The main purpose of this study was to investigate the cleanliness and microbial burden of a veterinary hospital to establish the extent of cross-contamination with faecal bacteria as an aid to reducing nosocomial infections. Enterococci and Escherichia coli were used as faecal indicator organisms as they can survive on inanimate surfaces for months and pose a threat to animal health. The study consisted of several elements: (i) a cross-sectional study to identify sites currently contaminated with faecal organisms that could be usefully included in a longitudinal study, (ii) a 3-week longitudinal study to identify sites from which faecal bacteria were repeatedly recovered, (iii) once-off monitoring of hand hygiene, (iv) a review of all hospitalised cases with confirmed E. coli or enterococcal infection during the 8-week study period to investigate possible hospital-acquired (HAI) infection and relationship with environmental contamination. Environmental surface and hand hygiene were assessed using 3M™ Clean-Trace™ ATP test, 3M™ Petrifilm™ plates and bacteriological culture of Enterococcus species and E. coli. Cross contamination was assessed using results of antimicrobial susceptibility testing. In the cross-sectional study, 26 of 113 (24.5%) of sites sampled exceeded the accepted microbial threshold (2.5 CFU/cm2) and Enterococcus species were isolated from 31 (27.4%) and E. coli from 9 (7.9%) of 113 samples. Organic residue and microbial levels were high in the dog kennels even after cleaning and faecal organisms were also recovered from sites such as the dispensary, a student computer and staff common room. Four of 51 (7.8%) hand samples were contaminated with faecal bacteria. Nine sites were monitored on three occasions in the longitudinal study and a total of 23 Escherichia coli and 6 Enterococcus species were recovered. Seven of the nine sites were positive for faecal organisms on more than one occasion. There was no change in cleanliness or microbial burden over 3 weeks. Twenty-one of the 73 isolates (28.8%) recovered during all parts of the study were multi-drug resistant. Enterococci and E. coli isolates with similar resistance patterns were recovered from the environment in the large and small animal hospitals and from a small number of patients during the same timeframe, suggesting possible hospital acquired infections. Results suggested that movement between the small and large animal hospital areas may have been responsible for cross-contamination and possible hospital-acquired infections. The data show that cross-sectional and longitudinal monitoring of faecal contamination across all hospital areas can play an important role in informing review of infection control protocols in veterinary hospital settings. Changes in practices in the hospital based on results generated are outlined.

中文翻译：

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改善兽医医院的感染控制：对粪便污染模式的详细研究以告知实践变化

本研究的主要目的是调查兽医医院的清洁度和微生物负荷，以确定粪便细菌交叉污染的程度，以帮助减少院内感染。肠球菌和大肠杆菌被用作粪便指示生物，因为它们可以在无生命表面存活数月并对动物健康构成威胁。该研究包括几个要素：(i) 一项横断面研究，以确定目前被粪便生物污染的地点，这些地点可以有效地包括在纵向研究中，(ii) 一项为期 3 周的纵向研究，以确定粪便细菌污染的地点多次康复，(iii) 一次性监测手部卫生，(iv) 对所有确诊大肠杆菌的住院病例进行审查。8 周研究期间的大肠杆菌或肠球菌感染，以调查可能的医院获得性 (HAI) 感染及其与环境污染的关系。使用 3M™ Clean-Trace™ ATP 测试、3M™ Petrifilm™ 平板以及肠球菌和大肠杆菌的细菌培养评估环境表面和手部卫生。使用抗菌药敏试验的结果评估交叉污染。在横断面研究中，113 个采样点中有 26 个 (24.5%) 超过了公认的微生物阈值 (2.5 CFU/cm2)，肠球菌从 31 个 (27.4%) 中分离出来，大肠杆菌从 9 个 (7.9%) 中分离出来113个样本。即使在清洁后，狗窝中的有机残留物和微生物水平也很高，而且还从药房、学生电脑和教职工休息室等场所回收了粪便生物。51 个手部样本中有 4 个（7.8%）被粪便细菌污染。在纵向研究中，对九个地点进行了三次监测，共回收了 23 种大肠杆菌和 6 种肠球菌。九个地点中有七个不止一次对粪便生物呈阳性。3 周内清洁度或微生物负荷没有变化。在研究的所有部分中回收的 73 株分离株中有 21 株 (28.8%) 具有多重耐药性。在同一时间范围内，从大型和小型动物医院的环境以及少数患者身上回收了具有相似耐药模式的肠球菌和大肠杆菌分离株，这表明可能存在医院获得性感染。结果表明，小型和大型动物医院区域之间的移动可能是造成交叉污染和可能的医院获得性感染的原因。数据显示，对所有医院区域的粪便污染进行横断面和纵向监测可以在兽医医院环境中为审查感染控制方案提供信息方面发挥重要作用。概述了医院根据生成的结果进行的实践变化。