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Restriction

Restriction is used proactively to protect other hospitalized animals and personnel from exposure to infectious diseases; by temporarily isolating a patient until its infection status has been clarified. The objective is to limit contact with the pathogen, by limiting the number of individuals in contact with the patient, limiting patient movement in the clinic, and carefully restricting the use of equipment and supplies to an individual stall.

Criteria for animals that must be placed under Restriction

    • A horse, not in isolation, that develops or presents with diarrhea,without fever or neutropenia.
    • A horse, not in isolation, that develops or presents with unexplained fever, without diarrhea or neutropenia.
    • A horse diagnosed with, or suspect of having, a disease on the Equine Suspect Infectious Diseases chart that indicates Restriction as the appropriate housing.
    • Foals have special instructions.  If restriction is required the policies on this page apply.

Exceptions

    • A horse presenting with chronic diarrhea (variable consistency, volume, and frequency) and chronic weight loss and no evidence of fever or neutropenia.
    • A horse, in the absence of diarrhea that has pleuritis, metritis, or peritonitis.
    • A horse that exhibits diarrhea in response to corrective surgery, particularly if fluid is infused; will be given a 24-hour “grace period” before being placed under Restriction. However, if the animal develops fever or neutropenia in addition to diarrhea at any time during the post-operative period, the horse is then moved to isolation.

A complete blood count must be performed within 24 hours on any horse that:

    • Demonstrates an unexplained fever
    • Develops diarrhea without fever
    • Has a physiologic diarrhea– these patients should be evaluated cooperatively with either the hospital epidemiologist or the chair of the Infectious Disease Control committee to decide how to proceed.

Use of Restriction and Communication

    • Stall Restriction status requires mandatory clear communication between the attending clinician and 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.
    • When the presence of a pathogen has been identified or is strongly suspected by a clinician, stall restriction is not a substitute for movement of the animal to isolation.
    • Stall restriction may be appropriate for animals that have recently had abdominal surgery or other procedures that may contribute to physiologically induce transient episodes of diarrhea.
    • Patients diagnosed with or suspect of having a zoonotic disease require further special management, including contact logs and mandatory communications. 
    • Animals are not permitted to leave the Restriction Zone/area except for:
      • an essential surgical procedure that must be performed in the VHC
      • a procedure to be performed that is essential to the diagnostic evaluation or management of the patient (and cannot be performed in restriction)
      • removal of any restricted horse must be coordinated with an EFAVC supervisor to ensure proper and immediate disinfection of all effected surfaces

ICU aisle (A aisle)

    • Any patient housed in the ICU aisle (A aisle) that meets the criteria for Restriction must remain in its current stall and Restriction procedures must be implemented immediately.

Restriction Zone

    • The Restriction Zone is at the north end of C aisle and consists of stalls C5, C6, C13, C14, C15, and C16.
    • Healthy patients can be housed in the Restriction Zone when it is not needed for a Restriction patient.
    • Any healthy animal housed in the Restriction Zone must be relocated before the area is declared a Restriction Zone for housing a patient that meets restriction zone criteria.
    • Patients on B aisle that need to be placed on Restriction must be moved to the Restriction Zone.
    • Access to the north section of C aisle and through the roll up door shall be limited to those caring for the patient when a patient is in the Restriction Zone.

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
    • Attending clinician or house officer shall instruct the visitor on how to properly decontaminate themselves to avoid transmission to animals or people.

Restriction stall setup and management

    • Restricted stalls 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.
    • Each restricted stall shall have a posted copy of the Restriction policy.
    • Each restricted stall will contain (within the chain barrier):
      • A cart containing pertinent medical supplies
      • A designated trash can, broom, manure fork, twitch, lead rope, dust pan and patient designated care kit.
      • Clean PPE should be conveniently located on the exterior of the restricted area for clean PPE application.
    • 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.
    • Restriction areas shall be kept clean and organized at all times.  Taking care to avoid shavings or debris contaminating surrounding, non-restricted areas.
    • Rabies suspects have additional requirements.

Standard Restriction PPE

    • Disposable boots, gloves, blue apron, hair covers if hair hangs below the collar, and face shield when applicable.
      • Clean PPE should be applied prior to entering the Restricted area
      • PPE is disposable and should be discarded as exiting the restriction area, avoiding contamination of the non-restricted area.
      • Blue aprons may be substituted for full gowns, if needed, however they are disposable and should be discarded after a single use.

Equipment use in restriction

    • All equipment used for providing care to restricted animals must be limited to an individual animal until appropriately disinfected or sterilized.

Sample Collection

    • Fecal samples must be collected daily from suspect patients meeting diarrhea restriction
    • Culture - Salmonella spp, Clostridium difficile
    • Toxin test - C. difficile
    • If Salmonella spp is cultured, or C.difficile toxin is positive – move immediately to isolation
    • If C.difficile is isolated but toxin negative - remain in restriction

Permanent withdrawal from Restriction

    • Animals may permanently leave restriction:
      • If they have tested negative for all pertinent diseases and have resolved all relevant signs (e.g., fever, neutropenia, or diarrhea).
      • If Salmonalla spp was suspected there must be five consecutive negative cultures for Salmonella. A 30 g aliquot of feces is obtained for Salmonella spp culture on day 1 and on 4 subsequent consecutive occasions. In a single day, no more than two samples separated by at least 8 hours should be submitted. If a sample has to be stored prior to submission it should be refrigerated.
      • If C.difficile was suspected they must have tested negative for C.difficile toxin.