Special Edition on Infection Prevention & Control | Page 24

The One Health
concept has been
successfully applied
to fields such as
emerging zoonotic
disease outbreak
investigation and
biosecurity risk
across humans and
animals.”
“We tend to have very siloed specialties,
and so the idea of bringing infection
control into a One Health framework can
feel novel, but our work hopes to bring
these two groups together,” Dalton
explains. “Especially relating to therapy
animal programs, we need to continue
to examine how we can continue to
conduct these beneficial programs but
in a way that is safe for patients, for
hospital staff, for handlers and for the
animals themselves.”
As Dalton and her colleagues note,
“The One Health paradigm has origins
in the recognition that diseases often
emerge from interactions of humans
and animals, termed initially as “one
medicine”, and incorporated preventative and public health.
It has since grown to include environmental science and
eco-health to encompass the shared environment role. The
combined assessment of health risks across the three domains;
humans, animals, and the environment; involves design and
implementation of intervention strategies that address all three
sectors with a goal to produce assimilated knowledge. The
One Health concept has been successfully applied to fields
such as emerging zoonotic disease outbreak investigation and
biosecurity risk across humans and animals.”
In the era of COVID-19 and its potential origins in animals,
the animal/human connection takes on new significance.
“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,”
Dalton says. “We are concerned about if this disease has an
animal reservoir and very likely from what we know about
previous SARS viruses; and now there’s a question of whether
it can be transmitted via companion animals and if they a
reservoir of the disease. Because of this question, institutions
have placed on hold or cancelled AAT programs, just as other
volunteer services have been, for the safety of patients as
well as the animal handlers. Patients are stressed out because
they are in the hospital during this pandemic, and healthcare
workers are stressed out due to longer hours and a chaotic and
constantly changing environment, and it’s a shame because
everyone benefits from these AAT programs. Because of a lack
of data, we are cautious about having them in the hospital at
this time, for everyone’s safety.”
Dalton continues, “Extra precautions are the new normal
now, and as a public health practitioner, I am always going
to err on the side of precautions and prioritizing safety for all
individuals. At this point, I don’t think we have enough concrete
data backed by science to safely have these AAT programs
in place right now. What that would take in terms of having
these programs return in the era of COVID-19 – a treatment,
a vaccine – I can’t say at this point. I do think it depends not
just on what is happening in local jurisdictions, but also what’s
happening in healthcare facilities; hospital systems must make
their own decisions. Hopefully they will use the One Health
framework and bring in stakeholders from multiple fields
including risk management, infection control, volunteer services,
patient experience and public health practitioners, taking all
viewpoints into consideration when they decide to restart these
AAT programs. I do think the public is much more aware of
the importance of taking their own safety precautions so I am
hopeful that will continue even after things have returned to
the new normal. People will be more educated and that will
transfer not only to being safe specifically against COVID-19,
but all HAIs as well.”
The microcosm of the healthcare environment is a likely
home for One Health, the researchers say. As Dalton, et
al. (2020) observe, “Hospitals serve as an incubator that
incorporates dynamic microbial inputs from the community
from both people and animals. Antimicrobial use exerts
selective pressure on these incoming microbial ecosystems,
shifting to a higher prevalence of resistant organisms. Microbial
ecosystems are defined for this paper as the composition, and
the networks, of the entire microorganism population within
a single niche or site. Individuals in the hospital (both patients
and employees) may become colonized with hospital-associated
multidrug-resistant organisms (MDRO) and then are discharged
back to the community, creating a cyclic feedback loop. Finally,
MDRO acquisition and infection is more likely diagnosed in
the hospital setting, resulting in the hospital serving as both
a surveillance point and multiplier for resistant organisms
and infections, which underscores the need to describe
community and hospital-based risk factors that influence the
hospital environment.”
As the researchers acknowledge, the application of One
Health principles to hospital infection prevention and control
has not been described previously, but they say that, “In the
clinical setting, One Health can provide practical ways to
incorporate environmental and animal contact considerations
into patient care.”
But awareness of how the One Health framework can be
applied to IP&C is not where it could be. As Dalton, et al.
(2020) note, “While the concept has been endorsed by major
medical and public health organizations, studies of physicians
reveal limited awareness to the environmental health aspects
of medical problems in the patient-care settings, as well as low
awareness levels about prevention or treatment of zoonotic
diseases from animals.”
“Had one asked about the awareness of One Health among
clinicians five years ago, it would have been a completely
different answer and it would have been negative,” Dalton says.
“There is a significant push to integrate systems-thinking and
the One Health framework into medical education, whether
that be for nurses, physicians, or public health practitioners.
There is movement toward schools of public health requiring
lectures on One Health in their master’s degree programs, as
well as integrating it into nursing education as well. We know
there are nursing students who will take classes at veterinary
schools and vice versa, so I think that having that integration
of multiple backgrounds, viewpoints and experiences, early on
in their training, will have a profound impact on the future.”
Dalton continues, “Clinicians will come to appreciate
the benefits of an integrated approach to infection control,
using the One Health framework. I think the push now is to
bring together the expertise of all stakeholders, integrate the
knowledge of all these different experts together, and bring
it to bear against HAIs and other challenges. Each expert has
24 IP&C Special Edition June 2020 • www.healthcarehygienemagazine.com