Nosocomial infections.

Nosocomial infections and antimicrobial resistance are topics that have been intensely studied in human medicine because of their significant impact on human health. In recent years, concerns have been raised that the use of antibiotics in veterinary medicine, animal husbandry, and agriculture may be contributing to the development of resistance in common bacterial species affecting human beings. Although there is inadequate proof at this time that the resistance is transmitted from animals to people, if antibiotics continue to be used indiscriminately in veterinary medicine, veterinarians may find themselves facing regulations restricting the use of some antibiotics. Nosocomial infections have been reported in veterinary medicine and are likely to increase in prevalence with the increase in intensive care practices in many hospitals. Prolonged hospitalization and the use of invasive devices and procedures increase the risk of nosocomial disease. As in human medicine, organisms isolated in the nosocomial infections reported in veterinary patients have an increasingly broad spectrum of antimicrobial resistance. Despite these findings, the use of empiric and prophylactic antibiotic therapy is still widespread in veterinary medicine. Nosocomial infections and antimicrobial resistance may have a serious impact on the future of [table: see text] veterinary medicine, because the cost and ability to treat our patients may be affected by the loss of access to or effectiveness of antimicrobial drugs. Despite the millions of dollars spent on research to reduce the incidence of nosocomial infections in human patients, the strategies that have consistently proven successful are simple and inexpensive to implement. The most important factor in preventing nosocomial infections is improving the hygiene practices of health care providers. Hand-washing or the use of disposable gloves can dramatically reduce the transmission of bacteria between patients. Aseptic technique should be used in the placement and management of all invasive devices. All staff members should be educated on the risks and symptoms associated with nosocomial infections so that cases can be detected early and treated appropriately. We in the veterinary profession have the opportunity to learn from the experiences of the human medical profession and can take steps to prevent the escalation of nosocomial infections and their impact on our profession.     

Methicillin-resistant Staphylococcus aureus (MRSA) in veterinary medicine: a "new emerging pathogen"?

The problem of nosocomial infections is of increasing importance in veterinary medicine. As an example, this review summarizes current knowledge regarding methicillin-resistant Staphylococcus aureus (MRSA) as a typical example, as these pathogens are the most important agents of nosocomial infections in human medicine worldwide and are being increasingly reported in veterinary medicine. MRSA are classified by their ability to be resistant against oxacillin/methicillin, this feature being confered by mecA, a gene which was acquired by horizontal gene transfer of the staphylococcal gene cassette (SCCmec). It is this genetic information that enables MRSA to be resistant against all penicillins, cehalosporins and carbapenems. In addition, MRSA are often resistant against a variety of other antiinfectives, i.e. aminoglycosides, macrolides, lincosamide, streptomycins, tetracyclin, chloramphenicol, but also against fluorquinolones and rifampicin. Presumably, these highly adapted strains are particularly able to acquire resistance genes located on plasmids or transposons.They are also able to develop point mutations, further leading to resistant phenotypes. If these pathogens are leading to infectious diseases, veterinarians may be confronted with a worst-case scenario, being left without any antiinfective therapeutic. As Staphylococcus aureus is highly tenacid, professional hygiene management is of utmost importance. The increasing number of published sporadic MRSA infections, MRSA-infectious diseases as well as MRSA outbreaks in veterinary medicine justifies their recognition as a "New Emerging Pathogen". So far, horses and dogs are mostly affected by MRSA. Although transmission between humans and animals has been reported occasionally, the sources, routes of transmission or the epidemiological relevance of MRSA infections in animals are far from being understood. Therefore, epidemiological investigations utilizing molecular typing tools are mandatory. Typing tools like multilocus-sequence-typing (MLST), pulsefield-gelelectrophoresis (PFGE), sequence analysis of the gene encoding protein A (spa-typing) as well as SCCmec-typing are all at hand.     

Measuring and comparing constraints to improved biosecurity amongst GB farmers, veterinarians and the auxiliary industries

Constraints to the introduction of enhanced biosecurity systems are rarely considered in sufficient detail when population medicine specialists initiate new control schemes. The main objective of our research was to investigate and compare the different attitudes constraining improvement in biosecurity for cattle and sheep farmers, practising veterinary surgeons and the auxiliary industries in Great Britain (GB). This study was carried out utilizing farmer focus groups, a questionnaire survey of veterinary practitioners and a telephone survey of auxiliary industry representatives. It appears that farmers and veterinarians have their own relatively clear definitions for biosecurity in relation to some major diseases threatening GB agriculture. Overall, farmers believe that other stakeholders, such as the government, should make a greater contribution towards biosecurity within GB. Conversely, veterinary practitioners saw their clients’ ability or willingness to invest in biosecurity measures as a major constraint. Veterinary practitioners also felt that there was need for additional proof of efficacy and/or the potential economic benefits of proposed farm biosecurity practices better demonstrated. Auxiliary industries, in general, were not certain of their role in biosecurity although study participants highlighted zoonoses as part of the issue and offered that most of the constraints operated at farm level.     

