Table 1 Main themes surrounding the topics of barriers to infection control and Hendra virus management in private veterinary practices identified in Queensland, Australia, between 2009 and 2010, as illustrated by participants' quotes

The emerging epidemiology of the virus

"When the first case of Hendra came about, it was seen as being rare so we didn't see [it] as a problem." (V3/Pa)

"It would have been better to have known more about the virus. Where do you draw the line when you don't know enough about the risks and the non-risks?" (V4/Pc)

"The drive [for IC*] needs to be continuous-HeV cases are seldom, so it's easy for people to be slack, to back off from infection control." (V10/Pg)

"The biggest challenge is how to manage a hospital facility for horses, because the case definition is not clear-Our biggest concern'a horse that shows up without Hendra on the differential list and it [HeV^#] shows up on the list later." (V16/Pl)

"This is a disease that is here to stay….so we have to learn to live with it." (V15/Pk)

Risk perception determines risk mitigation

"Some think that Hendra is only a North Queensland problem and that it wouldn't happen in South Queensland or northern New South Wales." (V7/Pa)

"I didn't think a great deal about it [HeV] because I studied in Victoria and it was presented to us as a disease only found in Queensland." (V14/Pj)

"No way in the world would I put a mask or gloves on unless I saw something dramatic."(V13/Pi)

"You will not get a primary Hendra case with a horse living in a stable." (V1/Pa)

"At the time [before HeV], human safety was not being kicked [by a horse patient], not being trampled on, avoiding any physical injury…Zoonoses were not a big one on my list." (V14/Pj)

"Seeing a mate die I think is enough. Obviously you think of self-preservation. I have a life to live…Dying is a pretty big cost." (V5/Pd)

Risk and risk mitigation communication

"There were no guidelines in place in regards to what [protective] equipment should be worn…there was information on what samples were needed but not how to take them." (V14/Pj)

"The trouble with AVA^†is that there is only 50% membership…weekends are when the AVA has the workshops and that is when we have a lot of work on here." (V15/Pk)

"Most vets would receive information through email. Some think it's not enough but some of those don't read their emails." (V1/Pa)

"They [people at the DPI^‡] are excellent. The DPI is the most authoritative source of knowledge because they have been dealing with the issues and they are responsible for biosecurity." (V15/Pk)

"The local DPI were useless, almost burying their heads in the sand. They didn't have enough knowledge, were unwilling to investigate and had a lack of resources and people." (V9/Pf)

"I contacted Biosecurity Queensland on a Saturday afternoon…They transferred me on the phone 19 times to talk to a vet… they have to realise that private vets work 24/7…This disease is too serious to be ignored…they should have been more responsive. It would have been easier to put the horse in a hole and forget about it!" (V5/Pd)

"I find great difficulty dealing with owners because it is a power play and ultimately we are responsible for the safety of all involved but some owners don't believe that, which compromises the legal situation. We usually end up with less authority out of concern for the welfare of the animal." (V4/Pc)

"By the time you get to the horse you are only the 3rd or 4th opinion…A lot of people around here are gung ho who[think they] know better." (V5/Pd)

"Some owners burr at the cost…He [the owner] said `if you want to test the horse why don't you pay for it'." (V14/Pj)

"[The owner said] I don't want them tested for Hendra. If they turn up positive they'll have to be put down. My horses are like my children and I wouldn't euthanase my own children." (V9/Pf)

Education and work culture

"Students are very well aware of the risks to the point of being scared to do things." (V7/Pa)

"These days young vets lack confidence around horses because of their lack of experience through their training and personal life." (V1/Pa)

"Coming out of Uni the biggest issue was not whether I could follow protocols it was getting the practice of using those protocols." (V17/Pm)

"[I]had been inadequately trained [about HeV] when studying in Victoria [another state] …I didn't realise that interstate [studies] did not offer the same information. Some things should not be disregarded in the curriculum because it doesn't happen in that area." (V14/Pj)

"Hopefully they [the students] will go into practice in clinics where they follow best practice." (V7/Pa)

"Poor mentorship is a problem. Training is very important. A principal vet can teach a lot to younger vets." (V8/Pe)

"I think overall we, as vets, were pretty grubby...to get around with blood on your shirt all day that is just what veterinarians did." (V16/Pl)

"Old school vets always considered getting infected with a zoonosis as a badge of honour." (V8/Pe)

"The biggest obstacle is trying to retrain someone who has done something a certain way for 30 odd years." (V13/Pi)

