This project aimed to preserve the effectiveness of antibiotics by promoting a group of dairy producers to become role models for antibiotic stewardship and biosecurity in Washington State. We engaged eight dairy producers and their veterinarians in creating, implementing, and evaluating individualized antibiotic stewardship and biosecurity plans aimed at ensuring appropriate antibiotic use and infection control on the farm. Additionally, we developed standardized assessment tools and best practices resources, which we distributed to all dairy producers in Washington State. Finally, we worked with several key stakeholders in Washington to promote the diffusion of project results to the wider dairy industry.
Objective 1: Create, implement, and evaluate individualized Antibiotic Stewardship and Biosecurity Plans on six to ten dairy farms, aimed at ensuring appropriate antibiotic use and biosecurity procedures. Educate participating dairy operators about the importance of and methods for preserving the efficacy of antibiotics.
Target: Six producers will participate in developing stewardship plans.
Performance: Target exceeded; eight producers developed stewardship plans.
Target: Four producers will implement at least 50% of the recommended practices in the stewardship plans within the first nine months.
Performance: This target was difficult to measure. In developing the plans, producers were offered a menu of goals to which they assigned priority levels. Some producers were offered more than ten possible goals to work toward. It would have been unrealistic to expect that all goals be completed, as most of the goals involved some investment of time and/or money; rather, we asked the producers to assign a priority to each and then work in step-wise fashion on the top goals. Some producers worked on their top goals, while others ended up actually working on goals that initially were given a low priority.
Deciding which goals to include in this performance measure was, thus, subjective. In addition, assessing implementation was difficult, as it was unclear how to count partial implementation of a broad goal or the selection of an alternative solution to a problem. In looking only at goals assigned a priority level of one to three (on a scale of one to ten), counting substantial or full implementation or the use of an alternative solution, then six of the eight farms implemented at least 50% of the recommended practices within the first nine months of the project. By this measure the target was met.
Examples of recommendations included: use milk replacer not containing antibiotics, refrigerate waste milk to be fed to calves, improve pen hygiene or fly control, isolate new additions to the herd for 30 days, culture milk from all cases of mastitis, and discard vials of expired or unapproved antibiotics.
The eight participants undertook a total of 54 recommended changes (average of 6.75 per farm), with certain changes being recommended for all farms such as establishing written treatment protocols, obtaining written veterinary prescription labels on vials of all prescription & extra-label uses of over-the-counter antibiotics, and keeping written or computerized records of all drugs administered. At the final assessment, 24 recommendations had been completely implemented (average 3 per farm), 12 had been partially implemented with continuing activity (average of 1.5 per farm), and 7 had been addressed with an alternate solution. The remaining 11 recommendations had been partially implemented but then halted or reversed without completion.
Target: The final assessments will demonstrate overall increases in knowledge, application of biosecurity practices, use of protocols for disease management, documentation of antibiotic use and disease occurrence, participation by the herd veterinarian in antibiotic use decisions; and decreases in the use of non-recommended antibiotics.
Performance: We were able to complete in-person, on-farm final assessments on seven of the eight participating farms. Although we knew that the eighth farm had implemented several recommended changes, this producer was minimally engaged in the project and declined to participate in the final on-farm assessment. Of the seven farms that we were able to assess at the end of the project, the changes from the baseline assessment were:
-All seven had implemented new procedures or improved existing procedures to control or prevent infections such as biosecurity measures, improved pen hygiene, enhancing calf immunity, isolating animals coming onto the farm, and routine hoof-trimming;
-Two had adopted disease treatment protocols;
-All seven had improved documentation of drug treatments and disease occurrence;
-At least six had increased involvement of the herd veterinarian;
-All seven had decreased their use of non-recommended and/or extra-label antibiotics.
In addition, five farms increased the use of or implemented new diagnostic procedures, which can help better target antibiotics. We did not systematically test participants’ knowledge at the start of the project and therefore could not evaluate changes in knowledge.
