Special Edition on Infection Prevention & Control | Page 22

Taking a ‘One
Health’ Approach
to IP&C
By Kelly M. Pyrek
The concept of “One Health” is a collaborative, multisectoral
and trans-disciplinary approach—working at the local,
regional, national, and global levels—with the goal of achieving
optimal health outcomes recognizing the interconnection
between people, animals, plants, and their shared environment.
As the U.S Department of Agriculture
explains, “A One Health approach
embraces the idea that complex problems
that affect the health of humans, animals,
and the environment are best solved
through improved communication,
cooperation, and collaboration across
disciplines and sectors. Complex problems
require a ‘whole system’ approach
to identify the elements, see relationships
and patterns, identify potential root causes
and determine the course of action.”
Integrating a One Health approach
into infection prevention and control
(IP&C) has been undertaken by Kathryn
Dalton, VMD, MPH, of the Department
of Environmental Health and Engineering
at the Johns Hopkins Bloomberg School
of Public Health, and colleagues,
who conducted a study to explain
the epidemiology, demonstrate key
knowledge gaps in infection prevention
policy, and explore improvements to
control Gram-positive pathogens in the
healthcare environment.
As Dalton, et al. (2020) explain, “One
Health approaches are based on the
belief that we cannot truly understand
human, animal, and environmental
health by addressing each in isolation.
To address complex public health
challenges, we must understand the
interconnectedness of these domains
with a holistic methodology. Similar to
other systems-thinking models, One
Health focuses equally or more on the
While there
has been a
preponderance
of negative
consequences
from the zoonotic
origin of
SARS-CoV-2,
the silver
lining is the
recognition of
this connection
and the push for
more research
that utilizes this
One Health
framework.”
— Kathryn Dalton,
VMD, MPH
relationships between the factors in the system, rather than
on the individual-level factors themselves.”
Prevention and control of healthcare-associated infections
(HAIs) is a complex dynamic that Dalton says can be reframed
within the One Health model, especially as it relates to the
interaction of patients and healthcare personnel with the
hospital environment that can lead to transmission of the
most common Gram-positive hospital pathogens – methicillin-resistant
Staphylococcus aureus, Clostridioides (Clostridium)
difficile, and vancomycin-resistant Enterococcus (VRE). She
also says that animals play a key role, especially with the
popularity of animal-assisted therapy (AAT) programs in
healthcare institutions.
A key component of the One Health model that has received
less attention in the context of hospital-associated pathogen
control is the roles of animals. As Dalton, et al. (2020) state,
“Animals are potential sources of pathogens, including
ones commonly considered nosocomial, which can spread
to humans. It has been documented in multiple studies that
MRSA strains found in companion animals such as dogs and
cats are identical to epidemic strains found in human hospitals.
There are many ways that animals, and their corresponding
and unique microbial ecosystems, can positively and negatively
enhance transmission of infectious pathogens. Exposure to
animals, from pets in the home to farm animal exposure,
can increase an individual’s overall microbial diversity, which
can then be protective against colonization of opportunistic
pathogens. This balance of being both a supply and deterrent
of human pathogen colonization is the reason why animals are
so essential to examine in any context, including the hospital
environment. Our understanding regarding direction of transmission,
colonization persistence, animal-human transmission
rate, animal carriage and inter-species transmission risk factors,
and the significance of companion animals as reservoirs for
human pathogens are all incomplete.”
22 IP&C Special Edition June 2020 • www.healthcarehygienemagazine.com