Editor’s note: second in a two-part series.

The most well-designed dairy hospital pen can be a disaster if employees are unable to manage the pen and the cattle correctly. It should go without saying that the words “cleanliness” and “hospital” should be synonymous on a dairy.

Sometimes the hospital is the worst place to be -- for humans or cows -- when they are sick because of the pathogens that are present coming into contact with a weakened immune system. Periparturient cows excrete coliforms in feces at a higher rate than other cows, and Salmonella excretion is possible in sick cows, even in cows that fail to show signs of disease due to the infection. Leaked milk from mastitis cows can also contaminate hospital pen bedding.

“Daily pen cleaning and efforts to remove retained fetal membranes and other residues of health events is paramount to preventing disease to other cows,” says Greg Goodell, DVM, the Dairy Authority, Greeley, Colo. “This should be reiterated to the hospital pen employees over and over.” Routine cleaning of the pen (including waterers) with a strong disinfectant and decontamination of tools used in the hospital pen (stomach pumps, pilling guns, halters, etc.) should be closely monitored and cleaning frequency changed as needed.

Asking employees to wear latex or nitrile gloves, washing boots, wearing clean coveralls daily and even in extreme situations utilizing footbaths has helped dairies get through outbreaks of Salmonella and other contagious disease outbreaks as well as maintaining a rapid recovery rate for most of the common diseases seen on the dairy.

Most of the big Mycoplasma outbreaks Jim Brett, DVM, Macon County Animal Hospital, Montezuma, Ga., has attended have been made worse by poor hospital pen management -- poor hygiene at milking, mixed sick and fresh cow groups and inadequate training of personnel.

Goodell agrees and says Mycoplasma mastitis outbreaks are a good example of poor management when the pen and its employees act as fomites. What would have been a small problem easy to fix turns into an expensive disease outbreak because pens were not cleaned and employees did not follow simple protocols such as wearing gloves and disinfecting health care utensils. “This is true not only for mastitis but for any disease where the pathogen will take advantage of its ability to spread in a contagious fashion, including pneumonia, foot warts, enteric disease, etc.”

Training employees

Should everyone have access to the hospital pen? If the dairy is large enough to specialize the workforce, then only certain people should deal with sick cows. “There should be one person in charge that makes the treatment decisions day one and he/she should supervise a limited number of other well-trained employees that take care of the daily monitoring if the number of cows exceeds the ability of one individual to do all of the work,” says Nigel Cook, BVSc, MRCVS, University of Wisconsin, Madison.

Brett adds that employees working with sick cows should attempt to limit their activities to the hospital area. “However, they cannot practically do that and help out in other areas as we all know happens,” says Brett. “Wearing protective clothes and gloves and changing when leaving the hospital area is a practical option.”

Cross-contamination to other groups of animals can be a risk. Brett advises that on large farms thecalf staff should look after sick calves, which are housed away from cows in the hospital pen. “On small farms, we always advise producers to care and treat calves before breeding and treating sick cows.”

Contaminating calves aren’t the only thing to worry about -- employees and their families can be at-risk for zoonotic diseases. Discussing zoonotic diseases is critical, especially on large dairies. “Employees should not enter their own homes without removal of work clothing and washing thoroughly -- especially those with young children,” says Cook.

In Brett’s training session, he reviews the diseases that have been seen on-farm and point out those that are communicable to humans. “This helps drive home the importance of hygiene and using protective measures.”

Diseases such as salmonellosis and leptospirosis should be talked about routinely, and diseases like tuberculosis and Brucella should also be added to the list for discussion. “Persons employed from outside the U.S. are more likely to have run into the latter two diseases and the fact should be noted that zoonotic diseases can be spread from human to cow as easily as it can go from cow to human,” states Goodell.

Goodell suggests that dairies make washing machines/dryers available to employees, provide coveralls or employ a uniform service to help compliance in the area of preventing disease transmission. “After that, stressing a clean environment and correct hospital pen hygiene will usually get the job done. The example needs to be set by the owner or manager for best results.”

Help employees make the best of it

For it to function well, the hospital pen has to be convenient and accessible.  “Hospital pens are not the most pleasant place to work on the dairy so make the area work-friendly for you and the staff,” advises Brett.

The hospital pen should be built so that it is easy to get carts, wheelbarrows, golf carts or some other form of transport in behind the cow in order to carry notebooks or binders for record keeping, thermometers, drugs, syringes, needles, etc., suggests Goodell. Most dairies administer treatments and take temperatures as the cow is examined each morning and for the best job on the cow it is necessary to have these tools at hand. “This increases protocol compliance for treatment therapies as well as for recording of information pertinent for determining clearance of beef and milk withhold dates.”

Monitoring hospital cows

For the veterinarian or the manager who is not around the hospital pen on the dairy every day, tracking DIH (days in hospital) by disease is an excellent tool and can be done using most dairy management software by tracking when the cow moved into the hospital pen and when she moved out. “If the capabilities of the dairy allow, I also have created more sophisticated monitoring tools which break DIH down by health events, i.e. average DIH for mastitis, pneumonia, lameness and so on, and even assign treatment cost for each event,” explains Goodell. When DIH goes up or treatment costs go up (adjusting for price increase) then he knows cows are not recovering as quickly as they once were, and the process or the protocols (or both) need to be reviewed.

Cook adds that someone needs to keep accurate records and review them. “The veterinarian should be in charge of regular monitoring and review of case trends, antibiotic use trends, examination of ‘tricky cases’, training etc.,” says Cook.

Record keeping will become an issue the industry will set standards for, or it will become part of the PMO, notes Brett.