Objective 2: Develop an Antibiotic Stewardship and Biosecurity Assessment Tool and Model Plan for distribution to dairy producers in the Northwest.
Performance: We developed a set of three Antibiotic Stewardship and Biosecurity Assessment Tools. Each tool is a self-administered questionnaire that producers can use to identify good stewardship practices as well as areas for improvement, and to determine their level of stewardship. The three tools represent basic, intermediate, and advanced levels of antibiotic stewardship.
After consulting with members of our Advisory Board, including potential users of our final educational products, we decided that a Model Plan as initially envisioned would be redundant with the assessment tools. Instead, we created a best practices resource to accompany each level of the assessment tool, describing the benefits of each recommended practice and providing information on implementation and links to additional resources.
A packet containing the three Antibiotic Stewardship and Biosecurity Assessment Tools and three Best Practices Resource Guides, along with an instruction sheet and cover letter was sent to all known dairy producers in Washington State in November 2008.
Thus, this goal was met with one modification.
Objective 3: Promote the diffusion of antibiotic stewardship and biosecurity concepts from the participating farms to the wider industry.
Target: Participants will demonstrate a commitment to promoting antibiotic stewardship and biosecurity in the dairy industry, evidenced by speaking at industry meetings or other channels.
Performance: The objective was partially accomplished during the project, but will continue to be addressed after the project ends, although through a different means than anticipated.
Project participants attended two small group meetings that involved primarily producers who were in the project. They were reluctant to speak at larger industry meetings. They reported that they sometimes discussed what they have learned through the project with neighboring dairy producers in casual settings if the topic comes up, but they are unwilling to initiate such discussions or speak in public. We were unable to document these informal discussions and therefore are unable to provide a clear measure of performance. The participants’ commitment to speaking was disappointing. However, we believe that the changes participating producers have made on their farms will ultimately have an impact by contributing to awareness of antibiotic resistance, which, combined with activities of other organizations and reports in the media including farm journals, should continue to increase.
This disappointing outcome was offset by an unanticipated commitment from the Director of Veterinary Medicine Extension at Washington State University, Dr. Dale Moore, to disseminate the results. Our work on the participating farms allowed us to develop a better understanding of the practicality of implementing widely recommended best practices. We worked closely with Dr. Moore to combine what we had learned with the scientific literature and accepted best practices to create tools for producers to use to assess their level of antibiotic stewardship. Dr. Moore, who has published many studies on antibiotic use and antibiotic resistance in cattle, intends to use the Assessment Tools we created as a basis for her work promoting antibiotic stewardship with dairy producers and dairy veterinarians in Washington State.
Objective 4: Investigate the feasibility of developing an Antibiotic Stewardship Certification Program to ensure the sustainability of this effort and to disseminate it beyond the participating farms.
Performance: We engaged in discussions with the Executive Director of the Washington State Dairy Federation (WDSF), Jay Gordon, regarding antibiotic stewardship certification. Almost every dairy producer in Washington is a member of WSDF, which provides substantial leadership and representation to the industry. WSDF has worked with our agency and actively promoted the judicious use of antibiotics since 2002. In 2008 WSDF received a USDA grant to work in collaboration with the Oregon Dairy Farmers Association to create the Northwest Sustainable Dairy Program. This program will develop and promote industry standards in environmental conservation, animal care and welfare, milk quality, energy conservation, and labor relations. Mr. Gordon’s vision is that all dairies in Washington State will meet minimum standards in all these area, and he is committed to incorporating antibiotic stewardship into the animal care and welfare standards for Washington State farms, using the three stewardship levels developed by our project. Methods for auditing farms for compliance with standards have yet to be developed.
Although the NW Sustainable Dairies Program might not become a full-fledged certification program, it should promote the adoption of many standards including antibiotic stewardship standards. We determined that certification for antibiotic stewardship alone would be difficult to accomplish. It would require the creation of a certifying agency along with market research and public education. It could be difficult to convince retail outlets such as grocery stores to accept a new category of milk – antibiotic stewardship milk – in addition to organic and conventional milk.