Evaluation of Specific Infection Control Practices Used by Companion Animal Veterinarians in Community Veterinary Practices in Southern Ontario

This study evaluated specific infection control practices in community veterinary practices in southern Ontario. Environmental disinfection, management of infectious patients and antimicrobial use in clean surgical procedures were investigated. Community companion animal veterinary practices (n = 101) in Southern Ontario were recruited, and a questionnaire was administered to one veterinarian and one veterinary technician from each practice. The veterinarian questionnaire gathered data on clinic demographics, management of infectious patients, infectious diseases of concern, environmental disinfection and antimicrobial use in surgical procedures. The veterinary technician questionnaire gathered data on environmental disinfection. None of the veterinary practices had a formal infection control programme. Sixty‐five per cent (n = 66) of the veterinary practices did not have an isolation area and 61% (n = 40) of these practices did not employ any specific infection control measures for infectious cases. The products most frequently used for environmental disinfection were hydrogen peroxide based or quaternary ammonium compounds. Bleach was the agent most commonly used for environmental disinfection of infectious body fluids; however 60% of the veterinarians and 40% of the veterinary technicians did not identify a product for environmental disinfection of infectious body fluids. Twenty‐four per cent of the veterinarians reported using antimicrobials in animals undergoing elective sterilization surgeries and 60% reported using antimicrobials in other clean surgical procedures. There is a need for community veterinary practices to develop infection control programmes specific to their individual practice. In addition, veterinarians should discontinue the common use of antimicrobials for clean elective sterilization surgical procedures.     

Aggressive clients in Dutch veterinary practice

Aggressive clients seem to be becoming more common. This article describes a study in which questionnaires on client behaviour were sent to veterinary assistants and veterinarians in randomly selected practices in the Netherlands. Results showed that 26.4% of the veterinarians and 29.3% of the assistants had experienced aggressive clients in the last year. Age, experience, and sex of the veterinarian or assistant did not influence the frequency with which aggressive clients were encountered. The same was true for the type of veterinary practice (companion animals, farm animals, horses, etc). The risk of encountering aggressive clients was higher among practices in large towns and in practices with a small turnover Of the veterinarians who had encountered aggressive clients at least once in their career, 31% has taken some kind of action after the aggressive encounter Nearly a quarter (24.9%) of veterinary practices have adopted a Risk Inventarization and Evaluation (RI&E) approach to preventing client aggression and 26.6% of practices have adopted another approach. While veterinarians tend not to consider aggression a big problem, they are often open to the suggestion that more attention should be paid to aggression in veterinary practice.     

Knowledge and attitudes of Australian livestock producers concerning biosecurity practices

Biosecurity risks are a major threat to the profitability of the industry as well as impacting human and animal health. Livestock producers play a crucial role in biosecurity as the first to notice changes in the health or productivity of their stock and are generally responsible for implementing protective measures. However, uptake of biosecurity measures by producers is variable. We critically appraised the current literature regarding biosecurity practices in Australian livestock industries and highlight aspects that are well understood as well as those where further research or information is needed. Findings from 12 cross-sectional studies suggest that Australian producers' knowledge of biosecurity methods and importance might have a positive influence on their willingness to implement or incorporate biosecurity practices. There is moderate evidence supportive of biosecurity being well understood by livestock producers across Australia. Barriers to producers using biosecurity practices included lack of information or communication from agricultural, veterinary or government organisations. It was found that larger stock numbers were positively correlated with biosecurity implementation and that producers used veterinarians, government and industry agencies as resources for trusted information.     

