastic containers with tight lids.

      • Disposal of food waste promptly.

      • Elimination of potential rodent nesting sites (eg, clutter).

      • Removal of sources of standing water (eg, empty buckets, tires, and clogged gutters) to reduce potential mosquito breeding sites.

      • Installation and maintenance of window screens to prevent entry of insects and rodents.

      Additional measures may be warranted for control of specific pests. For example, birds and bats should be excluded from hospital barns and veterinary medical facilities. Facility managers may wish to contact a pest control company for additional guidance.

    7. Other Environmental Controls

      It is important to provide an employee break room or area for eating and drinking. Such activities should be prohibited in laboratories, treatment rooms, and other patient care and housing areas. Separate, appropriately labeled refrigerators should be used for human food, animal food, biologics, and laboratory diagnostic samples. Dishware for human use should be washed and stored away from animal-care areas.



    Veterinary clinic managers should develop a comprehensive employee safety and health program on the basis of their own workplace risk assessment addressing the potential for animal-related and non–animal-related occupational injuries and illnesses.174,175 Utilizing control measures that place the least amount of burden on the individual employee will be most effective. Personal protective equipment (while often essential) represents the least effective and least desirable control measure in any workplace environment. Some elements to consider when implementing a safety and health program follow.

    1. Employee Vaccination Policies and Record Keeping

    2. Management and Documentation of Exposure Incidents

      Workplace injuries and illnesses will still occur despite best efforts to identify and reduce hazards. The management team should review recent work-related injuries and illnesses in the practice to ascertain any patterns or cause. Additional or new administrative or engineering controls may be warranted. Another important step is to conduct refresher training for employees that addresses the cause of the incident and covers new control measures.

      Pursuant to OSHA's recordkeeping and reporting requirement (29 CFR 1904), employers must complete the following186:

      • Form 301: Within 7 calendar days after you receive information that a recordable work-related injury or illness has occurred, you must complete this injury and illness incident report form that is specific to an individual event. This form will contain information about individual employee health and must be used in a manner that protects confidentiality of employees. You must keep this form on file for 5 years following the year to which it pertains.

      • Form 300: Each incident, as recorded on Form 301, must be entered on Form 300. This is an injury and illness log that contains summary information for each event recorded on a Form 301. This will help employers identify trends and complete Form 300A. This form will contain information about individual employee health and must be used in a manner that protects confidentiality of employees.

      • Form 300A (summary of injuries and illnesses): This report summarizes, for all employees, the number of work-related injuries and illnesses, the number of days away from work, and the total numbers of injury and illness types. This form will not contain confidential information and must be publicly posted for employees to review.

      • Employers with 10 or fewer employees throughout the previous calendar year are not required to complete these forms. This exemption applies to employers in states with federal as well as state OSHA plans.187

    3. Staff Training and Education

      Comprehensive staff training and education are essential components of an effective employee safety and health program. Training should have defined objectives and a means of measuring the effectiveness of the training.188 Furthermore, all training, whether written or oral, must be provided at a level of complexity and in a language that employees can understand.189 Before new staff begin work, they should receive training that emphasizes infection control practices and the clinic infection control plan, the potential for zoonotic disease exposure, hazards associated with work duties, and injury prevention.104,190–193 Training should also include instruction in animal handling, restraint, and behavioral cue recognition. Additional in-service training should be provided at least annually and as recommendations or policies change. Staff participation in infection control and hazard awareness training should be documented.

      Although training is critical to reducing the incidence of occupational illness and injury, remember that it is only 1 component of an employee safety and health program. Practice managers and supervisors must ensure that all feasible engineering and administrative controls have been implemented on the basis of a workplace risk assessment.


    Personnel with a weakened immune system as a result of disease or medication and pregnant women are more susceptible to infection with zoonotic agents and more likely to develop serious complications from zoonotic infections.194 Employees with immunocompromising conditions should talk to their primary health-care provider to clarify work parameters and obtain guidance.

