Managing risks

On this page:

• Planning and preparation
• General contact with horses
• Contact with a sick horse with potential Hendra virus infection

Veterinarians have a duty of care to manage Hendra virus risks wherever activities associated with their business are carried out. While dealing with potential Hendra virus infection in horses, they must ensure their work does not risk the health and safety of:

• workers including veterinarians, veterinary nurses, locum staff, administrative staff, students, trainees and volunteers
• other people, including clients
• themselves.

Steps to ensure the health and safety of people when dealing with potential Hendra virus infection in a sick horse include:

• providing adequate instruction, supervision and personal protective equipment (PPE) during a veterinary examination
• providing information about how to ensure health and safety until the results of the Hendra virus exclusion testing are known
• ensuring the person is not exposed to risk from veterinary treatments or procedures administered to the horse before the results of the Hendra virus exclusion testing are known .

Planning and preparation

Hendra virus requires careful planning and preparation. Consider the following steps:

• Develop and implement a plan for responding to potential Hendra virus infection in horses and establish supporting policies, procedures and safe work practices.
• Train workers in the plan, including the use of infection prevention and control and biosecurity measures and the selection and use of PPE. The veterinary practice should keep worker training records.
• Keep a Hendra virus field kit at all places where horses are examined to minimise the risk of being unprepared for an unexpected potential case. The kit should include:
• sufficient supplies of PPE for the clinical situations likely to be encountered
• hand cleansers (e.g. soap, alcohol-based hand rub)
• cleaning agents and disinfectants
• plastic zip lock bags
• waste disposal bags
• sampling equipment.
• Keep a first aid kit at the clinic and in the practice vehicle so that cuts and other non-intact skin can be covered.

General contact with horses

It is important to practise good infection prevention and control and biosecurity measures when working with all horses, regardless of the horse's clinical or vaccination status.

Standard precautions

Standard precautions are basic infection prevention and control measures that should be applied to the veterinary examination and treatment of all horses and for contact with their blood, body fluids, mucous membranes and non-intact skin. This is important to protect veterinarians and other veterinary workers from potential exposure to undetected infectious diseases. Standard precautions include:

• covering non-intact skin (e.g. cuts and abrasions) with a water-resistant dressing
• regularly cleaning hands using soap and water, or alcohol-based hand rub if there is no visible soiling of hands:
  • before and after contact with a horse
  • after exposure to blood and body fluids should this occur
  • after contact with a horse's environment
  • after removing PPE
• handling and disposing of sharps safely, including:
  • recapping needles is high risk for needle stick injury and you should plan ahead for the safe handling and disposal of used needles without recapping
  • never recapping a used needle where the technique creates a needle stick injury risk
  • disposing of sharps in a sharps container
• routinely cleaning the work environment using suitable cleaning agents and disinfectants
• cleaning spills of blood and body fluids promptly
• reprocessing reusable clinical equipment and instruments after use
• handling, storing and disposing of clinical waste safely
• handling, storing and laundering soiled linen safely
• routinely using risk-based PPE to manage human health and biosecurity risks
• managing accidental contamination with blood and body fluids:
  • if blood or body fluids gets on unprotected or non-intact skin, by washing the area with soap and water as soon as possible. Where water is not immediately available, wiping the area clean and applying a waterless hand sanitiser such as alcohol based hand rub
  • if eyes are contaminated, by gently but thoroughly rinsing the eyes with water or normal saline for at least 30 seconds
  • if the mouth is contaminated, by spitting the fluid out and rinsing the mouth with water several times.

Transmission-based precautions

Transmission-based precautions are additional infection prevention and control measures that are applied in addition to standard precautions if there is a suspected or confirmed presence of an infectious agent. Examples of situations where transmission-based precautions apply include:

• contact with animals that are suspected or confirmed to be infected with a highly transmissible, highly pathogenic or epidemiologically important pathogen (e.g. Hendra virus, Australian bat lyssavirus, psittacosis of equine origin and leptospirosis)
• containment of multi-resistant organisms (e.g. methicillin-resistant Staphylococcus aureus (MRSA)
• outbreak management (e.g. salmonellosis)
• veterinary procedures that increase the risk of disease transmission (e.g. aerosol generating procedures¹).

¹Aerosol generating procedures include endotracheal intubation, endoscopy of the respiratory tract, respiratory tract secretion sampling or lavage, dentistry using power tools, nebuliser treatment, nasogastric intubation and necropsy.

The additional infection prevention and control measures will depend on what infectious agent the veterinarian suspects or knows to be present and how the pathogen spreads.

