Observational study of patient and surgeon preoperative preparation in ten companion animal clinics in Ontario, Canada

BMC Veterinary Research

J Scott Weese¹  Brittany A Foster²  Maureen E C Anderson¹ 

[1] Department of Pathobiology, University of Guelph, Guelph, Ontario N1G 2W1, Canada;Biological Sciences Department, University of New Orleans, New Orleans, LA 70148, USA

关键词: Video observation;    Hand antisepsis;    Surgical site antisepsis;    Companion animal;    Disinfection;    Surgery;    Veterinary;   

Others  :  1119444
DOI  :  10.1186/1746-6148-9-194

 received in 2013-04-25, accepted in 2013-09-25,  发布年份 2013

【 摘 要 】

Background

Surgical site infections (SSIs) are a recognized risk of any surgical procedure in veterinary medicine. One of the keys to prevention of SSIs is reducing exposure of the surgical site to endogenous and exogenous microbes, beginning in the preoperative period. While guidelines are available for preoperative preparation procedures, there has been no objective investigation of compliance with these recommendations in veterinary practices. The objectives of this pilot study were to describe preoperative patient and surgeon preparation practices in a sample of non-equine companion animal veterinary clinics, and to determine if there were any areas that consistently did not meet current guidelines.

Results

Observation of preparation practices was performed in 10 clinics over 9–14 days each using up to 3 small wireless surveillance cameras. Data were coded for 148 surgical patients, and 31 surgeons performing 190 preoperative preparations. When patient hair removal was observed, it was most commonly done using clippers (117/133, 88%), and in only one case was it performed prior to anesthetic induction. Patient contact time with soap ranged from 10-462 s (average of clinic means 75 s, average of clinic medians 67 s), and with alcohol from 3-220 s (average of clinic means 44 s, average of clinic medians 37 s). Alcohol-based hand rub (AHR) was used preoperatively in 2/10 facilities, but soap-and-water hand scrub was most commonly used at all clinics. Proximal-to-distal scrubbing was noted in 95/142 (67%) of soap-and-water scrubs. Contact time during surgeon hand preparation ranged from 7-529 s (average mean 121 s, average median 122 s) for soap-and-water and from 4-123 s (average mean 25 s, average median 19 s) for AHR. No significant changes in practices were identified over time during the observation period. Practices that did not conform to guidelines available in major companion animal surgical textbooks were commonly observed.

Conclusions

Some preoperative preparation practices were relatively consistent between clinics in this study, while others were quite variable. Contact times with preoperative preparatory solutions for both patients and surgeons were often shorter than recommended. Evidence-based guidelines for these procedures in veterinary medicine should be established and implemented in order to help reduce preventable SSIs, while maintaining efficiency and cost-effectiveness.