    Occupational activities associated with a higher risk of exposure to zoonotic pathogens include processing laboratory samples, necropsy, and care of certain high-risk animals. High-risk animals include those that are young, parturient, unvaccinated, stray or feral, fed raw-meat diets, or housed in a shelter; animals with internal or external parasites; wildlife; reptiles and amphibians; and exotic or nonnative species.195,196

    Although data regarding the risks of zoonotic infection for HIV-infected persons employed in veterinary settings are limited, there are none that justify their exclusion from the veterinary workplace.197 Risk of exposure to zoonotic pathogens in the workplace can be mitigated through consistent use of the VSP outlined in this compendium.


    Pregnancy presents a situation in which multiple potential occupational hazards must be addressed. The employer, on the basis of a workplace risk assessment, should provide information about hazards to which the employee and fetus may be exposed. Pregnant employees should consult with their health-care provider about potential hazards including zoonotic disease, chemicals, waste anesthetic gas, radiation, and lifting hazards. Employers must then provide reasonable workplace accommodation for the employee.

    The ADA as amended in 2008 states that while pregnancy itself is not a disability, pregnant workers and job applicants are not excluded from the protections of the ADA. Pregnant workers with pregnancy-related impairments may demonstrate that they have disabilities for which they may be entitled to a reasonable accommodation under the ADA. Also, if an employee is temporarily unable to perform her job because of pregnancy, the employer must treat her the same as any other temporarily disabled employee; for example, by providing light duty, modified tasks, alternative assignments, disability leave, or leave without pay.198,199 Employees should notify managers as soon as they know they are pregnant so that potentially harmful activities may be avoided and necessary adjustments to workplace activities can be addressed.

    Pregnant women are more susceptible to certain zoonotic infections owing to physiologic suppression of cell-mediated immunity. Conditions to which pregnant women are more susceptible include toxoplasmosis, lymphocytic choriomeningitis, brucellosis, listeriosis, and psittacosis.200 Vertical transmission of certain zoonotic agents may result in miscarriage, stillbirth, premature birth, or fetal congenital anomalies.


Veterinary practices should have a written infection control plan.3,53 A model infection control plan that can be tailored to individual practice needs is available in electronic format from the NASPHV website (Appendix 4).201 Effective infection control plans should do the following:

  • Provide explicit and well-organized guidance specific to the facility and practice type.

  • Be flexible so that new issues can be addressed easily and new knowledge incorporated.

  • Indicate the staff members responsible for each area, activity, or function.

  • Provide contact information, resources, and references.


    All veterinary personnel are responsible for supporting and carrying out the activities outlined in the practice's infection control plan; however, it is the practice management team and senior clinicians who must play a leadership role in establishing the culture of infection control practice. Staff members should be designated for development and implementation of specific infection control policies such as monitoring compliance, maintenance of records, and management and documentation of workplace exposures and injuries. Breeches in infection control practice should be addressed.


    1. Leadership

      The management team should set the standard for infection control practices, champion the importance of infection prevention in daily activities, and model desired behaviors such as hand hygiene after every patient contact.

    2. New Staff

      New staff members should be given their own copy of the infection control plan. Detailed training should be provided. Receipt of the plan and training should be documented for each employee.

    3. Review and Revision

      Practice management should evaluate incidents as they occur and evaluate processes and identify deficiencies that may necessitate engineering or administrative changes. Revisions should be communicated to all staff members. If deficiencies in training are identified, the management team should ensure that corrective measures are taken and employee retraining is instituted.

    4. Compliance

      All team members should ensure that infection control policies and protocols are carried out consistently and correctly.

    5. Availability

      Copies of the infection control plan and resource documents should be readily accessible to all staff, including reception, administration, animal care, and housekeeping personnel.



Advisory Committee on Immunization Practices


Americans with Disabilities Act


US Environmental Protection Agency


Health care and social assistance


National Association of State Public Health Veterinarians


National Occupational Research Agenda


Occupational Safety and Health Administration


Personal protective equipment


Veterinary Standard Precautions


Bender J, Professor, College of Veterinary Medicine, University of Minnesota, Saint Paul, Minn: Personal communication, 2015.


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