When I give presentations to veterinarians about infection control, I often talk about legal liability as one reason they need a good infection control program. I talk about the potential bad scenarios, such as someone getting an MRSA infection from an animal and then turning around and suing the vet. I usually say something like "I don’t think it’s happened yet, but you never want to be an index case". I may need to change that line now that a Texas veterinary clinic is being sued over a person’s MRSA infection.

However, the lawsuit, filed April 4, isn’t from an owner. Rather, it’s from a veterinary assistant. The woman is suing the clinic, claiming they were negligent because they didn’t warn her that she would be caring for an MRSA-infected animal. She claims that she contracted the infection on the job and that it "has physically impaired her for the rest of her life."

I know nothing about this case beyond what’s in the link above, however it raises a few important issues and questions.

What does this mean for the veterinary clinic?

• I’ve been saying for years that the bar is being raised and clinics need a good infection control program, including training and education, to reduce infections of both pets and people.
• As awareness of zoonotic diseases and veterinary infection control increases, the potential for lawsuits may similarly increase.

What level of warning is required for veterinary employees?

• This varies with the type of person.
• A veterinarian shouldn’t need to be informed that they will work with animals carrying zoonotic pathogens. If they didn’t pick that up in vet school, they’ve got some other major issues.
• A veterinary technician should have a similar understanding of the risks and measures that should be undertaken to reduce those risks.
• Lay personnel are a different story. You can’t assume a lay employee has any knowledge whatsoever about infectious diseases, zoonotic diseases or infection control.
• If there are minors in the clinic (e.g. co-op students, volunteers), you need to go even farther, and there should be written notification of parents of the risks, and measures that are taken to reduce the risks.
• In general, the less the veterinary education, the greater the need for clear and documented education about disease avoidance.
  

How do you prove this person acquired MRSA on the job?

• That’s tough. Perhaps there was a clear link with a case. Even stronger would be showing that the human and animal MRSA strains were the same, but that’s unlikely to have been done. Just because MRSA can be found in animals doesn’t mean that MRSA infections all come from animals. Humans are thought to be the source of the vast majority of MRSA infections and pets, and while pets can potentially spread it back to people, this is ultimately a human disease. People pick up MRSA all the time in the general population, although the percentage  of people who carry it at any given time is still low.
• MRSA carriage rates have been shown to be higher in veterinarians than in the general public in a few different studies. I think it’s clear that MRSA exposure is a risk of veterinary practice. However, proving that an individual infection came from a pet in a clinic is still difficult.

How can vet clinics reduce the risk of MRSA (and other) infections, as well as lawsuits?

• Have an infection control program in place.
• Make sure infection control practices and policies are written down.
• Make sure all employees are appropriately trained and document the training.
• Make sure people follow all of the required protocols.

Infection control isn’t rocket science. At its heart, it’s the application of some very basic practices. Infection control hasn’t had a high profile in companion animal veterinary medicine in the past, but things are changing (albeit slowly). Available resources can help veterinary clinics implement a decent infection control program with minimal effort. A good resource is the document Infection Prevention and Control Best Practices for Small Animal Veterinary Clinics, which is available (free) for download on the Worms & Germs Resources page.