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Best Practices for Surgical Site Infection Prevention in Veterinary Surgery

Question:

Discuss about the Veterinary Surgical Practices.

The five best practices that are shown in the video included:

  1. Use of hand and feet gloves. Surgeons and surgical assistants are required to wear sterile surgical gloves in order to carry out operations in an aseptic manner. Gloves are used only once and then they are disposed off. These help to prevent surgical site infections and contaminations. Both hand and feet gloves prevent contamination of the surgical site as well as the operating room. Shoes can be a very good source of contamination and as a result, feet covers are needed to prevent contamination of operation theater air and prevent surgical site infection. These also protects the surgeon from getting infections from the surgery (Eyarefe, 2016).
  2. Head and face masks. The human body consists of normal body flora, which can cause infection of surgical wounds and thus, face masks are highly essential. Head masks or covers help to control the infection spread through aerosols of hair microbes that are normally present in the human body. Such microbial aerosols can cause contamination of the surgical sites, if proper head covers are not used.
  3. Sterile surgical instruments in sterile packets. Surgical instruments are highly vital in surgical techniques and their improper sterilization or usage can give rise to surgical site infections. Pre-sterilized surgical instruments that are available in sterile packets are the best ways to reduce contamination and surgical site infections obtained from surgical instruments (Coisman, Case, Clark, Wellehan, & Ellison, 2013).
  4. Sanitization of the surgical table. It is necessary to carry out disinfection of the surgical table and the area prior to surgery to prevent surgical site infections and contaminations. It also helps to prevent the spread of multi-drug resistant bacteria. Common disinfectants include phenols, aldehydes like formaldehyde, alcohols like isopropyl alcohol. Anti-microbial detergents or soaps can also be used (Addie et al., 2015).
  5. Autoclaving of the surgical instruments after surgery. Surgical instruments are usually sterilized by moist heat using autoclaving techniques. It is necessary to sterilize surgical instruments after surgery to prevent spread of wound infections from one surgery to another. The recommended autoclaving temperature is 250ºF for 13-15 minutes and an additional 2-5 minutes for extra safety precautions. Autoclaving helps top kill the microorganisms that are present in the surgical instruments after the surgical procedure (Dancer, Stewart, Coulombe, Gregori & Virdi, 2012).


The ten inappropriate practices that are shown in the video included:

  1. The VOA surgical assistant nor the surgeon was shown to wash hands prior to wearing gloves. Gloves do not completely reduce the chances of contamination and therefore it is necessary to wash and disinfect the hands prior to wearing surgical gloves. Gloves can tear during surgeries and as a result, clean hands can prevent bacterial transmission from the surgeon to the patient.
  2. The VOA surgical assistant placed the gloves, which would be used to cover her hands and feet on the table, which was not disinfected. This can cause infections in surgical sites and can result in the spread of pathogenic microorganisms.
  3. During the surgery, the VOA surgical assistant did not wear gloves in her hands. She used her uncovered hands to open the surgical wrap and touch other surgical instruments, which can cause spread of infection giving rise to surgical site contaminations.
  4. The VOA surgical assistant did not cover her hair completely with the head cover and some of her hair was exposed, which can give rise to infections.
  5. There was no evidence of preparation of the animal for surgery. There was no evidence of hair clipping. The clipped skin was not shown to be treated with disinfectants to prevent bacterial contaminations. It is necessary to disinfect with the use of chlorhexidine or iodine (Davids, Davidson, TenBroeck, Colahan, & Oli, 2015).
  6. The surgical wrap, which was used was not shown to sterilized or not prior to surgery. The VOA surgical assistant held the surgical wrap in her bare hands, which can cause transmission of infection.
  7. The VOA surgical assistant took the body temperature during recovery but did not monitor heart and pulse rate. Respiratory rate was also not monitored (Research.utexas.edu, 2017).
  8. The animal was not provided with a warm environment like blankets and a heat source to prevent occurrence of post-surgical hypothermia.
  9. The surgical instruments were not cleaned properly prior to autoclaving.
  10. The autoclaving was not done properly. It was carried out at 184ºF, when the temperature should be 250 º