Characteristics of biosecurity and infection control programs at veterinary teaching hospitals

OBJECTIVE: To characterize biosecurity and infection control practices at veterinary teaching hospitals located at institutions accredited by the AVMA. DESIGN: Cross-sectional survey. POPULATION: 50 biosecurity experts at 38 veterinary teaching hospitals. PROCEDURES: Telephone interviews were conducted between July 2006 and July 2007, and questions were asked regarding policies for hygiene, surveillance, patient contact, education, and awareness. Respondents were also asked their opinion regarding the rigor of their programs. RESULTS: 31 of 38 (82%) hospitals reported outbreaks of nosocomial infection during the 5 years prior to the interview, 17 (45%) reported > 1 outbreak, 22 (58%) had restricted patient admissions to aid mitigation, and 12 (32%) had completely closed sections of the facility to control disease spread. Nineteen (50%) hospitals reported that zoonotic infections had occurred during the 2 years prior to the interview. Only 16 (42%) hospitals required personnel to complete a biosecurity training program, but 20 of the 50 (40%) respondents indicated that they believed their hospitals ranked among the top 10% in regard to rigor of infection control efforts. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that differences existed among infection control programs at these institutions. Perceptions of experts regarding program rigor appeared to be skewed, possibly because of a lack of published data characterizing programs at other institutions. Results may provide a stimulus for hospital administrators to better optimize biosecurity and infection control programs at their hospitals and thereby optimize patient care.     

Detection and Management of an Outbreak of Equine Herpesvirus Type 1 Infection and Associated Neurological Disease in a Veterinary Teaching Hospital

Background: Because of the serious disease sequelae associated with equine herpesvirus type 1 (EHV‐1) infections, awareness and control measures used to control outbreaks are important issues for all horse populations. Objectives: Describe the occurrence and management of an outbreak of EHV‐1 infection at a veterinary hospital. Animals: Horses hospitalized at a referral veterinary hospital. Methods: A horse with myeloencephalopathy associated with EHV‐1 infection (EHM) was admitted for diagnostic evaluation and treatment under strict infection control procedures. We describe the occurrence and management of a nosocomial outbreak of EHV‐1 infections associated with admission of this patient. Results: Despite institution of rigorous biosecurity precautions at the time of admission of the index case, EHV‐1 infections spread to 6 other horses that were hospitalized at the James L. Voss Veterinary Teaching Hopsital, including 2 that served as sources of infection for horses on their home premises after discharge. Infection with EHV‐1 was confirmed by polymerase chain reaction (PCR) and by seroconversion documented by glycoprotein G ELISA. A voluntary quarantine was imposed and admissions were restricted to prevent additional horses from being exposed. Quarantine duration was abbreviated by serial testing of all horses with PCR. Conclusions and Clinical Importance: These findings illustrate the contagious disease risk that can accompany management of horses with EHM. Horses with active nasal EHV‐1 shedding should be isolated in an airspace that is separate from other horses by strictly enforced biosecurity and isolation procedures. Serial testing with PCR may be a useful adjunct to determine when the risk of transmission has been minimized.     

Evidence‐Based Infection Control In Clinical Practice: If You Buy Clothes for the Emperor,Will He Wear Them?

In the fabled story of the Emperor's New Clothes, nakedness is ignored, denied, and accepted despite its obviousness. Similarly, we seemingly have ignored, denied, and accepted the risks of healthcare‐associated infections (HCAI) in veterinary settings, despite common occurrence and obvious importance. Risks for HCAI in veterinary medicine cannot be denied and are increasingly apparent because of improved surveillance and reporting. We have an ethical responsibility to take all reasonable precautions to minimize foreseeable infectious disease hazards, and provide an environment in which personnel and patients are protected from infectious disease hazards so that care can be optimized. Yet, there is often a pronounced mismatch between what we know about risks for infectious disease and our actions. Veterinarians often fail to act on well‐known, universally accepted risks for infectious disease in patients and in people contacting these animals. We must educate personnel so they are well‐versed regarding agents commonly causing HCAI (including zoonotic infections), can identify patients with higher risks for shedding agents and for developing HCAI, have awareness of which procedures and management practices are associated with higher rates of HCAI, and have skill in applying effective prevention methods. We need to develop standardized benchmarks for risks of HCAI in veterinary settings, better understand efficacy and cost‐effectiveness for prevention practices, and develop good educational materials that will promote an effective understanding of risks and prevention methods for HCAI among personnel and the public. We need to buy new clothes for the emperor and be sure he actually wears them!     

