Content

Isolation

Criteria for immediate admission to the Isolation Unit

  • Horses with any 2 of the following 3 signs: diarrhea, fever, neutropenia.
  • Horses with a primary complaint of diarrhea that is not physiologic.
  • Horses with a disease on the Equine Infectious Disease chart that indicates “Isolation” as the appropriate housing.
  • Horses with a fever >102°F (38.9°C), and any 2 of the following 3 signs; cough, nasal discharge, lymphopenia
  • EHV-1 suspects have additional special instructions, beyond the requirements of isolation.
  • Foals have special instructions.  If isolation is required the policies on this page apply.
  • If the Isolation stalls are full, a patient presented with diarrhea can be refused admission if a pathogen is suspected. If a pathogen is not suspected, the patient’s status must be discussed with the hospital epidemiologist or chair of the Infection Control Committee before being placed in a restricted stall.
  • Restriction status, at no time, should be used to accommodate a lack of availability of an isolation stall.

Exceptions

  • Horses with a fever >102°F (38.9°C), and any 2 of the following 3 signs; cough, nasal discharge, lymphopenia, where the clinical signs have been present for at least 10 days (e.g., pleuropneumonia)

Criteria for transferring hospitalized horses to the Isolation Unit

  • Horses that develop 2 of the following 3 signs: diarrhea, fever (>39.2°C; >38.9°C if received NSAID in previous 24-hour period), and neutropenia (<2000 cells/µl)
  • A positive Salmonella culture is obtained.
  • A positive Clostridium difficile toxin test is obtained.
  • Any nosocomial pathogen is obtained.
  • Anytime there is a high index or suspicion of Salmonella, or an infectious disease; even without the confirmation of diarrhea.
  • A patient diagnosed with a disease on the Equine Infectious Disease chart that indicates “Isolation” as the appropriate housing.

Use of Isolation Unit and Communication

  • Isolation status requires mandatory clear communication from the attending clinician to the EFAVC Technical and Attendant Staff and an EFAVC Supervisor.
  • The senior clinician is responsible for informing all personnel, which may have contact with an animal, about the nature of the infectious disease(s) to be encountered.
  • Patients diagnosed with or suspect of having a zoonotic disease require further special management, including contact logs and mandatory communications. 
  • A patient that has had diarrhea and tested positive for Salmonella spp. necessitating it’s transfer to an isolation stall shall remain in isolation for the duration of its stay.
  • Patients with salmonellosis or which test culture positive for Salmonella spp should not be exercised outside the isolation facility.
  • The client will be informed and educated about Salmonella when any patient tests positive for Salmonella regardless of the clinical status.
  • If an animal in isolation is to be discharged to a client’s property at the request of the client, but against the advice of the clinicians, the discharge comments must clearly state that:
    • The patient is discharged against Veterinary Health Complex (VHC) advice.
    • The patient may present a zoonotic risk to humans.
    • The patient may present an infectious disease risk to other animals on the property.

Safety

  • Access to this area requires orientation by an EFAVC supervisor, technician, clinician, or house officer.
  • Students are not permitted to be in the stall with a patient alone.  A staff member, house officer, clinician, or a second student must be physically present.
  • A two way radio must be available for emergency calls when in the stall.
  • Staff members should notify another staff member when visiting an occupied stall.  Supervision via camera is mandatory if a second staff member is unable to be physically present.  Two people must be physically present if the patient is ataxic, neurologic, or in any way unstable.

Visitors (Non-CVM persons)

  • Are permitted visitation at the discretion of the attending clinician. 
  • Visitor must be oriented by the attending clinician or house officer, including proper ppe use, safety precautions, health risks, risk to other animals, etc.
  • Visitor must be accompanied by a service member at all times, no exceptions
  • Visitor is not permitted to immediately re-enter the EFAVC main hospital after visiting the isolation area.  Attending clinician or house officer shall instruct the visitor on how to properly decontaminate themselves to avoid transmission to animals or people.  Instructions shall include proper laundering/disinfection of clothing, shoes, and person.  Upon proper decontamination the visitor can return to the EFAVC and enter the main hospital.

Isolation unit setup and management

    • Occupied isolation unit will be identified by yellow poles and yellow chain.  The designated area shall be entirely enclosed by yellow chain, leaving no gaps in the barrier.  The enclosed area will include the covered area, exterior to the nursing station.
    • Each isolation unit shall have posted copies of the Isolation Flyer and the PPE instructional poster
    • Each occupied isolation unit will contain
      • A storage unit containing pertinent medical supplies
      • A designated trash can, broom, manure fork, shovel, twitch, lead rope, dust pan, and patient designated care kit.
      • Clean PPE should be conveniently located on the exterior of the Isolation area for clean PPE application. Refer to the posted PPE instructions for proper procedures.
    • All trash, bedding, waste, etc shall be loaded into a red cart and incinerated.
      • Exterior of red cart should be kept clean or disinfected when contaminated.  Wheels should be disinfected upon removal of the red cart from the contaminated area.
    • Isolation units shall be kept clean and organized at all times.  Taking care to avoid shavings or debris contaminating surrounding, non-restricted areas.

Standard Isolation PPE

    • Disposable boots, gloves, and disposable coveralls (and hair covers if hair hangs below the collar).  Face shields and masks shall be warn when applicable.
      • Clean PPE should be applied prior to entering the Isolation area
      • PPE should be applied and removed following this PPE instructional poster.

Equipment use in Isolation

    • Only buckets, pumps, twitches, thermometers, stethoscopes, stomach tubes, etc; designated for isolation patients will be used.
    • All equipment used for providing care to isolated animals must be limited to an individual animal until appropriately disinfected or sterilized.

Permanent withdrawal from Isolation

    • As general practice; animals admitted into isolation should not be transferred to the general hospital population or main facility.  They should remain in isolation through their entire stay and be discharged from isolation.
    • In cases of a precautionary placement in isolation where all potentially contagious conditions have been ruled out; animals may be removed from isolation and hospitalized in the main facility; following approval from the EFAVC Operations Manager, whom will consult an additional member of the Infectious Disease Committee if needed.