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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 (only if they are not suspect of a disease requiring isolation)
    • Any adult bovine, with projectile diarrhea that lasts 24 hours, unless it has a displaced abomasum.
    • Any adult bovine with diarrhea that develops or is admitted with a displaced abomasum if the diarrhea continues for 96 hours
    • Any ruminant admitted from a herd with a history of diarrhea unless the cause of the herd’s diarrhea is known to be non-infectious
  • 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.
    • Any patient that meets the criteria for Restriction must remain in its current stall and Restriction procedures must be implemented immediately.
  • 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.
  • Exemption criteria to policy on restriction
    • Any animal, in the absence of diarrhea that has metritis or peritonitis.
    • 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 Salmonella spp was suspected there must be five consecutive negative cultures for Salmonella. A 30g 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, and stomach tubes designated for Restriction patients will be used for patients 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