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Zoonosis Prevention and Infection Control in Zoos Donald L. Janssen, DVM, Dip. ACZM Corporate Director, Animal Health San Diego Zoo and San Diego Zoos Wild Animal Park Slide 2 Topics for Today 1.General Biosecurity in Zoos 2.Handling Zoonotic Disease Cases 3.Zoonosis Training for Zoo staff 1.General Biosecurity in Zoos 2.Handling Zoonotic Disease Cases 3.Zoonosis Training for Zoo staff Slide 3 Organization-wide approach to infection control 1. General Biosecurity Guidelines Slide 4 Slide 5 1 1 7 7 Slide 6 Slide 7 Those precautions taken to minimize the risk of introducing an infectious disease into an animal population. All programs of infection control within our facilities Those precautions taken to minimize the risk of introducing an infectious disease into an animal population. All programs of infection control within our facilities Slide 8 Facilities Animal Care Staff Collection Animals Animal Feed Wild and Feral Animals Surveillance Education and Communications Occupational Health Care Enhanced Biosecurity Measures Facilities Animal Care Staff Collection Animals Animal Feed Wild and Feral Animals Surveillance Education and Communications Occupational Health Care Enhanced Biosecurity Measures Slide 9 Primate Safety PolicyPrimate Safety Policy Reptile Handling GuidelinesReptile Handling Guidelines Bat Handling GuidelinesBat Handling Guidelines Placenta and Newborn Animal Handling GuidelinesPlacenta and Newborn Animal Handling Guidelines Highy-Pathogenic Avian InfluenzaHighy-Pathogenic Avian Influenza Exotic Newcastle DiseaseExotic Newcastle Disease Primate Safety PolicyPrimate Safety Policy Reptile Handling GuidelinesReptile Handling Guidelines Bat Handling GuidelinesBat Handling Guidelines Placenta and Newborn Animal Handling GuidelinesPlacenta and Newborn Animal Handling Guidelines Highy-Pathogenic Avian InfluenzaHighy-Pathogenic Avian Influenza Exotic Newcastle DiseaseExotic Newcastle Disease Slide 10 Design and manage with biosecurity in mind Facility control points Back of house Entrance and exit procedures Slide 11 Includes employees, volunteers, contractors, etc. Hand hygiene Uniforms and outerwear, footwear Animal products from outside Includes employees, volunteers, contractors, etc. Hand hygiene Uniforms and outerwear, footwear Animal products from outside Slide 12 Quarantine incoming animals Cleaning and disinfection of transport carriers, nets, gloves, Quarantine incoming animals Cleaning and disinfection of transport carriers, nets, gloves, Slide 13 All food will be procured through the Nutritional Services department Do not feed uncooked poultry products General food safety principles will be followed in food storage and preparation areas. All food will be procured through the Nutritional Services department Do not feed uncooked poultry products General food safety principles will be followed in food storage and preparation areas. Slide 14 Feeder crickets Slide 15 Minimize access by wildlife around animal enclosures Follow protocols for handling sick and injured native wildlife Prevent standing water accumulation in accordance with West Nile virus prevention program. Minimize access by wildlife around animal enclosures Follow protocols for handling sick and injured native wildlife Prevent standing water accumulation in accordance with West Nile virus prevention program. Slide 16 Passive Surveillance Post-mortem Examinations Morbidity and Mortality Investigations Active Surveillance Preventive Medicine Examinations Passive Surveillance Post-mortem Examinations Morbidity and Mortality Investigations Active Surveillance Preventive Medicine Examinations Slide 17 Public Communications Regulatory Communications Employee and Volunteer Training Public Communications Regulatory Communications Employee and Volunteer Training Slide 18 Slide 19 Occupation Safety and Health Administration Employee occupational medicine provider Occupation Safety and Health Administration Employee occupational medicine provider Slide 20 Foreign Animal Diseases Exotic Newcastle Disease Highly Pathogenic Avian Influenza (e.g. H5N1) Foot and Mouth Disease Foreign Animal Diseases Exotic Newcastle Disease Highly Pathogenic Avian Influenza (e.g. H5N1) Foot and Mouth Disease Slide 21 Slide 22 Clean before disinfection Contact time Proper dilution label directions