QUARTERLY BEAT
JULY 2026
Looking at all potential hazards does more than improve general safety. It changes how we think about infection control. For this article, we are primarily focused on biological hazards, but those risks do not exist in isolation. A patient that poses an infectious disease risk may also present a bite risk requiring chemical restraint, or involve environmental contamination. Identifying all relevant hazards is what allows you to choose the right layers of control.
WHAT DOES THIS LOOK LIKE IN PRACTICE?
Consider an aggressive dog that needs a detailed oral exam. It is difficult to visualize through a muzzle, so you could rely on restraint and hope your reflexes are fast enough, or you could sedate the patient and eliminate the bite risk before your hands are ever near the mouth. That is an upstream control. You may still need a muzzle or bite-resistant gloves during recovery, but the highest-risk step, the oral exam, has already been controlled. If you rely on PPE alone in this scenario, you are removing stronger layers of protection and depending on a single, less reliable barrier. In terms of the Swiss cheese model, you are taking away layers instead of stacking them, which increases the chance something will pass through the gaps. Now consider the shelter puppy adopted two days ago and scheduled for work up of vomiting and diarrhea. You could use a standard exam room and rely on additional PPE and clean up afterward, or you could route that patient directly into isolation. Controlling that animal's movement is far more protective than allowing it through shared traffic areas and trying to manage contamination afterward. Upstream controls do the real work. Ventilation, clean-to-dirty workflows, and facility design reduce exposure before it happens. PPE is the safety net, not the scaffolding. When we treat it as both, we overestimate our protection and underestimate our exposure.
You cannot select the right protection if you have not first identified what you are protecting against.
QUESTION 2: HOW DOES IT SPREAD?
For biological hazards, the route of transmission should guide the barrier we choose. Get this wrong, and your PPE is just for show. • Contact transmission: is the most common route in veterinary settings, and the most underestimated. Think about everything you or your patient touches in a single visit: the exam table, the scale, your stethoscope, the keyboard, and the door handle on the way out. Your scrubs become fomites the moment a patient sneezes on them or a contaminated surface brushes your sleeve. Cages, leashes, and muzzles all act as potential fomites. • Respiratory transmission: includes both droplet and airborne spread. Droplet transmission occurs with the sneezing cat with feline herpesvirus or the coughing dog in the lobby. These particles are larger and typically travel short distances, so proximity and time both matter. • Airborne transmission: is less common but higher consequence. Coxiella burnetii during ruminant birthing and Mycobacterium tuberculosis are classic examples. These pathogens remain suspended in the air and can travel beyond typical droplet range. In these situations, an N95 respirator, properly fit-tested, becomes essential. • Vector-borne transmission: is less common in the clinic setting, but still relevant. Ticks, fleas, and other pests can introduce pathogens into the clinic environment and transfer them to other patients, staff, or equipment. • Oral exposure: deserves its own mention. I have watched a veterinary student eat lunch without washing their hands after handling a Cryptosporidium-positive patient. That student was one bite away from a very unpleasant weekend. Infection requires three things: an infectious source, a susceptible host, and a route of transmission. We often have limited control over the patient and only partial control over host susceptibility. The route of transmission should dictate the barrier we choose, every time. If you block the route, you break the chain of transmission.
START WITH RISK, NOT EQUIPMENT
Understanding where PPE fits in our risk assessment is only part of the equation. We also have to decide what protection is actually needed in the moment. I've watched technicians put on N95 respirators to clean a kennel and then walk bare-handed into a room with a leptospirosis suspect. The issue isn't laziness. It's that no one ever gave them a framework for matching controls to the level of risk. Risk assessment is the foundation of infection control. At its core, it is a simple process: identify the hazard, understand how it spreads, and decide what happens if you are wrong.
QUESTION 1: WHAT IS THE HAZARD?
In veterinary medicine, biological hazards dominate: bacteria, viruses, fungi, and parasites, but they are only part of the picture. A comprehensive approach to safety considers multiple categories of risk. Chemical hazards include chemotherapeutics, disinfectants, anesthetic gases, and euthanasia solutions. Physical hazards include sharps, slippery floors, and animal-related injuries such as bites and scratches. Radiation hazards come from imaging equipment and therapeutic exposures. Ergonomic hazards, like restraining a thrashing 90-pound dog, are injury risks we often overlook. Noise and psychosocial stressors also contribute to overall workplace risk.
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