Discussion of the Compendium of Veterinary Standard Precautions: preventing zoonotic disease transmission in veterinary personnel

Veterinary practices are unique environments that bring humans into close contact with many different species of animals; therefore, the risk of exposure to infectious pathogens is inherently different in veterinary medicine than in human medicine. In contrast to the risk of exposure to blood in human medicine, infections from zoonotic diseases in veterinary personnel are primarily related to exposure to animal faeces, infected skin, wounds, droplets and puncture wounds. Infection-control measures in veterinary practices are often insufficient to prevent zoonotic disease transmission. The Veterinary Standard Precautions (VSP) Compendium is designed to help prevent transmission of zoonotic pathogens from animal patients to veterinary personnel in private practice.     

Antimicrobial drug use in veterinary medicine

Recognizing the importance of antimicrobial resistance and the need for veterinarians to aid in efforts for maintaining the usefulness of antimicrobial drugs in animals and humans, the Board of Regents of the American College of Veterinary Internal Medicine charged a special committee with responsibility for drafting this position statement regarding antimicrobial drug use in veterinary medicine. The Committee believes that veterinarians are obligated to balance the well-being of animals under their care with the protection of other animals and public health. Therefore, if an animal's medical condition can be reasonably expected to improve as a result of treatment with antimicrobial drugs, and the animal is under a veterinarian's care with an appropriate veterinarian-client-patient relationship, veterinarians have an obligation to offer antimicrobial treatment as a therapeutic option. Veterinarians also have an obligation to actively promote disease prevention efforts, to treat as conservatively as possible, and to explain the potential consequences associated with antimicrobial treatment to animal owners and managers, including the possibility of promoting selection of resistant bacteria. However, the consequences of losing usefulness of an antimicrobial drug that is used as a last resort in humans or animals with resistant bacterial infections might be unacceptable from a public or population health perspective. Veterinarians could therefore face the difficult choice of treating animals with a drug that is less likely to be successful, possibly resulting in prolonged or exacerbated morbidity, to protect the good of society. The Committee recommends that voluntary actions be taken by the veterinary profession to promote conservative use of antimicrobial drugs to minimize the potential adverse effects on animal or human health. The veterinary profession must work to educate all veterinarians about issues related to conservative antimicrobial drug use and antimicrobial resistance so that each individual is better able to balance ethical obligations regarding the perceived benefit to their patients versus the perceived risk to public health. Specific means by which the veterinary profession can promote stewardship of this valuable resource are presented and discussed in this document.     

AVMA guide for veterinary medical waste management

Lawmakers have enacted a variety of laws and regulations to ensure proper disposal of certain potentially infectious or otherwise objectionable waste. The veterinary medical profession supports scientifically based regulations that benefit public health. In 1988, Congress passed the Medical Waste Tracking Act, a federal program that mandates tracking certain regulated waste. Several types of waste generated in the typical clinical veterinary medical practice are considered regulated veterinary medical waste. Discarded needles, syringes, and other sharps; vaccines and vials that contained certain live or attenuated vaccines; cultures and stocks of infectious agents and culture plates; research animals that were exposed to agents that are infectious to human beings and their associated waste; and other animal waste that is known to be potentially harmful to human beings should be handled as regulated veterinary medical waste. Regulated veterinary medical waste should be handled with care. It should be decontaminated prior to disposal. The most popular, effective methods of decontamination are steam sterilization (autoclaving) and incineration. Chemical decontamination is appropriate for certain liquid waste. Waste should be packaged so that it does not spill. Sharps require rigid puncture- and leak-resistant containers that can be permanently sealed. Regulated veterinary medical waste that has not been decontaminated should be labeled with the universal biohazard symbol. Generators retain liability for waste throughout the entire disposal process. Therefore, it is essential to ensure that waste transporters and disposal facilities comply with state and federal requirements. Veterinary practices should maintain a written waste management program and accurate records of regulated veterinary medical waste disposal. Contingency planning and staff training are other important elements of a veterinary medical waste management program. The guide includes a model veterinary medical waste management program; however, it does not address all the variations in state and local regulations. Veterinarians should obtain copies of state and local laws and regulations and modify AVMA's model plan to create an individualized practice plan that complies with federal, state, and local laws and regulations. State and local veterinary medical organizations should monitor state and local regulation to influence decisions that affect veterinarians and to keep their members informed of changing requirements. Veterinarians and veterinary medical organizations must stay involved so that regulations do not unfairly burden the veterinary medical profession.     