Frequency Disinfectant classes and spectrum of action Clean before disinfection Contact time Proper dilution label directions Frequency Disinfectant classes and spectrum of action Slide 23 Foot baths Hand washing Non-porous surfaces Porous surfaces Animal handling equipment Footwear Foot baths Hand washing Non-porous surfaces Porous surfaces Animal handling equipment Footwear Slide 24 Slide 25 2. Managing Cases Diagnosed With a Zoonotic Disease Agent Slide 26 What should we do when we diagnose a zoonotic disease in our zoo? Slide 27 Definition: Zoonotic Disease Any infectious disease that can be readily transmitted between animals and humans Slide 28 Zoonotic Disease Occurrence Zoonotic Disease Occurrence Questions to Ask Ourselves What do we do? Who is in charge and making decisions? Who should we notify and what do we say? What do the caretakers need to know? Do we need to isolate the animal? How? How do we handle animal waste? Do we need to report to government regulators? How do we manage the medical care of the infected animal? What do we do? Who is in charge and making decisions? Who should we notify and what do we say? What do the caretakers need to know? Do we need to isolate the animal? How? How do we handle animal waste? Do we need to report to government regulators? How do we manage the medical care of the infected animal? Slide 29 Zoonotic Disease Occurrence Zoonotic Disease Occurrence Consequences What are the consequences of mishandling this? Animal well-being Public health Institutional reputation Professional reputation Unnecessary human and animal illness What are the consequences of mishandling this? Animal well-being Public health Institutional reputation Professional reputation Unnecessary human and animal illness Slide 30 Zoonotic Disease Occurrence Zoonotic Disease Occurrence Solution Zoo clinicians are well-suited to handle this Decide what to do before the occurrence Develop a pre-determined process Decide what will trigger the process Zoo clinicians are well-suited to handle this Decide what to do before the occurrence Develop a pre-determined process Decide what will trigger the process Slide 31 Zoonotic Disease Occurrence Zoonotic Disease Occurrence Trigger A zoonotic agent is diagnosed or highly suspected in an animal or human contact Slide 32 Zoonotic Disease Occurrence Zoonotic Disease Occurrence Suggested Steps 1.Notify 2.Infection Control Isolate Handle waste 3.Report 4.Treat/manage animal 1.Notify 2.Infection Control Isolate Handle waste 3.Report 4.Treat/manage animal Slide 33 #1 - Notify #1 - Notify Key Stakeholders Animal care supervisors Occupational health provider Provide disease fact sheet to keepers Remind all to report signs and symptoms of disease in themselves Animal care supervisors Occupational health provider Provide disease fact sheet to keepers Remind all to report signs and symptoms of disease in themselves Slide 34 #2a - Isolate #2a - Isolate Animal from others 1 st Infection Control step Consider feasibility and risk Required if guest contact Reinforce personal hygiene Institute PPEs as indicated Footbath Use of separate tools and equipment 1 st Infection Control step Consider feasibility and risk Required if guest contact Reinforce personal hygiene Institute PPEs as indicated Footbath Use of separate tools and equipment Slide 35 #2b - Waste handling 2 nd Infection Control step Use sewer disposal if possible Contaminated bedding Prevent spreading contamination Disinfection Follow local regulations for biomedical wastes 2 nd Infection Control step Use sewer disposal if possible Contaminated bedding Prevent spreading contamination Disinfection Follow local regulations for biomedical wastes Slide 36 #3 - Report #3 - Report To authorities if required Know what diseases are reportable (federal, state, county) Develop rapport with local health departments Consider internal tracking document Know what diseases are reportable (federal, state, county) Develop rapport with local health departments Consider internal tracking document Slide 37 #4 Medical Care Appropriate treatment, if indicated Follow up diagnostics as appropriate Establish an end point for the isolation and precautions Appropriate treatment, if indicated Follow up diagnostics as appropriate Establish an end point for the isolation and precautions Slide 38 Resources Available CDC Zoonotic