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Restriction

Restriction is used proactively to protect other hospitalized animals from exposure to infectious diseases by temporarily isolating a patient until its infection status has been clarified. Stall Restriction is initiated to contain a potential pathogen that has not yet been identified. 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
    • Any animal not in isolation that develops diarrhea without fever or neutropenia.
    • 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 hospital epidemiologist or the chairperson of the infectious disease control committee.
    • 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.
  • 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 in Restriction must be moved to the Restriction Zone at the north end of C aisle (C5, C6, C13, C14, C15, and C16).
    • Access to the north section of C (F) aisle and through the roll up door shall be limited to those caring for the patient when a patient is in the Restriction Zone.
    • Restriction stalls are “off limits” to visitors. Only personnel immediately concerned with the restricted patient shall be allowed entry.
    • Disposable coveralls shall be worn in the stall, labeled for that patient, and hung outside the stall between uses.
    • Disposable boots and gloves (and hair covers, if hair hangs below collar) shall be worn in the stall.
    • Horses under Restriction because Salmonella spp is suspected may be removed from Restriction after 5 consecutive negative cultures at every 12-24 hours, or after Clostridium difficile toxin tests are negative.
  • Exemption criteria to policy on restriction
    • A horse presented with chronic diarrhea (variable consistency, volume, and frequency) and chronic weight loss and no evidence of fever or neutropenia.
    • Any animal, in the absence of diarrhea that has pleuritis, metritis, or peritonitis.
    • After exploratory laparotomy, horses may exhibit diarrhea in response to corrective surgery, particularly if fluid is infused. These animals 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.
    • Animals are not permitted to be taken off Restriction or leave the Restriction Zone 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)
  • 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.
  • Equipment use in restriction
    • Only buckets, pumps, twitches and stomach tubes designated for Restriction patients will be used for horses under 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 or isolation criteria
    • 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