Poultry husbandry and animal health

Close interactions are existing between poultry husbandry and poultry health. The more housing systems and the environment of the animals can be controlled, the less the general risk of disorders in poultry flocks--especially of diseases which are caused by the introduction of microoganisms. Resulting deterimental effects will affect not only the animals themselves, but also pose a risk indirectly for humans via food originating from animals under production. Also, by keeping the risk of infections as low as possible, the use of therapeutics can be avoided. This will reduce the risk of residues in food of animal origin. In summary, with all probability open poultry husbandry systems, especially those including free range systems pose increased risks for poultry health and consequently for the quality of food originating from poultry production. At least, those systems require highest standards of biosecurity, defined as management, location, farm layout, cleaning and desinfection incl. pest control programs, immunization and specific veterinary monitoring concepts to prevent infections.     

Relationship of biosecuriy practices with the use of antibiotics for the treatment of infectious disease on U.S. equine operations

This study is the first report estimating, on a national basis, the use of various biosecurity practices, singly and in combination, on U.S. equine operations. Use of biosecurity practices is described for operations by risk level, based on reported exposure of resident horses to outside horses during the previous 12 months. In addition, the association between use of various biosecurity practices and use of antibiotics to treat infectious disease in both adult equids and foals is reported. The comparison of these study findings with previously reported data in the literature is limited by the fact that few estimates of biosecurity practice use on equine operations have been reported and none has been published on a national basis beyond those in the National Animal Health Monitoring System (NAHMS) equine reports. A total of 78.5% of operations had some risk of exposure of resident horses to outside horses between summer 2004 and the time of the interview in summer 2005. For the majority of biosecurity practices, there was a significant (p<0.05) difference between different exposure risk levels in the percentage of operations using the practice. A higher percentage of high- and medium-risk operations implemented a combination of 4 or more biosecurity practices compared to low-risk operations. There was less use of antibiotics to treat infectious disease in adult horses on operations that required those who visit the operation to use separate equipment, change clothes/overalls, disinfect boots and equipment, or park vehicles away from animals than on those that did not. None of the other biosecurity practices were associated with use of antibiotics in adult horses and none of the biosecurity practices included in this study was associated with use of antibiotics in foals. For adults the use of antibiotics for infectious disease increased with decreasing herd size; this trend was reversed for antibiotic use in foals. The effect of exposure risk level was different for adults and foals. For adults, antibiotic use was lower for operations at higher risk; for foals, antibiotic use was higher for operations at higher risk.     

Staphylococcal control in the veterinary hospital

Staphylococcal infections are common in veterinary dermatology patients, as are patients whose health status places them at increased risk of staphylococcal infection. The rapid emergence and dissemination of meticillin-resistant staphylococci has had significant impacts on management of infections and also increased concerns about transmission of staphylococci between animals, from animals to humans and from humans to animals. The increasing incidence and implications of staphylococcal infections, particularly meticillin-resistant staphylococcal infections, is leading to more interest in infection control in veterinary hospitals as a means to help reduce the impact of these significant pathogens. Infection control is a series of principles and practices that can and should be implemented by every veterinary hospital to improve patient care, protect personnel and meet the increasing expectations. Fortunately, general concepts of infection control are both simple and practical, and application of a basic infection control programme requires limited time, effort or training. With an understanding of some basic concepts and use of available resources, development of an effective infection control programme is within the reach of any facility.     

Barrier precautions, isolation protocols, and personal hygiene in veterinary hospitals.

Because nosocomial and zoonotic diseases are inherent and ever-present risks in veterinary hospitals, proactive policies should be in place to reduce the risk of sporadic cases and outbreaks. Policies should ideally be put in place before disease issues arise, and policies should be effectively conveyed to all relevant personnel. Written policies are required for practical and liability reasons and should be reviewed regularly. Although no infection control program can eliminate disease concerns, proper implementation of barrier precautions and isolation can reduce the exposure of hospitalized animals and hospital personnel to infectious agents. Appropriate personal hygiene, particularly hand hygiene, can assist in the prevention of disease transmission when pathogens bypass barriers and are able to contact personnel. Veterinary hospitals have moral, professional, and legal requirements to provide a safe workplace and to reduce the risks to hospitalized patients. Based on experience in the human medical field and on the continual emergence of new infectious diseases, infection control challenges can only be expected to increase in the future. Regular reassessment of protocols based on ongoing research and clinical experiences is required.     

Global veterinary leadership.