• Contact precautions are applied to protect against infectious agents that spread by contact with blood, body fluids and contaminated fomites
• Droplet precautions are applied to protect against infectious agents that spread by droplets
• Airborne precautions are applied to protect against infectious agents that spread by aerosols.

Additional measures may include isolating the animal, using patient-dedicated equipment, enhanced cleaning and disinfection of the animal's environment, enhanced use of PPE, ventilation controls, establishing an entry-exit point, and restricted movement of the animal and potentially contaminated fomites and other objects within and between facilities and properties.

Contact with a sick horse with potential Hendra virus infection

It is important to ensure early diagnostic consideration of Hendra virus based on a risk assessment of all relevant factors including:

• the medical history, vaccination status and clinical presentation
• the exposure history (e.g. access to trees that are attractive to flying foxes, uncovered feed and water containers)
• the property history (e.g. flying fox roosting or activity at or near the property, prior Hendra virus spillover incidents in the area)
• other relevant epidemiological evidence.

If you consider that Hendra virus infection is a primary or differential diagnosis, apply the precautionary principle and implement standard precautions and transmission-based precautions (contact, droplet and airborne precautions) and biosecurity measures to the examination and treatment of the horse. You should do this even if the horse is vaccinated against Hendra virus as no vaccine can provide guaranteed protection.

This includes the following measures:

• Provide and use PPE to protect exposed skin, the mucous membranes of the eyes, nose and mouth, respiratory tract, clothing and footwear.
• Handle sharps safely and consider using safety engineered sharps such as retractable blood collection units and needles/syringes to minimise the risk of needle stick and other sharps injuries.
• Isolate the horse from people, other horses and animals and from public access areas where possible and safe to do so. If at another person's property, advise the owner to isolate the horse.
• Manage potentially infectious waste as clinical waste. Consider sealing the waste in a plastic bag and storing it in a secure area until the results of the Hendra virus exclusion testing are known.
• Take appropriate biosecurity measures to prevent the spread of infection within and between facilities and properties. For example, establish an entry-exit point with separate 'clean' and 'dirty' areas.
• Handle, package and transport pathology samples safely and always remove sharps from pathology samples prior to submission.

Assistance with veterinary examinations and procedures

If you need someone to assist you with the veterinary examination of a horse with suspected or confirmed Hendra virus infection, you must provide them with adequate instruction, supervision and personal protective equipment. Have available a selection of PPE in different sizes for assistants to wear so that they are properly protected.

Children should not assist with the examination of a sick horse, unless Hendra virus has been excluded. Keep non-essential people away during the examination.

High risk procedures and treatments

Some veterinary procedures and treatments may expose veterinarians and their assistants to a high level of contact with blood and body fluids. These include procedures and treatments that are invasive, aerosol generating, involve the respiratory tract and the handling of sharps. If you consider that Hendra virus infection is a primary or differential diagnosis, consider restricting procedures and treatments to obtaining samples for exclusion testing, providing immediate treatment and attending to the horse's welfare. However, if you plan to perform a procedure or treatment that may expose you, your workers or other persons to a high level of contact with blood and body fluids, first conduct a risk assessment to determine if this can be performed safely. If you decide to proceed, implement rigorous infection prevention and control and biosecurity measures to minimise risks to health and safety.

Ongoing procedures and treatments

You should not direct non-veterinary staff (e.g. the horse's owner) to administer ongoing procedures or treatments to a horse under investigation for Hendra virus infection where this involves close contact with the horse or could expose the person to blood and body fluids or to needle stick or other sharps injury, unless the risks to health and safety can be properly managed.

Other animals on the property

Other animals on Hendra virus affected properties, such as other horses and dogs, may be at risk of Hendra virus infection from contact with the infected horse. You should adopt a precautionary approach for contact with all animals that have had contact with a horse with suspected or confirmed Hendra virus infection.

Client information

If you suspect Hendra virus infection, before leaving the property, inform the client about the Hendra virus risk and ways to manage the risk until the results of the Hendra virus exclusion testing are known. If the horse dies or is euthanised during this period, inform the client and/or the horse carcase disposal contractor on how to safely dispose of the carcase (PDF, 0.2 MB). Consider providing this information in writing and then making a note in your veterinary records that you have provided this information.

Medical advice

Seek medical advice if you have health concerns about contact with a horse with suspected or confirmed Hendra virus infection.

Ceasing work

Under work health and safety laws, you can cease work, or to refuse to carry out work, if you have a reasonable concern about a serious risk to your health and safety from immediate or imminent exposure to a hazard. If you cease work, you must notify your employer as soon as you can and remain available to carry out suitable alternative work. You cannot be discriminated against in your engagement for exercising your right to cease unsafe work.