The Small Animal Isolation Unit is designed to house patients that fall into designated infectious disease categories as outlined in the online Infectious Disease Resource. Please review all information regarding Isolation and contact an ER Technician to be properly trained on Isolation Protocols before placing an animal in this space.
Personal Protective Equipment (PPE):
In order to maintain the safety of isolation patients and your personal safety, everyone will wear appropriate PPE at all times when in the isolation unit. Appropriate PPE procedures are detailed below.
- You will apply appropriate PPE from the main clean room. See diagram posted on the Isolation Clean Room door for step by step instructions.
- All supplies are kept in the stainless steel cabinets in the Isolation Clean Room.
- Keep the Isolation Anteroom as clean as possible.
- Use the threshold between the Isolation Anteroom and each Isolette as the de-gowning area. For the “G” run Isolette, if you are unable to remove PPE using this threshold, you may degown in the anteroom thus rendering this area contaminated (see #7).
- A poster is provided in each Isolette, detailing proper removal of PPE.
- The Isolation Anteroom floor will be sprayed with Accel disinfectant spray bottle, after each entry to the unit.
- If the Isolation Anteroom becomes contaminated, it will be thoroughly disinfected with high pressure hose and foam Accel. Contact a kennel technician during regular hours or see Isolation Cleaning Protocols for afterhours.
- All trash for “E” and “F” isolettes should be disposed of in each Isolette Red Biohazard Bin.
- All trash for the “G” run isolette should be disposed of in the Isolation Anteroom Red Biohazard Bin.
- If laundry is approved, use appropriate bins in “E” and “F” or the main Isolation Anteroom bin for “G”.
Always change PPE in between patients if multiple patients are housed and require treatment. See diagram posted on either the Isolation Clean Room door or inside of each Isolette for step by step instructions if you encounter a break in your PPE.
All supplies should be prepared for your patient before entering Isolation. Carts are provided and reside in the clean room. The clean room has all the stock you should need to bring into Isolation. Stock the individualized patient carts for the first 24 hours, then stock daily. Don’t overstock as things unused will be disposed of.
All PPE requirement items will be stocked in the Isolation Clean Room cabinets. See an ER technician if you are missing any items.
- Biohazard suit
- Blue Impervious Gown
- Shoe covers
- Boot Covers
- Hair Covers
- Face Shield
Examples for your cart: Choose what you need based on patient symptoms/treatments
- Clipper blade/clippers
- Dry erase board and marker- from Isolation Exam Room
- Disposable stethoscope
- IVC kit, a few extra catheters, extra T-ports
- Bandaging material
- BP cuff
- Doppler- from Isolation Exam Room
- Scrub- small bottle
- Alcohol- small bottle
- Saline- small bottle
- Peroxide- small bottle
- Paper litter box
- Blood tubes
- HDQ spray bottle
Isolation Patient Flow, Usage and Tips:
- Police/county seized, Good Samaritan, and any animal with an unknown history shall be placed in the Isolation Unit.
- Patients suspected prior to admission of having one of the designated infectious diseases (online resource) shall not be brought through the lobby or placed in a regular exam room. They shall be brought through the outside entrance to the Isolation Exam room.
- If a patient is identified to need Isolation housing after entering the main hospital, the patient must be carted to Isolation, either by exiting the building and entering through Isolation Exam or carting through Isolation Clean Room and into an Isolette. The exam room shall be labeled “Do Not Use”, a supervisor contacted, and the room and lobby thoroughly cleaned. If the patient was taken through Isolation Clean Room, the area shall be thoroughly decontaminated. (See Isolation Cleaning Protocol).
- The entry to Isolation from the Isolation Clean Room is an anteroom, essentially a larger room that enters into a smaller room. The intention is to keep this room clean and not contaminate. However, if this room does become contaminated, contact a kennel technician for thorough cleaning. If outside of kennel technician hours, see Isolation Cleaning Protocols.
