Equine Restriction

Equine Restriction

Purpose of Equine Restriction

Restriction is used proactively to protect other hospitalized animals and personnel from exposure to infectious diseases by temporarily restricting movement of a patient until its infection status has been clarified. The objective is to limit contact with the pathogen, by limiting the number of individuals in contact with the patient, limiting patient movement in the clinic, and carefully restricting the use of equipment and supplies to an individual stall.

Criteria for animals that must be placed under Restriction

    • Any patient identified, by the VH Microbiology lab, as having an Antimicrobial Resistant Infection
    • A horse, not in isolation, that develops or presents with unexplained fever, without diarrhea or neutropenia.
      • Any patient presenting on intake with fever of unknown origin should be worked up as a restriction case with proper PPE and precautions.
    • A horse diagnosed with, or suspect of having, a disease on the Equine Suspect Infectious Diseases chart that indicates Restriction as the appropriate housing.
    • Foals have special instructions.  If restriction is required the policies on this page apply.
    • Exception to Restriction housing: A horse, with fever and/or neutropenia that does not have diarrhea and has an explainable non-contagious disease (eg. pneumonia, sinusitis, septic arthritis, metritis, etc.).

Exceptions

    • A horse,with fever and/or neutropenia that does not have diarrhea and has an explainable non-contagious disease (eg. pneumonia, sinusitis, septic arthritis, metritis, etc.).

A complete blood count must be performed within 24 hours on any horse that:

    • Demonstrates an unexplained fever
    • Develops diarrhea without fever

Use of Restriction and Communication

    • Restriction 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.
    • The EFAVC Supervisors are responsible for informing all personnel, who may have contact with an animal, about the nature of the infectious disease(s) to be encountered.
    • When the presence of a pathogen has been identified or is strongly suspected by a clinician, stall restriction is not a substitute for movement of the animal to isolation.
    • Stall restriction may be appropriate for animals that have recently had abdominal surgery or other procedures that may contribute to induced transient episodes of diarrhea.
    • Patients diagnosed with or suspect of having a zoonotic disease require further special management, including contact logs and mandatory communications.
    • Animals are not permitted to leave the Restriction Zone/area except for:
      • an essential surgical procedure that must be performed in the VH
      • a procedure to be performed that is essential to the diagnostic evaluation or management of the patient (and cannot be performed in restriction)
      • Removal of any restricted patient must be coordinated with an EFAVC supervisor to ensure proper and immediate disinfection of all effected surfaces

ICU aisle (A aisle)

    • Any patient housed in the ICU aisle (A aisle) that meets the criteria for Restriction must remain in its current stall and Restriction procedures must be implemented immediately.

Restriction Zone

    • The Restriction Zone is at the north end of C aisle and consists of stalls C5, C6, C14, C15, and C16.
    • Healthy patients can be housed in the Restriction Zone when it is not needed for a Restriction patient. However, these should be the last stalls filled to avoid the possibility of relocating several horses when the restriction zone is needed.
    • Any healthy animal housed in the Restriction Zone must be relocated before the area is declared a Restriction Zone for housing a patient that meets restriction zone criteria.
    • When all A aisle stalls are full or unavailable, additional ICU admissions will be housed in the Restriction Zone.
    • Patients on B aisle or the top of C aisle that need to be placed on Restriction will remain in their stall and upgraded to restriction status.
    • Access to the north section of C aisle and through the roll up door shall be limited to those caring for the patient when a patient on Restriction is in the Restriction Zone.

Visitors (Non-CVM persons)

    • See EFAVC Visitation Policy for specifics.

Stall setup and management

    • Restricted stalls will be identified by red barriers.  The designated area shall be entirely enclosed by red retractable barriers, leaving no gaps in the barrier.
    • Each restricted stall shall have a posted copy of the Restriction policy.
    • Each restricted stall will contain (within the barrier):
      • A cart containing pertinent medical supplies
      • A designated trash can, broom, manure fork muck bucket, and patient designated care kit.
      • Clean PPE should be conveniently located on the exterior of the restricted area for clean PPE application.
    • 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.
    • Restriction areas shall be kept clean and organized at all times.  Taking care to avoid shavings or debris contaminating surrounding, non-restricted areas.
    • Treatment sheets should be hung on the red barriers or conveniently located on the outside of the restriction area to prevent contamination.

Standard Restriction PPE

    • Disposable boots, gloves, gown, and face shield as indicated by the Equine infectious Disease Chart.
    • Clean PPE should be applied immediately prior to entering the Restricted area
    • PPE is disposable and should be discarded as exiting the restriction area, avoiding contamination of the non-restricted area.

Equipment use

    • All equipment used for providing care to restricted animals must be limited to an individual animal until appropriately disinfected or sterilized.

Sample Collection

    • Fecal samples must be collected for Salmonella PCR & culture in accordance with the EFAVC Biosecurity Surveillance Program Policy.
    • Any horse that develops diarrhea or fever, should have a CBC run and the service should consult with the Equine Medicine faculty on clinics.
    • If any infectious disease testing is positive (Salmonella PCR positive, culture negative as exception)– move the patient immediately to isolation.

Permanent withdrawal from Restriction

    • Animals may permanently leave restriction:
      • If they have tested negative for all pertinent diseases and/or have resolved all relevant signs (e.g., fever, neutropenia, or diarrhea).
      • If Salmonella spp was suspected there must be five consecutive negative cultures for Salmonella. Please refer to the EFAVC Biosecurity Surveillance Program Policy for specific details.