These guidelines should also be followed in the practice setting . Any affected areas should be left to dry for 48 hours following the use of QACs or bleach [ 11 ] . This may mean that positive cases have to be isolated in a hospital environment , to reduce disruption to the day-to-day running of the practice . Care should be taken to ensure no phenol-containing products are used in households or areas of the practice containing cats or reptiles , due to their high levels of toxicity to these species .
Steam cleaning of furniture and carpets may also be beneficial in reducing the number of cysts . Steam cleaning at a temperature of 70 ° C for 5 minutes or 100 ° C for 1 minute is 99 % effective in cyst reduction [ 10 ] . There is no risk of toxicity with this method , or the associated long drying times , which may be more appropriate in a home setting and could therefore encourage owner compliance . However , thermal burns are a potential risk , so owners should be advised of this and animals should be safely removed from the environment that is to be steam cleaned .
A thorough cleaning regime should be put in place . Daily cleaning of areas used by animals would be beneficial and may aid in preventing reinfection . Cleaning of toys and bowls with appropriate heat and disinfectants at regular intervals is also indicated . Washing bedding at high temperatures (> 60 ° C ) will also reduce the likelihood of repeat infections . The disinfection of sleeping areas is also indicated . It is advisable to test any products or steam-cleaning equipment on an inconspicuous area of a furnishing or surface prior to use , in case of potential damage . VNs have extensive knowledge of cleaning products and their efficacy against viruses , bacteria , spores and protozoa , making them well placed and qualified to advise owners on the cleaning regimes and products that will support better treatment outcomes for patients .
If a patient is admitted to the practice , it is important to employ good cleaning protocols , using products that will effectively reduce environmental cysts . Personal protective equipment ( PPE ) should be worn and hands washed thoroughly after handling patients to reduce the risk of zoonosis to clinical staff . As many cases display no clinical signs , it is advisable to wear PPE when handling all patients . This should be considered in risk assessments for immunosuppressed clinical staff in particular .
VN-led clinics
Following diagnosis of a case , VN-led clinics can be a helpful forum in which to discuss environmental treatment protocols and effective cleaning regimes with owners . Additionally , discussions can cover how to properly clean the patient to reduce reinfection and the importance of good hygiene protocols for the owner to reduce the risk of zoonotic infection . Owner education on the use of probiotics and hydrolysed protein-based food may also aid in the reduction of diarrhoea .
A VN-led clinic could be a follow-up to the owner ' s appointment with the VS to discuss treatment . Although VNs do not prescribe treatment , clients may be more open to discussion with a VN regarding their queries or perceived difficulties with compliance . The clinic will enable the VN to assess any potential lack of treatment compliance early , and help mitigate it , to provide a better outcome for the patient .
Conclusions
Giardia infections can be difficult to treat , requiring perseverance if initial treatment is unsuccessful . A multimodal approach to treatment , taking into consideration medical and environmental factors , should be implemented . It is important to consider multi-pet households and pets that do not display any clinical signs , which may increase the likelihood of patient reinfection . A thorough and repetitive cleaning regime using appropriate products should be put in place to increase treatment efficacy . VNs can play a pivotal role in helping owners to navigate environmental hygiene and treatment efficacy . VN-led clinics in this area could free up VS time , increase client compliance and satisfaction , and help reduce drug resistance .
Assessment of learning
1 . What is the estimated prevalence of Giardia in dogs worldwide ?
a ) 5 – 10 % b ) 15 – 30 % c ) 60 – 70 %
2 . In what form is Giardia infectious ? a ) Cyst b ) Trophozoite c ) Both
3 . What is the recommended treatment for Giardia ?
a ) Nitazoxanide b ) Fenbendazole c ) Febantel
4 . How effective are QACs in the treatment of the environment ?
a ) 5 – 10 % b ) 60 – 70 % c ) 90 – 99 %
12 Veterinary Nursing Journal