- If your patient is being admitted from the outside of the building, utilize the Isolation Exam room. There is a bank of cages in the room to use as needed before contaminating an Isolation Isolette. There are no supplies in this room, only extra PPE, cleaning materials, biohazard supplies, and equipment (syringe pump, ECG monitor, Doppler, fluid pumps). Come in prepared for your initial triage examination, knowing you will eventually return to main ER before admitting your patient.
- Once your clinician has received client approval to admit the patient, your Isolette room should be set up.
- All supplies should be in the Isolette for that patient only, and should not be taken out of the room.
- Each Isolette has its own biohazard bin for trash and for laundry. Laundry is allowed on a case by case basis- see a supervisor. Decub pads and blue diaper pads are used primarily for bedding and are disposable.
- A small dry erase board/marker will be designated to the exam room and each Isolette. Write vitals/treatments/notes on this board inside the room. Add patient identification and presenting problem to the top of the board.
- Put any notes on your dry erase board and magnetically attach to the paper towel holder (E&F) lean on the window for “G” run.
- Keep inner pair of gloves on to exit each Isolette. Wash hands in Isolation Anteroom before exiting to the Isolation Clean Room.
- Patient charts/flowsheets will be kept in ER main treatment area propped against the glass. Transfer your notes from the dry erase board to the flowsheet.
- The next time you enter the Isolette, utilize the same dry erase board.
- After patient is fully admitted to its Isolette and initial treatments are complete, page kennel technicians to notify them of the patient and to thoroughly clean the Isolation Anteroom and Isolation Exam Room.
- After the patient is discharged, all supplies in patient cart will be disposed of. Page kennel technicians to thoroughly clean the entire Isolette and Isolation Anteroom, cart, dry erase board, cages, bowls, etc. After cart is properly disinfected it can go back to the Isolation Clean Room. After stainless steel bowls have been disinfected, they will go through the dishwasher in the Isolation Clean Room for a sterilization cycle.
- Patient weights and treatments should be grouped together to minimize traffic in the Isolation Unit, yet staggered from other patients in individual Isolettes to prevent cross contamination. Cleaning should be scheduled around these treatment times to provide maximum disinfection.
Admission to Isolation Unit:
- Check to make sure Isolation Unit is clean prior to admitting a patient.
- A technician/supervisor shall be alerted to patient admission.
- Patient identification shall be placed on the dry erase board to identify patients in each Isolette:
- Patient UVIS number
- Patient Name
- Presenting Problem
- Traffic in the Isolation Unit shall be restricted to only what is necessary for optimal patient care.
- Patients should only be transported through the Isolation Clean Room when absolutely necessary. Normal flow should be from Isolation Exam Room – through Isolation Anteroom – into Isolettes – back to Isolation Exam Room.
- Patients are not walked outside for any reason while hospitalized.
- One kennel attendant shall be assigned on a rotating basis for patient/area cleaning. Unless otherwise instructed, the kennel technician will utilize the Isolation Cleaning Protocol. If modification of this protocol is needed in order to assure adequate removal of organisms, the clinician shall inform the supervisor or Infectious Disease Control (IDC) committee member.
- To the extent possible, diagnostic and therapeutic procedures shall be performed within the Isolation Unit. All oxygen and waste hookups are available for anesthetic procedures.
- When procedures outside the Isolation Unit are necessary, these procedures shall be cleared and scheduled with the appropriate supervisors of housing and ancillary areas. Diagnostic and therapeutic treatments shall be scheduled after all other patients and strict protocols will be used to decontaminate areas after procedures. See Isolation Cleaning Protocols
- Items brought into the isolation unit shall be disposed of following use, or shall be thoroughly cleaned/autoclaved prior to returning to general use.
- Isolation patients shall have staggered treatment/examination schedules that differ from ICU and IMC treatment times to allow for students and staff to treat isolation patients after all others when applicable.
- If a patient is transferred from regular housing to the Isolation Unit, the cage previously occupied by that animal shall be thoroughly disinfected. Cultures may be required depending upon the organism. (see Isolation Cleaning Protocol)
- Patients admitted to Isolation Unit shall not be transferred to another housing area for any reason, unless the infectious disease has been thoroughly ruled out. Decisions will be made in conjunction with a patient care supervisor, a senior clinician and an IDC member.