This objective was simply to investigate the feasibility of a certification program; it was obviously beyond the scope of the project to actually implement such a program. By engaging in dialogue on this topic, however, we promoted the incorporation of antibiotic stewardship standards into the NW Sustainable Dairies Program, which might be a more practical alternative to a certification program.
The dairy industry depends on antibiotics to treat infections and maintain healthy herds. However, the current armament of antibiotics is threatened by the emergence and spread of drug-resistant bacteria. Dairy producers, like other agricultural producers, veterinarians, and medical providers, have a serious responsibility to act as guardians of these precious drugs.
Judicious use of antibiotics and infection control/biosecurity can contribute to the long-term economic viability of the dairy industry by:
-Enhancing dairy producers’ ability to produce safe products,
-Reducing the potential for antibiotic residue violations and associated penalties,
-Decreasing the potential for resistant bacteria and antibiotic residues to enter the environment,
-Improving treatment efficacy and therefore decreasing treatment costs,
-Lowering the threat of resistant infections to farm workers and families,
-Reducing the threat of introduction of disease into dairy herds, and
-Reducing disease in animals, which can result improved livestock productivity and longevity.
In the autumn of 2006 we began working with eight dairy producers in Washington State to develop and implement antibiotic stewardship plans. The farms represented a variety of geographic areas and climates and size ranged from 225 to 2100 lactating cows. Using results from in-depth assessments we had completed on these farms earlier in the year, we developed a set of recommendations for each. We then met with each producer and (in most cases) his herd veterinarian to discuss the recommendations. We asked them to prioritize the recommendations and select a small number of the top ones to begin working on. The result of this was an individualized Antibiotic Stewardship and Biosecurity Plan for each participating operation.
Subsequently, we assisted the participating producers to implement their plans. Through frequent interaction via telephone, email, and on-farm visits and mailings we educated them about judicious antibiotic use, provided supporting literature and educational publications, gave suggestions on implementing changes, facilitated networking opportunities and access to experts, and provided other resources as available. We worked not only with the dairy owners but their herdsmen and other workers, as well as their veterinarians. We provided the veterinarians and producers with information on changes in regulations such as the Pasteurized Milk Ordinance, drug indications, drug labeling requirements, and withdrawal periods.
In addition, project staff attended industry conferences and meetings, Extension meetings, and other meetings put on by veterinarians and epidemiologists from the Washington State University College of Veterinary Medicine.
Throughout the project we were supported by a 28-member Advisory Board. Members included agricultural and veterinary experts from Washington and across the nation, most of whom had experience working with the dairy industry and/or had studied antibiotic resistance. In addition, we were supported by the Washington State Dairy Federation, which had recruited the eight participating dairy producers, provided opportunities to speak at meetings, and assisted with accessing resources.
After the Antibiotic Stewardship and Biosecurity Plans had been implemented for approximately 18 months, we returned to each farm to carry out a final assessment and evaluation. This involved assessing progress toward implementing the top priority goals in the Plans. In most cases the herd veterinarian was present for this visit along with the producer.
In the final months of the project, we worked with faculty in the Washington State University College of Veterinary Medicine to create a standardized assessment tool for dairy producers to use for carrying out on-farm self-assessment of antibiotic use and biosecurity. We based this tool on widely-accepted recommendations from respected sources and the scientific literature. Our own experience working on the project farms informed our knowledge of the practical aspects of implementing these recommendations. We developed a system whereby producers can determine whether they are implementing basic antibiotic stewardship, intermediate antibiotic stewardship, or advanced antibiotic stewardship. Producers can use the self-administered assessment tool to determine their level and to identify practices which they should continue and practices they should consider changing. A major focus was to encourage producers to work closely with their herd veterinarians in implementing the recommendations. Each of the three levels of assessment tool has an accompanying best practices resource guide containing more information on the benefits and implementation of each recommendation. In December 2008 we mailed these publications to all dairies in Washington State, with assistance and a supporting letter from the Washington State Dairy Federation. As noted above, the WSDF plans to use these tools and recommendations in their NW Sustainable Dairies Project, and the Dairy Extension Veterinarian at WSU plans to use the tools as a basis for her work with dairy producers.
