Implementation of the “One Health” Approach against COVID-19 in Nursing Homes and other Social-Sanitary Centres: Our Experience in 59 Centres/3609 Population

The purpose of this article is to show the result of a collaborative and transdisciplinary effort between human and veterinary medicine (ONE HEALTH) in fading up the spread of the SARS-CoV-2 among nursing homes and other social-sanitary centres in the province of Almería (Spain). The term One Health, although relatively new, is being increasingly used in conferences, communications, and various organizational frameworks that advocate global health. As the results have shown, this approach benefit not only the individual but the entire community, reducing the number of infections and the transmission of the disease in retirement homes, which would have caused a greater number of ill and deceased. Results: Of the total of 59 CREs, which accumulate a total number of 3.609 residents, 93 positive residents were registered, belonging to 6 residential centers for the elderly and none belonging to a socio-sanitary center for the disabled. With regard to employees, out of a total of 1.500 there were 38 confirmed positives, all of them from centres that had confirmed positive residents, except for 3 workers who were COVID-19 positive despite working in a centre with no positives registered. The implementation of the basic principles of biosafety imply the creation of environments in which the care of residents is optimized. It is a priority for Public Health to promote disease-control practices among resident people and employees, as it leads to reducing the risk of exposure to the disease, and therefore the threat posed by COVID-19. Approach Our in 59 Centres/3609


Introduction
The concept "ONE HEALTH" is a methodological approach conceived to design and apply programs, policies, laws and research in which the different sectors involved communicate and collaborate closely with one another in order to achieve the best results regarding public health, understanding that both human and animal health are interdependent and necessarily linked to the environment in which they coexist. This strategy is recommended by the World Organization for Animal Health (OIE, 1924) to address the interrelation between Public Health, Animal Health (including both domestic and wild animals), and ecosystems.
Many pathogenic microorganisms that represent global risks to public health affect both animals and humans when they share the DOI: 10.26717/BJSTR.2021.35.005661 same habitat, so to concentrate the efforts into just one sector will not prevent nor eliminate the problem. Examples of this are RNA viruses-retroviruses, such as the human immunodeficiency virus (HIV), the West Nile virus, the avian influenza virus, the Zika virus and, more recently, the coronavirus (SARS, MERS). All these disease outbreaks, including the current COVID-19 pandemic, illustrate how essential these transdisciplinary collaborations are [1].
It therefore becomes clear that a comprehensive protection of public health should be based on the development of global strategies for the prevention and control of pathogens, through the implementation of adequate and coordinated policies that act in the animal-human-ecosystem interface. This is why the FAO Director-General has recently requested in the context of "One Health" the inclusion of veterinarians as specialists in animal health in the prevention and control of COVID-19. Hence, veterinarians play an essential role in the development and implementation of health risk management policies: protecting animals health and welfare and controlling food safety, ultimately public health.

Objectives
General a.
To apply the "One Health" concept to the highly transmissible and serious pandemic caused by SARS-CoV-2 throughout the collaboration between medicine and veterinary.

Request for a Contingency Plan and isolation of Residents with Suspicion or Confirmation of Covid-19, Through the Elaboration of a "Plan of Action" Foreseen by the Health Territorial Delegation
Each center must assume a firm commitment to risk Each center must have a documented protocol for handling infected COVID-19 corpses.

Interpersonal Distance, Training and Qualification of Work Personnel
Protecting the health and safety of employees must be a priority. Tasks must be planned in such a way that the 2-metre safety distance established by the health authorities is guaranteed.
To this end, Centres were adapted and guidelines were developed for the distribution of spaces and movement of the people, avoiding the overlap in entrances and common areas such as bathrooms, changing rooms and dining halls. Work shifts were organized so that the same employees were always on the same shifts, avoiding exchanges between groups as well as joint activities. A person in charge was assigned on each working group to ensure compliance with the planned preventive measures. All personnel-including new recruits, work leaves, and R&D personnel-received theoretical and practical training in occupational risks, infection control and potential infectious diseases exposure prevention. For the success of the training program it was subsequently supervised and followed on-site.

Biosafety and Infection Control Measures
The first step in preventing a disease is to understand its etiology. In COVID-19, the preferred route of transmission and the route of exposure are believed to be identical, that is through the respiratory route: from respiratory aerosols (droplets) from an infected person to a susceptible one [2,3]. Recent studies have shown that the SARS-CoV-2 virus is capable of remaining suspended in aerosols for hours [4][5][6]. However, it is believed that there may also be a spread by direct or indirect contact with contaminated surfaces or objects (fomites) where the virus can remain active for up to several days, depending on the nature of the contaminated surface [7].
Taking this into account, the following measures were adopted:

Control of the Entry of the Infectious Agent to the Facilities:
As a general measure, in order to prevent the entry of the infectious agent into the facilities, the access of non-essential visitors and the exits of residents outside the centre were temporarily interrupted. Every one of these areas must be correctly marked and identified with a placard, and both access and transit through them must be limited, with exclusive work personnel assigned for each of them. Footbaths and/or mats impregnated with water and bleach were placed for infection control when changing areas and the mandatory use of clogs. All the equipment to be used for this area must be exclusive for it and must be identified with some striking element, for example by colors. No object should leave the quarantine or isolation area without proper cleaning and disinfection or in sealed bags for proper disposal [9-17].

Discussion
Of the total of 59 CREs, which accumulate a total number of 3.609 residents, 93 positive residents were registered, belonging