- Medications will be left in the Isolation Clean Room, where bins and a refrigerator are available.
- All lab samples going to clinical labs will be carefully placed in a zip lock bag at the door so that the outside of the bag remains free from contamination. All laboratory specimens should be clearly identified as a potential infection control risk.
- Lab samples should be processed inside a hood.
- Owner visitations will be discouraged, however they will be allowed on a case by case basis depending on potential infectious diseases. Approval will be made in a discussion with patient care supervisor, a senior clinician and an IDC member. All appropriate PPE must be worn by owners and they must be accompanied by a clinician or staff member.
Isolation Patient Care Rotation
- Patients admitted to Isolation Unit will be cared for by the Emergency Service staff unless prohibited by caseload.
- The following will be assigned to each isolation case to ensure proper care and management of the case (use posted schedules for various areas):
- 8am-4pm Monday-Friday (weekday)
- Primary Emergency Technician(s)
- 1st Backup Service Student/Service Clinical Technician(s)
- 2nd Backup Clinical Technician Supervisor or Designee
- 4pm-8am Monday – Thursday (weeknight)
- Primary Emergency Technician(s)
- 1st Backup IMC Technician(s) or Emergency On Call Technician
- 2nd Backup ICU Technician(s) or Emergency On Call Technician
- 4pm Friday- 8am Monday (weekend)
- Primary Emergency Technician(s)
- 1st Backup IMC Technician(s) or Emergency On call Technician
- 2nd Backup ICU Technician(s) or Emergency On call Technician
- IMC and ICU can be used as either 1st backup or 2nd backup and changed depending upon caseload in respective areas.
- General Hospital technicians should be used to backup Intermediate Care and should not be assigned to isolation cases.
- Upon admittance to Isolation Unit, the ER Supervisor or on call supervisor will create the above plan and will communicate this to all individuals involved. In addition, this should be either posted near Isolation or e-mailed to the group for assignment. If patients are admitted after hours, the on call supervisor should be contacted to manage this coverage plan. Please e-mail the following individuals to an isolation case:
- ER Senior clinician
- ER Supervisor
- On call Supervisor (if different than area supervisor)
- Lead technicians
- Director of Clinical Services
- Each individual identified in the coverage plan
- Kennel Attendant assigned
- The following is a list of responsibilities for primary and backup isolation coverage individuals:
- Check in every hour to ensure ER is able to manage the case
- Familiarize yourself with the flow sheet if able
- E-mail the on call supervisor if you need to become primary technician
- Isolation patients that have primary case responsibility transferred to an internal hospital service will have the following assigned to them:
- A senior clinician
- A resident/intern
- A service student
- A treatment technician (see above)
- A kennel attendant(s)
- All AM treatments will be performed by a service student or clinician on the case. Every effort to maintain the same treatment individuals from the service should be made.
- The assigned service will create a daily treatment sheet and discuss with the assigned departmental technician. (Available in ER)
- After AM treatments have been completed, an assigned technician will care for the isolation patient throughout the day and through following shifts.
- At any point during the day the assigned technician may require assistance from the service appointed individual. Every effort should be made to minimize this individuals’ multiple patient contact.
- A kennel technician will be assigned to the isolation unit when occupied. This kennel technician will clean and disinfect the area daily when occupied. A member of the emergency service will assist by cleaning and disinfecting the area as needed between one patient being discharged and another admitted. Duties may include
- Removing trash
- Cleaning cages
- Cleaning equipment
- Restocking supplies
Owner visitation for patients housed in isolation or restriction in the Terry Center will be allowed on a case by case basis depending on the type of suspected infectious disease and its perceived transmissibility. Visitation may be granted following a discussion between the patient care supervisor, attending senior clinician, and a member of the infectious disease committee. Appropriate PPE must be appropriately fitted for each individual and owners must be accompanied by a service clinician, staff member, and/or student. The acknowledgement of risk by an owner must be documented in the communication log prior to entry. Failure to agree or comply with PPE and other requirements will result in a loss of visitation privileges.