【 授权许可】

   
2013 Anderson et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Darouiche RO, Wall MJ, Itani KMF, Otterson MF, Webb AL, Carrick MM, Miller HJ, Awad SS, Crosby CT, Mosier MC, Alsharif A, Berger DH: Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med 2010, 362:18-26.
• [2]Nicholson M, Beal M, Shofer F, Brown DC: Epidemiologic evaluation of postoperative wound infection in clean-contaminated wounds: A retrospective study of 239 dogs and cats. Vet Surg 2002, 31:577-581.
• [3]Mayhew PD, Freeman L, Kwan T, Brown DC: Comparison of surgical site infection rates in clean and clean-contaminated wounds in dogs and cats after minimally invasive versus open surgery: 179 cases (2007–2008). J Am Vet Med Assoc 2012, 240:193-198.
• [4]Weese JS: A review of post-operative infections in veterinary orthopaedic surgery. Vet Comp Orthop Traumatol 2008, 21:99-105.
• [5]Greene LR, Mills R, Moss R, Sposato K, Vignari M: Guide to the Elimination of Orthopedic Surgical Site Infections. APIC Elimination Guide. Washington, DC: Association for Professionals in Infection Control and Epidemiology; 2010:1-80.
• [6]Hurwitz B, Dupree M: Why celebrate Joseph Lister? Lancet 2012, 379:e39-e40.
• [7]Widmer AF, Rotter M, Voss A, Nthumba P, Allegranzi B, Boyce J, Pittet D: Surgical hand preparation: state-of-the-art. J Hosp Infect 2010, 74:112-122.
• [8]Gawande A: Two hundred years of surgery. N Engl J Med 2012, 366:1716-1723.
• [9]Fossum TW: Small Animal Surgery. 3rd edition. St. Louis: Mosby; 2007.
• [10]Slatter D: Textbook of Small Animal Surgery. 3rd edition. Philadelphia: Saunders; 2002.
• [11]Tobias KM, Johnston SA: Veterinary Surgery: Small Animal. St. Louis: Elsevier Saunders; 2012.
• [12]Canadian Committee on Antibiotic Resistance: Infection Prevention and Control Best Practices for Small Animal Veterinary Clinics. 1st edition. Guelph, Ontario: Canadian Commitee on Antibiotic Resistance; 2008:1-71.
• [13]Dohoo IR, Martin W, Stryhn H: Veterinary Epidemiologic Research. 2nd edition. Charlottetown, PEI, Canada: VER Inc; 2009.
• [14]Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR: Guideline for prevention of surgical site infection, 1999. Am J Infect Control 1999, 27:97-134.
• [15]Brown DC, Conzemius MG, Shofer F, Swann H: Epidemiologic evaluation of postoperative wound infections in dogs and cats. J Am Vet Med Assoc 1997, 210:1302-1306.
• [16]Kamel C, McGahan L, Polisena J, Mierzwinski-Urban M, Embil JM: Preoperative skin antiseptic preparations for preventing surgical site infections: a systematic review. Infect Control Hosp Epidemiol 2012, 33:608-617.
• [17]Stonecypher K: Going around in circles: is this the best practice for preparing the skin? Crit Care Nurs Q 2009, 32:94-98.
• [18]Durani P, Leaper D: Povidone-iodine: use in hand disinfection, skin preparation and antiseptic irrigation. Int Wound J 2008, 5:376-387.
• [19]Tanner J: Surgical hand antisepsis: the evidence. J Perioper Pract 2008, 18:330-334. 339
• [20]Pittet D, Allegranzi B, Boyce J: The World Health Organization Guidelines on Hand Hygiene in Health Care and their consensus recommendations. Infect Control Hosp Epidemiol 2009, 30:611-622.
• [21]Girard R, Bousquet E, Carré E, Bert C, Coyault C, Coudrais S, Regard A, Garcia EL, Valdeyron ML, Pergay V: Tolerance and acceptability of 14 surgical and hygienic alcohol-based hand rubs. J Hosp Infect 2006, 63:281-288.
• [22]Parienti JJ, Thibon P, Heller R, Le Roux Y, Theobald Von P, Bensadoun H, Bouvet A, Lemarchand F, Le Coutour X, Antisepsie Chirurgicale des mains Study Group: Hand-rubbing with an aqueous alcoholic solution vs traditional surgical hand-scrubbing and 30-day surgical site infection rates: a randomized equivalence study. JAMA 2002, 288:722-727.
• [23]Weight CJ, Lee MC, Palmer JS: Avagard hand antisepsis vs. traditional scrub in 3600 pediatric urologic procedures. Urol 2010, 76:15-17.
• [24]Verwilghen D, Grulke S, Kampf G: Presurgical hand antisepsis: concepts and current habits of veterinary surgeons. Vet Surg 2011, 40:515-521.
• [25]Kampf G, Widmer AF: Scrub or rub? What is best practice for hand hygiene before surgery? Vet J 2011, 190:307-308.
• [26]Verwilghen DR, Mainil J, Mastrocicco E, Hamaide A, Detilleux J, Van Galen G, Serteyn D, Grulke S: Surgical hand antisepsis in veterinary practice: evaluation of soap scrubs and alcohol based rub techniques. Vet J 2011, 190:372-377.
• [27]European Standard EN 455–1: 2000: Medical Gloves for Single Use, Part 1: Requirements and Testing for Freedom From Holes. Berlin, Germany: DIN Deutsches Institute fur Normung; 2001.
• [28]Ersozlu S, Sahin O, Ozgur AF, Akkaya T, Tuncay C: Glove punctures in major and minor orthopaedic surgery with double gloving. Acta Orthop Belg 2007, 73:760-764.
• [29]Misteli H, Weber WP, Reck S, Rosenthal R, Zwahlen M, Fueglistaler P, Bolli MK, Oertli D, Widmer AF, Marti WR: Surgical glove perforation and the risk of surgical site infection. Arch Surg 2009, 144:553-558.
• [30]Dodds RD, Guy PJ, Peacock AM, Duffy SR, Barker SG, Thomas MH: Surgical glove perforation. Br J Surg 1988, 75:966-968.
• [31]Palmer JD, Rickett JW: The mechanisms and risks of surgical glove perforation. J Hosp Infect 1992, 22:279-286.
• [32]Character BJ, McLaughlin RM, Hedlund CS, Boyle CR, Elder SH: Postoperative integrity of veterinary surgical gloves. J Am Anim Hosp Assoc 2003, 39:311-320.
• [33]Holden JD: Hawthorne effects and research into professional practice. J Eval Clin Pract 2001, 7:65-70.
• [34]Kohli E, Ptak J, Smith R, Taylor E, Talbot EA, Kirkland KB: Variability in the Hawthorne effect with regard to hand hygiene performance in high- and low-performing inpatient care units. Infect Control Hosp Epidemiol 2009, 30:222-225.