The practices, which the VOA surgical assistant did not carry out include washing her hands with suitable disinfectants. It is necessary to wash hands prior to wearing gloves as it will prevent the transfer of infection from her hands to the surgical wraps and also to the surgical instruments. It is necessary to disinfect hands and wear gloves prior to handling surgical wraps, surgical instruments and the patient. Gloves can tear sometimes and the presence of disinfected hands can prevent bacterial contamination to some extent. Wearing gloves also prevent contamination of surgical sites with body fluids. The surgical assistant did not wear a surgical gown and as a result her clothing was in contact with the sterile drape of the patient and with the surgical wraps. The animal needs to be prepared prior to surgery. This includes clipping of hair and fur from the surgical area at least 1-2 inches from the incision site. The clipped skin needs to be treated with disinfectants to prevent bacterial contamination. Three applications of surgical scrub products should be used to prevent bacterial contamination. These products contain povidone iodine or chlorhexidine. The disinfection starts from the incision site and radiates towards the clipped area margins in a circular motion. Each of these applications can be associated with cleansing with alcohol. A final washing of the area with disinfectants and not soaps can be used to complete the sterilization process (Hillier et al., 2014). It is necessary to determine whether the anesthetic tubing is connected properly and secured. It is also necessary to determine whether the patient is stable in the dorsal recumbent position and whether the head is comfortably resting on the surgical table.

Surgical site infections are nosocomial infections, which are surgery associated and is responsible for 0.8-18% of nosocomial infection occurrence in animal surgeries (Turk, Singh, & Weese, 2015). Proper practices are necessary to prevent infections of surgical sites. This assignment has helped me to understand the best practices that are to be carried out prior, during and after surgeries. It also helped me to understand the practices, which needs to be avoided before and after surgeries. The best practices were found to be proper disinfection of hands, wearing sterile gloves, face masks, head covers and surgical gowns. It is also necessary to properly disinfect the surgical environment and the surgical site (in case of the patient). Such practices will help to prevent contamination and spread of bacterial infections. It is also necessary to properly sterilize the surgical instruments before and after surgery by the process of autoclaving. Proper autoclaving temperatures and time is to be maintained to ensure proper disintegration of the pathogenic microorganisms. Thus, learning all these techniques will positively impact my role as a VOA.

References

Addie, D. D., Boucraut-Baralon, C., Egberink, H., Frymus, T., Gruffydd-Jones, T., Hartmann, K., & Marsilio, F. (2015). Disinfectant choices in veterinary practices, shelters and households: ABCD guidelines on safe and effective disinfection for feline environments. Journal of feline medicine and surgery, Vol: 17(7), pp: 594-605, doi: 10.1177/1098612X15588450.

Coisman, J. G., Case, J. B., Clark, N. D., Wellehan, J. F., & Ellison, G. W. (2013). Efficacy of decontamination and sterilization of a single-use single-incision laparoscopic surgery port. American journal of veterinary research, Vol: 74(6), pp: 934-938, doi: https://doi.org/10.2460/ajvr.74.6.934.

Dancer, S. J., Stewart, M., Coulombe, C., Gregori, A., & Virdi, M. (2012). Surgical site infections linked to contaminated surgical instruments. Journal of Hospital Infection, Vol: 81(4), pp: 231-238, doi: 10.1016/j.jhin.2012.04.023.

Davids, B. I., Davidson, M. J., TenBroeck, S. H., Colahan, P. T., & Oli, M. W. (2015). Efficacy of Mechanical versus Non?Mechanical Sterile Preoperative Skin Preparation With Chlorhexidine Gluconate 4% Solution. Veterinary Surgery, Vol: 44(5), pp: 648-652, doi: 10.1111/vsu.12335.

Eyarefe, O. D. (2016). Risk factors, prevention and control strategies for surgical site infections in veterinary practice in Nigeria-A review. Journal of Veterinary Medicine and Animal Health, Vol: 8(8), pp: 72-82, doi: 10.5897/JVMAH2015.0434.

Hillier, A., Lloyd, D. H., Weese, J. S., Blondeau, J. M., Boothe, D., Breitschwerdt, E., & Sykes, J. E. (2014). Guidelines for the diagnosis and antimicrobial therapy of canine superficial bacterial folliculitis (Antimicrobial Guidelines Working Group of the International Society for Companion Animal Infectious Diseases). Veterinary dermatology, Vol: 25(3), pp: 163, doi: 10.1111/vde.12118.

Research.utexas.edu. (2017). Cite a Website - Cite This For Me. Research.utexas.edu. Retrieved 10 November 2017, from https://research.utexas.edu/wp-content/uploads/sites/3/2015/12/guideline06.pdf

Turk, R., Singh, A., & Weese, J. S. (2015). Prospective surgical site infection surveillance in dogs. Veterinary Surgery, Vol:  44(1), pp: 2-8, doi: 10.1111/j.1532-950X.2014.12267.x.

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