Pets treated for a methicillin-resistant infection in a hospital environment must be treated as infectious and isolated from
the general hospital population. Do not allow outpatients with suspected or known methicillin-resistant infections to contact
other patients in the waiting room, but immediately usher them into an examination room. Use gloves and gowns or dedicated
laboratory coats when handling the animals or any in-contact items such as bowls or bandages. Pens and stethoscopes must also
be dedicated to the patient. Use disposable thermometer covers, or discard digital thermometers after the animal is discharged.
In people, the most critical step for reducing MRSA transmission is hand hygiene18 ; frequent hand washing was shown to reduce MRSA colonization in equine veterinarians,19 and the same likely applies to small-animal veterinarians. Perform hand hygiene, whether done by hand washing or alcohol-based
hand sanitizers, before patient contact, before aseptic procedures, after contamination of the hands, after removing gloves,
and after patient contact.20 MRSA can survive up to months on inanimate surfaces, depending on environmental conditions,21 and long-term survival of MRSP is also likely, as MRSP was isolated over a six-month period from household environmental
sites and, in some households, beyond resolution of MRSP infection in the pet.22
After discharge, just as with any patient, disinfect all examination room tables, floors, door and sink handles, light switches,
scale surfaces, cage items, and medical equipment used on animals with methicillin-resistant infections. Use appropriately
diluted disinfectants allowed to contact surfaces for the time listed on the product label (typically five to 10 minutes or
longer), after removal of any organic debris that could potentially inactivate disinfectants. Staphylococci, including methicillin-resistant
staphylococci, are susceptible to most commonly used disinfectants.20
The importance of environmental cleaning was highlighted by the finding that MRSA carriage in a kennel of rescue dogs resolved
spontaneously with regular kennel cleaning alone.23 The development of a good general infection control program in the hospital (rather than focusing solely on methicillin-resistant
staphylococci) is probably the most important factor for reducing methicillin-resistant staphylococcal transmission20 (see "Avoid the spread: Methicillin-resistant staphylococcal infection control" below in this article for helpful guidelines).
Methicillin-resistant infections in pets are an increasing problem in veterinary medicine and are driven by antibiotic pressure.
In patients with recurrent skin and ear infections, evaluation and treatment of the underlying disease is essential to reduce
the need for antibiotic treatment of secondary infections. Increased use of topical antiseptics, basing treatment decisions
on bacterial culture and antimicrobial susceptibility testing as much as possible, and clearly communicating with clients
about the need for full treatment compliance may help reduce selection pressure.20 Additionally, veterinarians must ensure, via frequent hand sanitation and effective hospital infection control programs,
that the risk of interpatient spread of infection or colonization is minimized. Also see Checklist: Environmental control of infectious disease to download a list of measures you can take to precent the spread of infectious disease in your practice.
Avoid the spread: Methicillin-resistant staphylococcal infection control
Useful recommendations for methicillin-resistant infection management can be found in the following online resources:
• Infection prevention and control best practices for small-animal veterinary clinics from the Canadian Committee on Antibiotic
• Information sheets for pet owners from the University of Guelph Centre for Public Health & Zoonoses
• Information on MRSA infections from the Centers for Disease Control and Prevention
• The British Small Animal Veterinary Association's online guidelines for MRSA management in veterinary hospital
• Responsible use of antimicrobials in veterinary practice: the 8-point plan, from the British Veterinary Association
Kimberly S. Coyner, DVM, DACVD
Dermatology Clinic for Animals of Las Vegas
5231 W. Charleston Blvd.
Las Vegas, NV 89146