When writing this blog, I tried to think of a way to put a pleasant spin on cleaning. Cleaning as a general rule is like licorice…either you love it or you hate it.  For a traditional animal hospital that sees euthanasia appointments among other appointment types, cleaning and disinfecting is pretty standard. It is typically carried out by support staff as part of SOPs. In my experience with home euthanasia and hospice services however, much of the medical support is provided by a microstaff of 1-2 very busy people trying their hardest to stay on time for the next appointment while remaining compassionate and supportive of client/patient needs.  Cleaning supplies and surfaces isn’t always at the top of the list. COVID likely made us better cleaners, but as with most things, it’s easy to default into old habits.

Recently the Companion Animal Euthanasia Training Academy (CAETA) teamed up with Virox Animal Health to develop disinfecting recommendations for specialty end-of-life (EOL) services. Virox is the company that gave us Rescue and Prevail, the trusted Accelerated Hydrogen Peroxide (AHP) germicide used extensively in veterinary medicine to reduce nasty pathogens like… well all of them.  We wanted to create a guide to help mobile EOL services in particular determine what exactly could use cleaning and disinfecting between appointments. 

In my almost 20 years providing euthanasia for my patients, most of it mobile in the home, I’ve seen my fair share of unpleasantries; the pee, the poo, the pus, the vomit, blood, mud, nasal fluid, and even nasal mites that emerged immediately following the death of a sweet old dog. I cringe a bit when I think back to all the times I moved from appointment to appointment with just a mere wet paper towel wipe down.  It looked clean, right? 

Some examples of germicide need in euthanasia work:

• DVM and technician enter the home of an elderly feline hospice patient with oral osteosarcoma.  The cat, harboring Bartonella and Pasteurella, is drooling excessively on nearby surfaces that the team must come into contact with, like the chair where the medical bag is set. 
• Euthanasia is requested for a highly anxious dog. The dog produces stress pheromones that transfer to the stethoscope, medical bag, and carrying basket. The next appointment is for another anxious dog whose owners are hoping to keep calm for the procedure.  Smelling stress pheromones will not improve matters.
• Deceased dog releases urine and diarrhea in the back of the mobile veterinarian’s vehicle on the stretcher on the way to the crematory.  Dog has unknown illnesses.  Stretcher needs to be used again in one hour for another family with other dogs who will be closely exploring it.
• Euthanasia procedure requires an elderly sick dog to be brought into a hospital comfort room commonly used for non-terminal procedures.  The dog has an open bleeding wound with necrotic and pustulant material.  The sedated dog is allowed to walk the room, inadvertently bumping into multiple surfaces leaving blood and infection behind before it falls asleep.  Following the euthanasia, the next patient is a rambunctious dog with Lupus eager to examine all the smells.

Disinfection becomes even more critical when dealing with terminally ill patients with infectious diseases living in homes with the young, elderly, or immunocompromised. Grieving people have been shown to have weakened immune systems in response to the loss of a loved one. Cleaning and disinfecting our equipment before entering their homes is a significant kindness to protect the living.   I make sure to wipe down everything I can between appointments, including my stethoscope so I can safely hand it over to a curious child, something I do often.

Euthanasia spaces and equipment that benefit from regular disinfecting:

~ Stretchers 
~ Clippers 
~ Tourniquets 
~ Stethoscope 
~ Drug bottles
~ Doctor and staff supply cases 
~ Body holding containers and coolers 
~ Memorialization items/tools 
~ Door handles 
~ Pads 
~ Vehicles (all interior surfaces)

Cleaning surfaces is made easier when we bring the supplies we need to do it. Virox produces sprays and wipes that can be stored in the exam room, carried in medical bags and tucked in vehicles for quick use. I keep their wipes in a little compartment in my euthanasia supply bag and pull them out anytime I see even a hint of blood.  Their hydrogen peroxide based products are perfect for that.  Keeping our equipment in tip top shape is important both with the living and deceased.
USA – learn more here. 
Canada – this one’s for you.

References

Stull JW, Brophy J, Weese JS. Reducing the risk of pet-associated zoonotic infections. CMAJ. 2015 Jul 14;187(10):736-743. doi: 10.1503/cmaj.141020. Epub 2015 Apr 20. PMID: 25897046; PMCID: PMC4500695.

Segerstrom SC, Miller GE. Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry. Psychol Bull. 2004 Jul;130(4):601-30. doi: 10.1037/0033-2909.130.4.601. PMID: 15250815; PMCID: PMC1361287.

Buckley T, Sunari D, Marshall A, Bartrop R, McKinley S, Tofler G. Physiological correlates of bereavement and the impact of bereavement interventions. Dialogues Clin Neurosci. 2012 Jun;14(2):129-39. doi: 10.31887/DCNS.2012.14.2/tbuckley. PMID: 22754285; PMCID: PMC3384441.

https://www.dvm360.com/view/zoonotic-disease-what-s-real-risk-immunocompromised-veterinary-clients