This was an educational, not a research, project. Therefore there are no findings to report. However, the results of the education are discussed under “Farmer Adoption.”
The participants have increased their knowledge and experience of judicious antibiotic use and infection control and are “early adopters” of change. Unfortunately, these producers were reluctant to speak about their experiences in front of audiences at meetings or conferences. However, because they are all leaders in the state (by virtue of being on the board of directors of a prominent industry group), they have influence among their peers and their presence in the community should encourage others to adopt new procedures over time.
In addition, the project caught the attention of the Northwest Sustainable Dairies Program and Washington State University Dairy Extension Service. The NW Sustainable Dairies Program, discussed above, will utilize the Antibiotic Stewardship and Biosecurity Self-Assessment Tools and Best Practices Resources produced by our project in developing their industry-wide quality standards. The Director of Veterinary Medicine Extension at Washington State University will also use these tools in working directly with dairy producers to assist them in controlling disease and using antibiotics effectively and judiciously.
The full impact of the project, therefore, has yet to be seen. Some of the greatest impacts are difficult to measure but are very real. For example, when our agency first began addressing antibiotic resistance both in humans and animals in the year 2000, the dairy industry was not involved in this issue in any organized manner. By working with the Washington State Dairy Federation (WSDF) for the past 6 years, most recently through this Western SARE-funded project, we have not only garnered WSDF’s support, but that organization has actively sought out opportunities to educate its staff and members and to promote judicious antibiotic use. This impact should carry into the future. In addition, we facilitated new or strengthened relationships between the dairy industry, academicians working in veterinary science and epidemiology, and the public health community, resulting in beneficial collaboration.
Educational & Outreach Activities
We developed a Tool Kit for Antibiotic Stewardship and Biosecurity, which was sent to all dairy producers in Washington State as well as our Advisory Board members (who are from institutions around the nation and also include industry personnel and dairy practitioners from within Washington State), Washington State University stakeholders, and the Washington State Dairy Federation. The Tool Kit includes Self-Assessment Tools on three levels (basic, intermediate, and advanced) along with corresponding Best Practices Resource Guides. In addition, the packet included a Spanish-language DVD on calf care which was produced by a separate project.
In addition, the Project Veterinarian spoke about antibiotics stewardship to audiences of dairy producers at industry meetings one to two times per year.
An economic analysis was not planned and was beyond the scope of this project.
The primary focus of this project was to develop a small group of dairy producers, who were already leaders in the state, into role models for antibiotic stewardship and biosecurity. We worked intensively with eight producers and their herd veterinarians to develop and implement farm-specific goals. These eight producers had a total of approximately 4,700 lactating cows at the beginning of the project.
Farm engagement in the project varied considerably. A few producers were extremely involved with the project and made significant changes in their operations. Most were moderately involved and also made positive changes, remaining engaged throughout the project period. Some continued despite obstacles such as family illness or major farm renovations. Only one of the eight participants had a low level of engagement; this farm practiced good antibiotic stewardship on the initial assessment.
One of the main accomplishments was to enhance the relationships that participating producers had with their herd veterinarians. Since dairy producers can obtain a significant number of antibiotics over the counter it is critical that they work closely with veterinarians to understand when and how these drugs should and can—legally—be used. In addition, they must obtain a veterinarian’s prescription for extra-label uses of drugs and utilize appropriate meat and milk withdrawal times. Because we involved the herd veterinarians from the start of the project they remained engaged and supported the goals of the project. Most worked with the producers to ensure proper drug labeling, provide information on treatment options, and document disease occurrence and treatment. We provided the producers and veterinarians with up-to-date information on regulations from the Pasteurized Milk Ordinance (PMO) and other FDA publications, as well as changes in drug indications. Seven of the eight farms substantially increased veterinarian involvement in decisions regarding antibiotic use.