Disease Fact Sheets Slide 39 Reportable Diseases Resources Available Slide 40 EPA Waste Management Resources Available Slide 41 Gorilla shigellosis Elephant MRSA Aviary Psittacosis Case Examples Slide 42 Gorilla - Shigellosis Trigger Notify Isolate Waste Handling Report Medical Care Slide 43 Trigger Notify Isolate Waste Handling Report Medical Care Elephant Calf - MRSA Slide 44 Trigger Notify Isolate Waste Handling Report Medical Care Aviary - Psittacosis Slide 45 Summary 1.The consequences of mishandling a zoonotic disease occurrence are enormous 2.A systematic process will help avoid mistakes and failures to act 3.Set up a process ahead of time 1.The consequences of mishandling a zoonotic disease occurrence are enormous 2.A systematic process will help avoid mistakes and failures to act 3.Set up a process ahead of time Slide 46 3. Zoonosis Training Program for Zoo Staff Adapted from materials supplied by: Carol Roach, RN, PHN San Diego Health and Human Service Agency Community Epidemiology Branch Adapted from materials supplied by: Carol Roach, RN, PHN San Diego Health and Human Service Agency Community Epidemiology Branch Slide 47 Basic infection control principles for all employees Course 1 Advanced training for animal care staff Course 2 Slide 48 1. Choices and Responsibilities 2. Definitions 3. Factors for Disease Transmission 4. Transmission Pathways 5. Simple Rules of Infection Control 6. Hand washing 101 Basic infection control principles for all employees Course 1 Slide 49 ZOONOSES PATHOGEN INFECTION CONTROL Infectious diseases that move easily between animals and humans Any disease-producing agent (especially a virus, bacterium, fungi or parasite) A system of preventive measures to reduce the risk of infectious disease transmission Slide 50 THERE ARE 3 FACTORS NECESSARY FOR DISEASE TRANSMISSION 1. A Source of Pathogens 2. A Susceptible Host 3. A Means of Transmission The How, When & Where of Disease Transmission Slide 51 A Means of Transmission 3 Main Pathways: Vector Contact Air-borne Contact Transmission includes food-borne and blood-borne disease Slide 52 THREE SIMPLE RULES OF INFECTION CONTROL AVOID TRANSFER 1. AVOID TRANSFER : Dont transfer pathogens from a contaminated area or surface to clean area or surface DISINFECT 2. DISINFECT : Kill or remove as many pathogens as possible by cleaning and disinfection done the right way with the right products EQUIP 3. EQUIP : Give information and tools to workers to protect themselves, the environment, and the public All the preventive measures mentioned in this training are based on the 3 Simple Rules Remember: The 3 Simple Rules of Infection Control Slide 53 Ignaz Semmelweis 1818 1865 Slide 54 HANDWASHING IS THE SINGLE MOSTIMPORTANT THING YOU CAN DO CAN DO TO LOWER TO LOWER YOUR RISK YOUR RISK FOR FOR TRANSMITTING TRANSMITTING OR GETTING OR GETTING AN INFECTIOUS AN INFECTIOUS DISEASE DISEASE Slide 55 Hand Hygiene When? Frequently! Before and after animal contact After using the restroom Before hand-to-mouth activities When going from dirty to clean activities When changing activities Frequently! Before and after animal contact After using the restroom Before hand-to-mouth activities When going from dirty to clean activities When changing activities Slide 56 1. WET HANDS & WRIST 2. APPLY & LATHER SOAP 3. SCRUB PALM TO PALM 4. SCRUB BACKS OF BOTH HANDS 5. INTERLACE FINGERS AND SCRUB 6. SCRUB BACKS OF FINGERS ON PALMS 7. SCRUB THUMBS Always use liquid soap Wash for about 15-20 seconds -- About as long as it takes to sing Happy Birthday Dont forget to wash your wrists Use paper towels or a clean unused towel to dry your hands Turn off the tap with the paper towel you used to dry your hands Slide 57 1.Review Course 1 2.General biosecurity guidelines 3.Disinfection guidelines 4.Personal Habits at Work 5.Personal Health 6.Personal Protective Equipment 1.Review Course 1 2.General biosecurity guidelines 3.Disinfection guidelines 4.Personal Habits at Work 5.Personal Health 6.Personal Protective Equipment Advanced Training For Animal Care Staff Course 2 Advanced Zoonosis and Biosecurity Training Slide 58 1.Improving infection control in zoos biosecurity principles 2.Zoonotic disease occurrence - systematic process for what to do 3.Zoonosis prevention - training for zoo employees and volunteers Conclusions Zoonosis Prevention and Infection Control in Zoos