The public needs no reminder that deadly infectious diseases such as FMD could emerge in any country at any moment, or that national food security could be compromised by Salmonella or Listeria infections. Protections against these risks include the knowledge that appropriate and equivalent veterinary education will enable detection and characterization of emerging disease agents, as well as an appropriate response, wherever they occur. Global veterinary leadership is needed to reduce the global threat of infectious diseases of major food animal and public health importance. We believe that the co-curriculum is an excellent way to prepare and train veterinarians and future leaders who understand and can deal with global issues. The key to the success of the program is the veterinarian's understanding that there is a cultural basis to the practice of veterinary medicine in any country. The result will be a cadre of veterinarians, faculty, and other professionals who are better able (language and culture) to understand the effects of change brought about by free trade and the importance of interdisciplinary and institutional relationships to deal effectively with national and regional issues of food safety and security. New global veterinary leadership programs will build on interests, experience, ideas, and ambitions. A college that wishes to take advantage of this diversity must offer opportunities that interest veterinarians throughout their careers and that preferably connect academic study with intensive experiential training in another country. At its best, the global veterinary leadership program would include a partnership between veterinarians and several international learning centers, a responsiveness to the identified international outreach needs of the profession, and attention to critical thinking and reflection. The global veterinary leadership program we have described is intended to be a set of ideas meant to promote collaboration, coalitions, and discussion among veterinarians and veterinary educators who may be intrigued by the concept. The impact of the program can be summarized as follows: Outreach Programs: The global veterinary leadership program will establish new partnerships between veterinarians and veterinary college faculty as they supervise the international internships and see a relationship between their goals and the value of food safety to this country. Strategic Opportunity: The program will build on the critical role that US veterinarians and veterinary colleges already play in strengthening the safety of free trade in this hemisphere. Diversity in an Age of Specialization: The program will combine a global orientation, language ability, and access to comprehensive, research- and economic-related work/study opportunities to expose veterinarians to the expanding world market for veterinary expertise. New Linkages Through Corporate Partners: Through the success and high visibility of current research and education programs, most veterinary colleges are well positioned to engage industry, government, and university leaders in ways to use the proposed program to increase the flow of new ideas and talent into the world food enterprise. International Funding: A new partnership among veterinarians, industry, government, and university leaders can coordinate strong multilateral requests for funding from national and international sources. An Interdisciplinary Strategy that Benefits Veterinary Medicine: The program will combine the diverse veterinary research and education system with our strong national and international network of collaborators to provide globally competent veterinarians who will be needed for the corporate and public opportunities of the future.     

Use of stakeholder analysis to inform risk communication and extension strategies for improved biosecurity amongst small-scale pig producers

Extension and communication needs amongst small-scale pig producers, described as pig producers with less than 100 sows, have been previously identified. These producers, who are believed to pose a biosecurity risk to commercial livestock industries, are characterized by a lack of formal networks, mistrust of authorities, poor disease reporting behaviour and motivational diversity, and reliance on other producers, veterinarians and family for pig health and production advice. This paper applies stakeholder identification and analysis tools to determine stakeholders' influence and interest on pig producers' practices. Findings can inform a risk communication process and the development of an extension framework to increase producers' engagement with industry and their compliance with biosecurity standards and legislation in Australia. The process included identification of stakeholders, their issues of concerns regarding small-scale pig producers and biosecurity and their influence and interest in each of these issues. This exercise identified the capacity of different stakeholders to influence the outcomes for each issue and assessed their success or failure to do so. The disconnection identified between the level of interest and influence suggests that government and industry need to work with the small-scale pig producers and with those who have the capacity to influence them. Successful biosecurity risk management will depend on shared responsibility and building trust amongst stakeholders. Flow-on effects may include legitimating the importance of reporting and compliance systems and the co-management of risk. Compliance of small-scale pig producers with biosecurity industry standards and legislation will reduce the risks of entry and spread of exotic diseases in Australia.     

Application of risk assessment and management principles to the extralabel use of drugs in food-producing animals

A risk assessment of the food safety implications of drugs used in food-producing animals is an essential component of the regulatory approval process for products containing these drugs. This ensures that there is negligible risk to human health if these drugs are used according to the instructions that appear on the approved label. A relative paucity of approved products for veterinary species; however, forces veterinarians worldwide to use drugs in an extralabel manner to treat disease and alleviate suffering in animals. In food-producing animals, this may result in residues that are potentially harmful to the human consumer. This review describes how risk assessment principles can be extended to evaluate the risks posed by different classes of extralabel drug use. Risk management practices in the United States and Europe are summarized and contrasted to illustrate the application of these principles.