"The culture needs to change…[but]…change won't happen overnight. Human medicine was hit in the 1980s [by HIV^Ω], it sparked infection control improvement but it's still not perfect now. The [veterinary] profession has to change but this will take time." (V8/Pe)

Use of Personal Protective Equipment

"If I am going to be completely honest, a few years ago there would be no way I'd put it [PPE^◊] on." (V13/Pi)

"We have always been casual about horses. In cattle you have brucellosis but I have never been worried about catching anything from horses." (3/Pa)

"The right PPE … was not available at the clinic at the time. PPE was still not considered to be an issue at the time." (V10/Pg)

"You can read the protocol all you like but until you actually do it and take the gear off under the assumption that you are contaminated it is not an easy thing to do." (V12/Ph)

"By following the DPI protocol it took us two hours before the animal was finally sedated." (V4/Pc)

"PPE can be cumbersome…smelling the breath of a horse gives you an idea of what's going on. If you are wearing a mask it makes it difficult." (V11/Pg)

"The ability to move properly…can be a problem. When you have to deal with horses with fractures you have to move quickly!" (V10/Pg)

"The biggest obstacle: heat and humidity…When you are wearing the full PPE it can be very hot." (V6/Pa)

"I hate masks, they press on the bottom of my eyes and I can…t see…I won't wear goggles it's too difficult with my glasses." (V5/Pd)

"Comfort and practicability is an issue for me because one size fits none!!…PPE suits are baggy on me, with a lot of flapping about and this scares horses." (V7/Pa)

"During the EI^§campaign I had to vaccinate between 800 and 1000 horses and at each farm I had to put on a new set of PPE so it's not a big issue for me." (V2/Pb)

"Cost is a big one. You have to pass the cost on. The bill can be a lot dearer than before and if the horse turns out negative, the owner will whinge about the money spent." (V5/Pd)

"We are lucky in that our clients are used to spending money on their horses." (V12/Ph)

"It is potentially dangerous…to have two people walk up [to a horse] looking like spacemen with their clothes rustling and their voices distorted." (V12/Ph)

"Vets like me don't want to be seen with over the top PPE…in more rural situations you tend to think you are being a bit of a Wally[silly] dressed up for minor issues." (V10/Pg)

"…You felt silly in front of other colleagues to be wearing all the gear." (V3/Pa)

"Clients could be a driving force behind it [IC] because they would start questioning why some vets use PPE and others don't." (V1/Pa)

Running a private veterinary practice

"When you have a big backlog of work there is time pressure… your logistics are stretched…many cases end up being emergency cases at the end of the day, which is a recipe for disaster because you start cutting corners and making mistakes." (V4/Pc)

"Vets are often busy and to get through a large case load is hard enough, let alone stopping to put protective gear on." (V16/Pl)

"Cost is an issue …Do you then transfer the cost onto the owner? What if the case turns out negative? How do you justify it?" (VN2/Pe)

"There would be cases out there that have not been reported because of the cost…I think this puts people at risk. As long as it is hurting the pocket of the clients or the pocket of the vet, cases will go unreported." (V14/Pj)

"In the hospital system everything is …disposable. If we had to treat everything as disposable our cost would increase…The industry would suffer from it." (V3/Pa)

"As vets we don't have the luxury of the health system behind us to make [IC] decisions, we don't have a large buying power… for vets the one size fits all approach doesn't work". (V8/Pg)

"You look at the paper trail that they [WHS^¥ authorities] say you need to have…you would have to employ somebody full time for six months to put it in place." (V12/Ph)

"As an employer you can do everything in your power and you can make all the recommendations but it comes down to the individual and if the individual doesn't have Hendra on their mind there is not much you can do." (V14/Pj)

"Legally the only way you could send a staff to a property is if on the day the employer went to that property and addressed the risks and said it was safe to work there, because the conditions from yesterday might not apply today." (V9/Pf)

"More positive cases are going to land in our hospitals…Infection control is imperative but what scares me is the unknown [when HeV is not readily suspected]." (V16/Pl)

"The DPI^‡contacted me to do this work and they weren't being flexible about it: they wanted me there and then. This was [8 months ago] …I am still waiting for my money! Next they'd have to pay me up front." (V5/Pd)

"Everyone's fear is you'll act to the best of your ability and you'll act in the best interest of everyone involved but later your actions will be audited by someone who has never worked in a vet practice and has no idea of the pressures at play and who will apply the letter of the law and potentially cost you your livelihood." (V12/Ph)

"I don't talk to local [WHS] officers anymore because they don't have enough knowledge. This immediately established a low level of credentials with us. Everything after that we see it more as an inconvenience." (V8/Pe)