(This is the first of 4 segments of this great interview.)
In this engaging discussion, veterinary infection preventionists (IPs) Leslie Kollmann, BS, AAS, CVT, CIC; Denise Waiting, LVT; and Leslie Landis, BS, LVT, share their career paths, daily responsibilities, and the pressing challenges of infection control in veterinary settings. They emphasize the need for more education, resources, and collaboration within the veterinary field, particularly in managing zoonotic diseases, ensuring good hand hygiene, and improving infection prevention protocols across various animal care environments.
ICT: Who are veterinary IPs, and what do they do? What does an average day look like?
Leslie Landis, BS, LVT: I work primarily in the clinical setting, mostly in small animal, although I do a little large animal as well. My major role here is to be a resource to answer questions on the hospital policy or how they should handle a certain case. I respond when a potential contamination issue occurs. I can help identify where a protocol might need to be modified to improve best practices or to ensure better buy-in. As we all know, if it’s too hard, they will probably not do it. I’m the link between our epidemiologist and the actual hospital working staff, as someone who’s actively on the floor and knows how our hospital operates day to day.
ICT Speaks With Veterinary Infection Preventionists
·Leslie Kollmann, BS, AAS, CVT, CIC, is a certified veterinary technician and board-certified in infection prevention and control. She works in Veterinary Infection Prevention at the Minnesota Department of Health and has 20 years of experience as a vet tech and 15 years in infection prevention. She is also a member of the ICT Editorial Advisory Board.
·Denise Waiting, LVT, is a licensed veterinary technician at Washington State Veterinary Teaching Hospital, with 30 years in the field and 4 years in infection control and biosecurity.
·Leslie Landis, LVT, BS, is a licensed veterinary technician at Michigan State University College of Veterinary Medicine, supervising small animal surgery and central sterilization for 25 years and serving as the infection control nurse since 2008.
Leslie Kollmann, BS, AAS, CVT, CIC: I worked on the clinical floor for a long time as a veterinary IP with small and large animals. You’re that go-to person for all things IPC [infection prevention and control]. If we have dog or cat bodily fluids everywhere, how do you clean that up? How do you mitigate that? Education is a huge part of the job as well, so making sure that your staff and or volunteers you’re working with are all educated on their risks and what to do if you have an exposure, mitigating some of those issues on my day-to-day stuff with being a vet IP, like subject matter expert here at the health department on the public health side of things, it’s taking and educating a lot of animal care facilities across the state on some of their risks, and then helping them get programs in place to protect their staff, because there aren’t many education and trainings out there.
ICT: It sounds like a regular IP, except you deal with dogs, cats, cows, and horses.
LK: Absolutely. We often look at our human health care IP partners to see where they are. What have they done? What mistakes have they made that we don’t necessarily want to make on our side? But we are also dealing with so many different animal species, and we are dealing with a different population of people in our field who care about the animals, and that’s why they’re here. And so, then not thinking so much about themselves. How do we get them to understand that we must protect them to protect the animals? And it’s a different mindset, and then we are like the human IP field. We are slightly behind, so we are trying to catch up.
ICT: What are the current challenges in veterinary infection control? What are your most pressing challenges, especially with zoonotic diseases?
LL: One of the most significant challenges is the lack of resources for our fields. There isn’t, to my knowledge, a program or special area that we can train in, and specifically in veterinary infection control, we have to take human best practices and human resources and modify them to fit our veterinary capabilities as best as we can and do as best as we can. But there’s some guessing work in there, and try to see how it goes, which isn’t the best when dealing with a zoonotic disease. It slows us down.
Denise Waiting, LVT: One of the struggles also is working with not faculty, but students. We try to keep our students safe, and yes, that’s a priority. Then, the technicians and the faculty, we need to keep the students safe, but they have to keep themselves safe…. So, we have wildlife, our exotics, and the Wildlife Department. It’s not what comes in; it’s what’s out there. And we are right on the Washington-Idaho border. If it comes from Idaho, we’ll call Idaho. It becomes big when you’re right on the border and getting it out to the local clinics, not only our facility. And how do we do that? Some local clinics have looked at me like, “I don’t understand what you’re talking about.” If we had more education, we could also get it out to them.
LK: There are many challenges and concerns regarding zoonotic diseases, especially now. Most emerging serious infections involve animals, or they start in animals. And so how do we get the information out there to protect our people immediately without knowing, like Denise is saying, what’s coming in through the doors, because there’s always something new. Whether you know it’s H5N1 today or something new tomorrow, we’ll always be concerned about needing to know the basics to protect our staff, but how do we do that correctly, and how do we educate and train without having many of the resources that our human partners do? Like Leslie said, we have to think outside the box a lot. We have to be creative. We need to start collaborating within the field to get some of this stuff together.
