Risks of Zoonoses in Veterinarians and Infection Control Practices

Zoonoses risks are evident in veterinary practices and are often neglected. Production of vaccines and diagnostic agents for effective control of zoonotic diseases is very important. The main objective of the study was to assess the level of knowledge and use of infection control practices among the veterinarians of developing country. A survey was undertaken to observe the level of knowledge, aptitude, practice and experience regarding occupational health risks among the veterinarians. A self administered questionnaire was distributed to 180 veterinarians to evaluate the relevance. The important determinants has been identified, verified and validated for risk assessment. The response rate of the questionnaires was 100% and results indicated that most veterinarians were unaware of appropriate use of personal protective equipment and need practices that may help in reduction of zoonoses transmission. The veterinary technicians have to face many problems due to lack of information, education, and training. It is necessary that the Government provide the vaccination facility to all the veterinarians against the relevant zoonotic diseases. The level of awareness about the risks associated is needed to improve through proper education, training, and establishment of written infection control policies could be effective means of improving veterinary practices.


Introduction
Zoonoses are the diseases and infections that are naturally transmitted between vertebrate, animals and man (Wong and Heidmann, 1999).Zoonotic disease risks and infection control practices in public and private research, public health, clinical and diagnostic laboratories, and in animal care facilities has expanded all over the world.Several new zoonoses have been recently identified.For all the zoonotic diseases, veterinarians played a key role and so the laboratory training is an essential tool and competency to meet the challenge of emerging zoonoses (chomel, 1982).Similarly individual workers who handle pathogenic microorganisms must understand the containment conditions under which infectious agents can be safely manipulated and secured.The vast majority of zoonotic disease in humans, as well as potential zoonotic diseases that the nontraditional companion animal is capable of transmitting are documented (Johnson, 2005).
Laboratory work involves many manipulations that are potentially dangerous such as handling glassware and work with needles and sharp instruments (Constable and Harrington, 1982).A wide range of chemicals used in veterinary laboratories which are toxic and mutagenic and some vapors are hazardous as they penetrate to the skin.Work with pathogens in laboratory animals poses special hazards (Shanker et al., 2009).Every infectious agent spreads easier when its hosts are closer together (Murphy, 2008).The commonest sources of injuries to veterinarians included animal bites, needle sticks, and exposure to hazardous substances.A variety of non parasitic zoonotic diseases may be encountered in small animal practice, including cat scratch disease (bartonellosis), cat bite abscesses, rabies, leptospirosis, methicillin-resistant staphylococcus aureus, clostridium difficile associated diarrhea, and blastomycosis.These may cause human disease ranging from mild and self limiting to fatal (Weese et al., 2002).
Zoonotic diseases can be highly variable in severity, ranging from subclinical to fatal.Despite the relatively low prevalence of serious zoonotic diseases, veterinarians must remain vigilant.Small animal veterinary practitioners must be aware of the risks of zoonotic diseases for their own safety (Jeyaretnam et al., 2000).
The veterinary surgeon possesses qualifications which can be directed to the investigation and management of human diseases and, although primarily trained to deal with diseases of lower animals, has a herd or population approach to the practice of medicine (Schwabe, 1986).In developed countries, a growing number of workers are referred to clinicians responsible for the evaluation of occupational infection risks following accidental exposure.These experts are responsible for evaluating risks of occupational infection with other emergent or rarer pathogens and their possible timely prevention (Arnaud et al., 2006).
Prevention of zoonotic diseases involves recognition and quarantine of infected animals, personal hygiene, and environmental disinfection (Foil, 1998).The management of occupational health risks in veterinary practices is an important issue and failing in active health risk management systems could be due to lack of training to ensure competence with responsibilities (Souza et al., 2008).It is important that veterinary personnel make their potential exposure to any infectious agent known to their physicians.An increase in awareness that some of these diseases may be associated with animals could provide a better plan for the prevention and treatment of common and uncommon zoonotic infections (Tan, 1997;Jennifer et al., 2008).

Material and Methods
A cross-sectional walkthrough survey of veterinary institutes was carried out to assess the health risks and level of KAPE among veterinarians.A self administered questionnaire was distributed to 140 veterinary technicians and 40 veterinary surgeons and the important determinants of responses has been identified, verified and validated for risk assessment of zoonoses.The response rate of the questionnaires was 100%.The level of knowledge, aptitude, practice and experience regarding occupational health risks among the veterinary technicians were observed according to frequency distribution.The data were coded and transferred to a spreadsheet (Microsoft Excel 2000 software; Windows 97).Free text responses were systematically recorded and coded where possible.Statistical analysis was limited to percentile and frequency descriptions.

