3. Oral Transmission
BUSINESS OF PRACTICE: STRENGTHENING THE FOUNDATION OF YOUR PRACTICE Industrial Coatings for Walls
Oral transmission involves the ingestion of patho- gens from contaminated food, water, or licking sur- faces. The contamination of the environment with exudates, feces, urine, or saliva containing an infec- tious dose of a pathogen can infect susceptible hosts. Salmonella spp. and Clostridium spp. are examples of orally transmitted diseases.2 Oral transmission prevention follows similar guidelines as for fomite transmission, but in addi- tion, special attention is paid to the quality of ma- terials and finishes within the environment, cleaning systems, and manure disposal.
Nonporous Materials and Systems
It is more difficult to design and construct non- porous materials and surfaces than it might seem to be. Numerous disease outbreaks have been corre- lated with environments that are either improperly cleaned or are impossible to clean. For example, Salmonella spp. can persist on surfaces for long periods and is a notorious cause of nosocomial infec- tions in equine hospitals.8 The following materials are acceptable depending on the circumstance:
● Seamless flooring. —For low-cost installations in lower-risk spaces such as healthy horse treatment rooms in smaller hospitals, rubber mats may be in- stalled if they are manufactured from virgin rubber (as opposed to recycled rubber which is porous), are thoroughly adhered to each other with a high-performance, flexible joint sealant, and are sealed to the slab below. Loose rub- ber mats are unacceptable because they can trap moisture and encourage biofilms to form. —For highest-quality flooring installations, utilize poured equine floors. These are man- ufactured from recycled rubber (which is po- rous) and then sealed with polyurethane binders. Because the installation of a poured floor depends on many factors from the condi- tion and preparation of the underlying slab to the skill of the installation crew, specific man- ufacturers are not listed here. Nevertheless, it is important to specify products from the most reputable companies for the equine mar- ket. The benefits of properly installed poured floors include the following:
● A longer-lasting solution. ● A complete seal from wall to wall, and around drains.
● The ability to provide a seamless joint between the floor and wall. —The most sanitary design for the joint be- tween the floor and wall is a cove (rounded) profile, with the flooring continuing onto the wall surface several inches.9
190 2020 Vol. 66 AAEP PROCEEDINGS
Most equine facility medical areas are constructed of concrete block and sealed with various coatings, most of which are ineffective and require frequent recoating. Anecdotal evidence suggests that the best long-term option is a cementitious block filler that fills the concrete pores, followed by two coats of an industrial marine coating developed to coat metal ships at sea. A system like this can remain intact on the walls over the lifetime of an equine hospital facility and decrease the chance for infectious dis- ease to remain in the environment, because the pores in the wall are sealed, leaving an easy-to- clean-and-disinfect surface.
Match the Materials with the Cleaning Protocol
One of the problems that facilities have is that in- stalled materials degrade over time in the presence of water and disinfectants. Degraded materials are more likely to become porous and allow biofilms to form.9 Be aware of the effect of the cleaning and disinfection protocols on materials and select mate- rials that can withstand them. Below are some principles to consider:
● Cleaners and disinfectants should always be diluted properly. Using more disinfectant than necessary is not only expensive, it is in- effective. Many surfaces repopulate them- selves with pre-cleaning microbial colonies within a few hours of cleaning, regardless of the vigor of the cleaning efforts.9
● Bleach degrades all finishes but especially steel. Exposed steel should ideally be galva- nized and painted with a high-performance coating such as a urethane. Fiberglass man doors hold up better than their steel counterparts.
● Accelerated hydrogen peroxide has less effect on materials, but if not properly diluted, it degrades some lower-quality metals, as well as concrete and epoxy coatings. If the hospital plans to use poured epoxy floors for the clean- able areas where horses are anesthetized and are therefore not standing on the floors (an example is surgery), then specify a urethane- based, poured-floor coating instead, which withstands peroxide-based cleaning agents.
● Utilize moisture-resistant cabinetry in wet/dry zones such as medical barn nursing stations or in treatment rooms. Suitable products in- clude stainless steel or powder-coated metal casework and plastic medical casework made by companies such as Midmark.
Manure Management
Control of oral transmission requires design for careful manure handling. The hospital should have a designated, restricted area for containment of contaminated manure. The path to this contam- inated manure storage should be disconnected from
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