Equine Isolation

Criteria for immediate admission to the Isolation Unit

Horses presenting with diarrhea.
Horses presenting with fever & neutropenia.
Horses with a disease on the Equine Infectious Disease chart that indicates “Isolation” as the appropriate housing.
Horses with a fever >102°F (38.9°C), and any two of the following three signs; cough, nasal discharge, lymphopenia
All cases presenting with or having history of fever & acute ataxia must be housed in isolation until a negative result for EHV-1 is obtained. Patients presenting with ataxia and exposure to new horses on the farm must be housed in isolation.
Horses that present with acute urine dribbling without a complete history must be housed in isolation until a negative result for EHV-1 is obtained or the following questions are answered to rule out EHV-1 suspicion: History of fever, acute ataxia? Respiratory disease in presenting patient/other equids on the farm? Recent travel?
Foals less than 30 days of age have special instructions. If isolation is required the policies on this page apply.
If the Isolation stalls are full, a patient presented with diarrhea can be refused admission at the discretion of the EFAVC Director.
If the Isolation stalls are full and a hospitalized patient requires Isolation housing, the clinician will speak with the EFAVC Director for further housing instruction.
Restriction status, at no time, should be used to accommodate a lack of availability of an isolation stall.

Exceptions

Exceptions to the above criteria will be made on a case by case basis through consultation with the EFAVC Director and Equine Internal Medicine faculty on clinics.

Criteria for transferring hospitalized horses to the Isolation Unit

Horses developing diarrhea that persists >24 hours.
Horses that develop fever and neutropenia (<2000 cells/µl)
A positive Salmonella PCR is obtained.
A patient diagnosed with a disease on the Equine Infectious Disease chart that indicates “Isolation” as the appropriate housing.

Use of Isolation Unit and Communication

Isolation status requires mandatory clear communication from the attending clinician to the EFAVC Technical and Attendant Staff and both EFAVC Supervisors. This can be accomplished by emailing the LAZoonotic@lists.ncsu.edu email listserv.
Any case suspected of having infectious disease housed within the main hospital for any period of time must be communicated to the EFAVC Director.
Patients diagnosed with or suspected of having a zoonotic disease require further special management, including contact logs and mandatory communications.
A patient that has tested positive for Salmonella spp. should remain in isolation for a minimum of three weeks and must be retested & negative through a series of five Salmonella PCR + culture or rectal biopsy prior to being released into the main hospital for housing. This restriction does not limit patients from being discharged to private facilities, rather only specifies the requirements necessary to return the patient to the main hospital for continued hospitalization.
Approval from the EFAVC Director is required for patients housed within Isolation to graze or be exercised outside of their stall.
The client will be informed and educated about Salmonella when any patient tests positive for Salmonella regardless of the clinical status.
If an animal in isolation is to be discharged to a client’s property at the request of the client, the discharge comments must clearly state that:

1. The client has received education regarding the biosecurity risk.
2. The patient may present a zoonotic risk to humans.
3. The patient may present an infectious disease risk to other animals on the property.

Sample Collection

Diagnostic sampling is encouraged to determine the cause of our patient’s symptoms and to potentially remove hospitalized patients from isolation. These samples include fecal examination (Salmonella spp.) as well as respiratory pathogen ID, abortion panels, or other relevant laboratory tests.
Fecal samples must be collected for Salmonella PCR & culture in accordance with the EFAVC Biosecurity Surveillance Program Policy.
When there is strong suspicion of infectious contagious/zoonotic disease that necessitates Isolation housing and diagnostic testing is not performed, the patient will be treated as posing infectious/zoonotic risk and will be housed in Isolation.

Safety

Access to this area requires orientation by an EFAVC supervisor, technician, clinician, or house officer.
Students must notify a staff member before visiting an occupied stall. A staff member, house officer, or clinician, must be physically present with any student in an occupied stall.
A two way radio must be available for emergency calls when in the stall.
Staff members should notify another staff member when visiting an occupied stall. Supervision via camera is mandatory if a second staff member is unable to be physically present. Two people must be physically present if the patient is ataxic, neurologic, or in any way unstable.

Visitors (Non-CVM persons)

It is the general rule that visitation is not permitted in Isolation, however, in extenuating circumstances or end of life decision making, visitation may be allowed at the discretion of the attending clinician and is generally limited to cases where euthanasia is being discussed.
Visitor must be oriented by the attending clinician or house officer, including proper ppe use, safety precautions, health risks, risk to other animals, etc.
Visitor must be accompanied by a service member at all times, no exceptions
Visitor is not permitted to immediately re-enter the EFAVC main hospital after visiting the isolation area. Attending clinician or house officer shall instruct the visitor on how to properly decontaminate themselves to avoid transmission to animals or people. Instructions shall include proper laundering/disinfection of clothing, shoes, and person. Upon proper decontamination the visitor can return to the EFAVC and enter the main hospital.

Isolation unit setup and management

Occupied isolation unit will be identified by red barriers. The designated area shall be entirely enclosed by red barriers, leaving no gaps in the barrier. The enclosed area will include the covered area, exterior to the nursing station.
Each isolation unit shall have posted copies of the Isolation Flyer and the PPE instructional poster.
Each occupied isolation unit will contain
- A storage unit containing pertinent medical supplies
- A designated trash can, broom, manure fork, shovel, twitch, lead rope, dust pan, and patient designated care kit.
- Clean PPE should be conveniently located on the exterior of the Isolation area for clean PPE application. Refer to the posted PPE instructions for proper procedures.
All trash, bedding, waste, etc shall be loaded into a red cart and incinerated.
- Exterior of red cart should be kept clean or disinfected when contaminated. Wheels should be disinfected upon removal of the red cart from the contaminated area.
Isolation units shall be kept clean and organized at all times. Taking care to avoid shavings or debris contaminating surrounding, non-restricted areas.

Standard Isolation PPE

Disposable boots, gloves, and coveralls (and hair covers if hair hangs below the collar). Face shields and masks shall be worn when applicable.
1. Clean PPE should be applied prior to entering the Isolation area
2. Long hair hanging below the collar must be tied up off shoulders
3. Hats and other accessories must be removed and left outside of the stall
4. PPE should be applied and removed following this PPE instructional poster.

Equipment use in Isolation

All equipment used for providing care to an isolated animal must be limited to that individual animal until appropriately disinfected or sterilized.

Permanent withdrawal from Isolation

As general practice; animals admitted into isolation should not be transferred to the general hospital population or main facility. They should remain in isolation through their entire stay and be discharged from isolation.
In cases of a precautionary placement in isolation where all potentially contagious conditions have been ruled out; animals may be removed from isolation and hospitalized in the main facility; following approval from the EFAVC Director, whom will consult an additional member of the Infectious Disease Committee if needed.