Results
Health risk assessment of zoonoses and evaluation of infection control practices among veterinarians was a cumbersome task.However the response rate of questionnaires was 100% and all the veterinarians actively participated in this study.It was observed that majority of the veterinary technicians has to face many problems due to lack of information, education and trainings.Table 1 shows the level of awareness among veterinary technicians which was very poor only 14% knows how to play with microorganisms and 46% respondents were ignorant to their assigned duties and they were working according to the directions of veterinary surgeons.But the level of awareness among the veterinary surgeons was 60% and only 10% violating the criteria necessary.The reason of violation may be that they were newly appointed or less experienced.
Table 2 shows that junior veterinary technicians learn more from seniors rather than doctors or others sources.Only 15% get proper training and were usually guided by doctors that how to conduct laboratory work rest of the 71% works according to the instructions provided by senior staff.The old staff has the benefit of long time experience.While in the case of veterinary surgeon 52% has adequate education and 25% have adequate experience to deal with relevant work.
Table 3 shows the opportunities provided for trainings among the veterinary technicians and veterinary surgeons while, 64% staff was not satisfied about their training for laboratory working.Total 140 were interviewed for training provision but due to lack of proper training facilities most of them were not satisfied.The result of the table 4 shows that 57% veterinary technicians was diploma holders and the type of diploma was from 3 months to 1 year duration 14% having M.Sc degree but with diverse fields of specialization and 28% of the staff was graduate.The situation was totally different in veterinary surgeons that 20% Ph.D holders and 12% DVM while rest of them was post graduate with different fields of specialization.
Work line experience evaluation was also evaluated in risk assessment of the veterinarians.The experience was distributed from less than one year to 20 years work line.Highly experienced staff was in the range of 12% to 14% who had 15 to 20 years experience of the relevant field and 28% to 30% having low line experience from 1 to 5 years (Table 5).
The table 6 shows the type of hazardous waste and the number of persons handling the waste, so according to the type 57% of the veterinary technicians were involved in processed hazardous waste handling and 42% handle the non processed waste.While in the case of veterinary surgeons 50% were involved in processed and 50% in non processed waste handling.The distribution of the waste handling shows that the veterinarians were at high risk.Personal protection is the need of every hazardous work the employer is bound to provide personal protective equipments to the workers (Manual Handling, 1992).The table 7 shows that 25% workers were not using PPE and 17% were those who often use PPE but the situation was different for surgeons that 62% use PPE and only 12% avoid because of their careless nature.While 25% were those who often use and if use they don't have awareness about their proper usage.During the interviews it was revealed that the provided PPE were not according to their working like in freeze drying sections cryogloves were required but that were not provided.The knowledge and the use of appropriate techniques and equipment will enable the veterinarians to prevent personal, laboratory and environmental exposure to potentially infectious agents or biohazards.

Discussion
This study demonstrates firstly that knowledge, aptitude, practices and experience (KAPE) rely on guidance produced by professional bodies of veterinary research institutes (VRI), secondly (KAPE) lack access to competent advice; both in training of responsible staff within the practice and in accessing occupational health advice and thirdly the associated health risks to the veterinarians.Commission on veterinary economic issues formed several subgroups, including one to study the skills, knowledge, aptitudes, and attitudes (SKAs) that will be needed for success in the broad range of today's veterinarians (Brown and Silverman, 1999) These findings may explain the observed relative failings in health risk management activities due to lack of training and education.This excellent response rate probably introduces bias towards apparent legal compliance for risk management and improvements in the KAPE of all the vetrinarians to reduce the associated risks and improve the health of workers.Chomel (1998) suggested the need for training of professionals in the field of zoonotic diseases.Nessan et al. (2000) reported zoonoses a public health problem throughout the world due to lack of information on their significance and distribution.Kent et al. (2002) reported that failure to educate adequate numbers of veterinarians as PhD scientists will adversely affect public health.The health risks associated to the veterinarians due to inadequacy of knowledge, aptitude, practice and experience were followings:

Accidental Risks
The veterinarians were facing the risks of cuts and pricks caused by sharp objects, broken glass and syringes.Bites, kicks, scratches and stings caused by laboratory animals due to the improper use of PPE, and Albert et al. (2004) reported that approximately 66% of the reported accidents are due to scratches, bites, or kicks from animals.Claims of occupational disease are filed 2.7 times more often by veterinarians and their staff than by general practitioners and their staff.The occupational diseases filed most often concern the skin (39%), followed by allergic respiratory diseases (30.5%), and infectious diseases (19.1%).

Physical Hazards
The Exposure of skin and eyes to ultraviolet radiation used in different molecular laboratory techniques, exposure to excessive noise, heart stress, hand arm mechanical shocks and vibrations during forging and related operations can cause health problems (e.g., rheumatic) among veterinarians.The lack of training was the main reason of serious health issues and physical hazards.

Chemical Hazards
Dermatoses due to contact with chemicals, reagents, solvents, detergents and animal medication were common in some veterinary technicians.Allergies were due to contact with formaldehyde and other synthetic or natural allergenic substances.Health hazards caused by inhalation of formaldehyde vapors and mouth pippeting were frequent.

Ergonomic and social factors
Musculoskeletal problems particularly of back and knees were common due to extended working hours and bad work station design.Job dissatisfaction related to the working environment (dirt, smells, odor problems etc) was reported by all respondents.In Australia 46% of small animal practitioners reported chronic work-related musculoskeletal problems (Poole et al., 1998).

Conclusions
This study revealed that there was a lack of collaboration between the organizational structures and veterinarians involved in the infection control practices.Links between the two in the field of public health need strengthening.
There is a need for a discovery to-control continuum, beginning with initial recognition and identification, moving through epidemiological detailed investigation regarding the associated risks.It is necessary that the Government provide the vaccination facility to all the veterinarians against the relevant zoonotic diseases.The level of awareness about the risks associated is needed to improve through proper education, training, and establishment of written infection control policies could be effective means of improving veterinary practices.