ICT: Let’s recap. We’ve covered infection prevention in veterinary settings, focusing on small animals like pets and large animals like pigs or goats. In the office, you control the environment using disinfectants, like an IP for humans. But what do you do in the field during a farm call to have a sterile environment? How do you prevent infection when ultrasounding a mare to check for a foal? What advice do you give to doctors and students in those situations?
LK: Many wildlife rehabbers I work with conduct wildlife rehabilitation from their garages, sheds, or backyards. In those situations, being in the field or using mobile practices without a fixed location or a stationary spot that isn’t a somewhat sterile clinic can be very challenging. That’s when the basics of infection prevention become crucial, and having someone trained to think beyond basic clinic procedures is crucial.
There are basics that we look for, like hand hygiene. Where can they wash their hands? What type of PPE is available if we don’t have hand hygiene available? So, how do they wash their hands if they’re in the middle of the field, working on a horse? If you’re trained in some of the basics, there are obstacles that you can figure out, get materials to help, and then do the training beforehand. But it is super challenging. We’re dealing with dirt out there, a lot of organic stuff that gets in the way of doing infection prevention correctly, and keeping your supplies sterile, keeping your supplies out of the mud some days when it’s raining out in the field. There are many challenges in that arena.
DW: Then you bring those samples into your clinic or your laboratories, which is a lot of what we do. We’re testing all the different things related to COVID-19 through the clinic. This teaches them to handle things correctly before they even get to us.
ICT: What golden words do you have so that they understand your position? What are the difficulties?
LL: The animal-human relationship. Public health is essential. You can’t stress enough how important that is. And even though it’s that important, our resources are so minimal, we don’t have the answers, we don’t have the people, we don’t have the finances, and we’re struggling a lot, even though it affects everybody. We need to increase our resources to stress the importance of increasing communication. It’s essential. This new veterinary chapter in APIC [Association for Professionals in Infection Control and Epidemiology] will be huge. And we can’t say thank you enough to Leslie, [for being] a big part of getting that started. I love seeing the increase in the collaboration of the larger veterinary community. I’m starting to hear more and more about it, and it’s exciting because it is so important.
DW: I agree with what Leslie is saying. I also show dogs, so I watch things happen and know why these dogs get sick at the shows. It’s not educating in the vet clinics. It’s getting it out there, but we must start with [general IPC]. We need to educate ourselves and have the people go out and educate others. When this started, one of my bosses said, “You should start looking into this.” And I thought, oh, man, one more thing. This has become exciting for me because not only am I learning, but I answer the questions a lot easier if we had the resources to say, “Ok, here is the [short] version. But here’s some more information. Go to this site. This will help you a ton.”
LK: Leslie [Landis] is spot on with that One Health component aspect message for everyone. It’s important to educate the public that if you’re coughing and sneezing, there are ways to protect your pet. Even if you don’t know what it is, being aware that disease transmission can occur between animals and people is crucial. People should wash their hands. It’s huge: Wash your hands. Cover your cough. If you’re sick, don’t go out. If your dog is sick, don’t bring them to the dog park, shows, or your friend’s house. Be very cognizant of where you’re taking your animals. Be cognizant if you’re immunocompromised; you can pick up stuff from your animals.
Education is also important to the whole veterinary community. I, too, advocate for this position. Advocating for somebody to train in this infection prevention and control field is huge. Give them the dedicated time to learn. We are now collaborating with this networking team and APIC to get some of this material out and consistent across all fields. Get guidance out there for different animal care facilities, whether it be shelters, sanctuary zoos, wildlife rehabs, clinics, hospitals, or mobile clinics. Whatever it is, those are all we must cover. But advocating first and foremost for the space to have people in your facility learn and then empower them to do something about it in your facility. So, administration is huge in many of these facilities, and it is necessary to be able to do that correctly. And it does cost money. Unfortunately, IPC is not cheap, but there are cost-effective ways to do it. If you know those basic building blocks, it can be done in many of these facilities. Advocating education, training, and being current on what’s happening out there are also important.
ICT: Do you have any final thoughts?
LK: Thank you for getting this out there. The biggest thing we can do right now is to talk to each other and show that we exist, that this field exists. APIC has taken us under their wing at this point to help us and give us a space to collaborate and talk. Hopefully, the council we are forming with APIC will be coming out very soon, but in the meantime, we’ve been talking for over a year with this IPC networking team, and it has a global reach right now. Everybody needs IPC within their facilities or what they’re doing, and zoonotic diseases are across borders. We need to talk to each other.