With the emergence of source verification, organic milk, natural milk and the like, record keeping is becoming paramount. “This is in addition to the importance of knowing what the cow has been treated with in order to determine milk and beef withholds,” says Goodell. “A good producer will also
utilize this information to determine whether the cow should be culled as chronic or has a good chance to return as a productive unit to the herd. This cannot be done without records.”

Hospital management also extends to animals that die. “Overall, with terminal and downer animals, we must have plans for humanely euthanizing them and then handling the carcass in an environmentally conscious manner,” says Brett.

Veterinary involvement

The veterinarian plays a key role in the management and success of the dairy hospital pen. “It’s our job,” says Cook. “Our involvement is a necessity, and it should be a requirement to have drugs used by herd workers.”

“Who else is better suited for this job?” asks Goodell. “By the essence of a veterinarian’s training, this is what we do. The hospital pen is where a veterinarian can have one of the single largest impacts on the dairy. Treatment protocols should be reviewed at least annually if not more often. Changes in drug labels, monitoring of response to treatment protocols and constant training are all best done by the

The veterinarian is the key component, agrees Brett. “We can train the staff on proper techniques, develop the treatment protocols and evaluate the records to review its success. Farms that have cut us out in the past to save a little money have always called us back when they get back into trouble.”


Hospital pens are a necessity on the dairy, but their failure can be due to both animal sickness and management problems. “Hospital people should be your best workers, not the lowest paid members of the farm staff,” says Nigel Cook, BVSc, MRCVS.

Greg Goodell, DVM, believes poor hospital management results from not enough training both in the area of treatment protocols as well as the clinical setting (proper technique in IV, IM and SQ injection administration, identification of sick cows and explanation of clinical signs). “Often an employee will get put into a hospital pen position with little or no training and be expected to perform,” he says. “There’s also often no follow-up on diagnostic skills and administrative duties such as if protocols are being followed, treatments are being recorded and temperatures are being taken.”

For Jim Brett, DVM, failure of hospital pens is often caused by burn-out of employees. “They work so hard to do the treatments and it’s like a battle they never win, since the new patients will always continue to come in no matter how successful they are.”

If your clients’ hospital pens don’t seem to be helping sick or injured cattle, take note of these typical problems that might be occurring:

  • Poor hygiene between cows and during milking
  • Passing contaminated stomach tubes
  • Dirty needles
  • Manure contamination
  • Poor cow comfort
  • Overstocking
  • Animals develop another medical problem while in the hospital (i.e. the mastitis cow becomes lame). 
  • Insufficient training
  • Poor management structure -- no one reviewing/monitoring treatments
  • Lack of veterinarian involvement in training, supervising and monitoring


Not all sick/injured animals can be managed the same way in the hospital pen. Train employees to give different care in different situations. And don’t forget that environment isn’t everything -- nutrition of sick cows is extremely important and sick cows do not need to compete for nutrients on top of everything else. Nigel Cook, BVSc, MRCVS and Greg Goodell, DVM, offer these suggestions:


Cows with deep digital sepsis require surgery and a prolonged recovery period on a bedded pack, or they need to be shipped, says Cook. “It is unacceptable to have a pen filled with club-footed cows barely able to stand being treated with antibiotics.” AABP has recently developed fact sheets on lameness.

Ketosis/fresh cow problems

Monitoring of appetite and the severity of the ketosis using urine or milk is important. “We are becoming very focused on the misuse of IV dextrose and steroids in this group,” says Cook. Repeated daily dosing of dextrose may increase the risk for a displaced abomasum and do more harm than good, and repeated steroid treatments are a recognized risk for hypokalemia.” Access to clean, fresh hay is a great way to bring these cows around and monitor their eagerness to feed.

Goodell adds that prevention is the key here. “Teach employees what number is acceptable to see instead of just treating them as they come. Individual follow-up checks and treatments are important since we know these cows are much more likely to go on and become a DA.”

Severe mastitis problems

As with ketosis and metabolic problems it is important to monitor the number of cases and types of mastitis. Dairies are moving away from blanket antibiotic therapies and employing the use of cultures to more properly select an antibiotic that will cure the pathogen in the udder during the first course of treatment, says Goodell. The end result is quicker resolution of mastitis and fewer hospital pen days for cows with mastitis. A herd manager or hospital pen supervisor should be taught the basics about mastitis-causing organisms and understand the nature of the pathogen as it relates to contagiousness or the environment.

Cook says that poor case definitions and inadequate treatment, which usually means too many antibiotics and too little fluid therapy, is a problem. “Cows need two liters of hypertonic saline, so why give only one? Pain is an issue that needs to be addressed with appropriate use of NSAIDs.”


Recognition of cows with fractures of the femoral head early can help avoid prolonged futile periods of ‘recovery’. Cook says for injured cows, a bedding surface that is clean and non-slip is a must and that the use of flotation tanks can also work well.

“Proper care of down/injured cows is a must to increase recovery for these cows,” says Goodell. Cows must be lifted/floated/rolled side-to-side regularly to ensure the best possible outcome. This takes time, patience and dedication by those overseeing these cows. “Time is probably the key factor. A herdsman or supervisor expects to have the hospital pen done in an hour or two and when there is one down cow their time is often doubled.”

Sick (diarrhea, respiratory, etc.)

The lack of isolation for cows with diarrhea due to infectious causes leads to amplification and contamination of the environment. The contagious nature of these diseases is also often overlooked. These cows should be handled in a fashion that reduces the likelihood that the spread of the disease will occur. Things like using separate needles, changing latex/nitrile gloves and rinsing a balling gun in a chlorhexidine solution before treating the next cow will go a long way in preventing further spread of the disease in the hospital pen.