Another major area of accomplishment was in documentation. We stressed the importance of recording disease occurrence and treatment, both to comply with the PMO and to monitor treatment effectiveness. Five participants made significant improvements in record-keeping including computerizing records, working with a veterinarian to record treatments, and maintaining records for longer periods. We encouraged all farms to adopt disease treatment protocols if they did not already have these in place. Although several farms initially expressed an interest in doing this, only two actually obtained and implemented treatment protocols.
We also focused on reducing certain extra-label uses of antibiotics deemed particularly troublesome from the perspective of antibiotic residues, as well as the use and storage of unapproved and expired antibiotics. After we provided literature and recommendations from respected sources and worked with the herd veterinarians, there appeared to be a small shift away from extra-label drug use, as reported by the producers. Expired or unapproved antibiotics were also eliminated from several farms. There was an increase in the use of veterinarian labels on extra-label drugs. Three farms decreased or eliminated their use of subtherapeutic doses of antibiotics in feed.
Disease control (biosecurity) and prevention were also key project activities. Three farms took steps to reduce or eliminate mixing animals from other operations with their herds and farms that had sanitation problems improved pen hygiene. Some farms initiated mid-lactation hoof-trimming, decreasing the risk of lameness. Six producers completed biological risk management assessments provided by Iowa State University.
Thus, for the most part, the participating producers embraced the project and voluntarily undertook changing their operations. All but one of the producers wished to implement more changes than they did, as they believed our recommendations to be beneficial, but cost, time, or other constraints prevented them from doing so.
Areas needing additional study
One of the greatest challenges for this project was that the participating producers were unable to implement all of the changes they wished to due to financial and time constraints. In most cases the cost-benefit ratio is not known. Producers are, understandably, reluctant to undertake changes for which they do not at least break even. Thus, a cost-benefit analysis of some of the major recommendations around judicious antibiotic use and biosecurity would be useful. Producers know that certain antibiotics labeled for specific cattle ailments are expensive and sometimes resort to less expensive antibiotics that are not labeled for the condition being treated. Pharmaceutical firms have done cost-benefit studies showing that newer drugs are more cost-effective than older antibiotics, but some producers are not convinced that they will benefit from switching to costlier drugs.
Another barrier to judicious use of antibiotics relates to documentation of treatments. The participating producers indicated that they need fast, accurate, simple, and economical ways to input data for record-keeping. Further development of technology that increases the ease and decreases the cost of scanning and cow-side data input will be key to wider adoption.
Although producers know that an outbreak could be financially devastating, the capital expenditures necessary for establishing isolation facilities, testing and vaccination to prevent the introduction of a disease are large. Some producers prefer to take the chance rather than spend money preventing something that might never come to pass. Some simply do not have the finances and the decline in the price spread between organic and conventional milk pricing has made it difficult for even organic producers to set aside funds for new expenditures.
Most of the dairy veterinarians and producers involved in this project were unaware of the most recent update to the Pasteurized Milk Ordinance (PMO) and did not know where to find it. As of the date of this report, the FDA had not posted the most recent changes to the PMO on its website. Although not all states adopt the PMO in its entirety, the FDA should make the current version available for reference. Dairy producers and their veterinarians need to know all the regulations affecting them.
Additionally, research into the actual use of antibiotics on dairy farms is needed. Much of the information currently available is aggregate data based on sales of antibiotics, which might or might not reflect actual use and is not diagnosis-specific. In particular, data are needed on drugs used for the most common diagnoses in dairy cattle including over-the counter, prescription, and extra-label uses. This information would help target future activities promoting judicious antibiotic use.
Finally, work assessing and promoting judicious use of antibiotics is needed in all areas of agriculture, including animal and plant production.