Theatre cleaning protocols

Re: Theatre cleaning protocols

Rob Loxley — Wed, 14 Nov 2012 22:21:10 GMT

[quote user="CatherineThomas"]even cat spays have the socks put on[/quote]

I think you can go too far...

Re: Theatre cleaning protocols

Niall Taylor — Wed, 14 Nov 2012 22:05:58 GMT

[quote user="Michael Woodhouse"] I bet there is a sweepstake how far they can push things. Do you have to do the op list in alphabetical order?[/quote]

LOL

Baby socks!!! - jeeez oh!

Niall

Re: Theatre cleaning protocols

CatherineThomas — Wed, 14 Nov 2012 21:29:49 GMT

We're doing this for every op - so even cat spays have the socks put on. I'm going to suggest that we save it for just the long ops. That's a good idea about pre-op heat pads. Maybe if I suggest we do this instead the nurses will be happier.

Re: Theatre cleaning protocols

Claire Fisher — Wed, 14 Nov 2012 20:35:07 GMT

[quote user="CatherineThomas"]

Another thing we want to change is the preparation for surgery, this seems to take forever too. One of the things they do is put baby socks on every animal under ga to prevent heat loss. Does anyone else do this?

[/quote]

Not for every op but for we do for things like ex-laps that are likely to be out for a long time. The main thing we started doing to reduce postop hypothermia was putting heat pads in the kennels straight away rather than just post op - I think the vasodilation with ACP meant they were getting cold before they were even induced.

Re: Theatre cleaning protocols

Michael Woodhouse — Wed, 14 Nov 2012 19:58:31 GMT

[quote user="CatherineThomas"]

[/quote]

I bet there is a sweepstake how far they can push things. Do you have to do the op list in alphabetical order?

Re: Theatre cleaning protocols

CatherineThomas — Wed, 14 Nov 2012 19:28:13 GMT

We have heat pads too for all ops and microwavable heat pads for recovery. The socks just go on their paws, I don't think it is really of any use.

Re: Theatre cleaning protocols

Martin Atkinson — Wed, 14 Nov 2012 19:18:33 GMT

[quote user="CatherineThomas"]

[/quote] I put small animals or prolonged ops on a heated pad but I'm struggling to think how much of a dog you'd get in a baby sock!

Re: Theatre cleaning protocols

CatherineThomas — Wed, 14 Nov 2012 18:12:59 GMT

Re: Theatre cleaning protocols

CatherineThomas — Wed, 14 Nov 2012 18:05:37 GMT

The nurses were given the job of deciding on theatre protocols a while ago when our previous head vet was with us. She just let them decide and none of us had any input. So now we are all getting fed up of the time all of this takes up and want to change it but we have to tread very carefully so as not to upset the nurses who devised these protocols.

Re: Theatre cleaning protocols

Martin Atkinson — Wed, 14 Nov 2012 17:51:17 GMT

[quote user="Michael Woodhouse"]

[quote user="CatherineThomas"]We're not allowed to keep anything in theatre, I think this also adds to the extra time needed in the mornings. It means that all kits,gloves, hand towels, suture materials etc needed for the ops have to be put in theatre in the morning, obviously after they have dampdusted. Every other practice I have been in store their surgical equipment in theatre.[/quote]

I think the nurses need a good talking to!

[/quote] Presumably they didn't formulate this protocol off the top of their heads - they were either told by a vet or one went on a CPD course and got a bit pedantic about what they were taught. If you don't like the protocol tell 'em to change it, who's in charge around there anyway? OK if you value your head perhaps best not to be directly confrontational with nurses but you get the drift?

Re: Theatre cleaning protocols

Michael Woodhouse — Wed, 14 Nov 2012 17:32:42 GMT

I think the nurses need a good talking to!

Re: Theatre cleaning protocols

CatherineThomas — Wed, 14 Nov 2012 14:40:52 GMT

We're not allowed to keep anything in theatre, I think this also adds to the extra time needed in the mornings. It means that all kits,gloves, hand towels, suture materials etc needed for the ops have to be put in theatre in the morning, obviously after they have dampdusted. Every other practice I have been in store their surgical equipment in theatre. I think that the nurses mean well with these protocols but I think they are taken a bit far. In some cases I think it has detrimental effects, for example if we need extra equipment or decide we want a different type of suture material the nurse then has to go out of theatre to collect these items. Surely each time the door is opened and someone goes in or out we are compromising the suposed "sterility" of the room.

We also do cleaner ops first whenever possible. We do dirty surgery in the prep room and dentals in a seaparate room.

Re: Theatre cleaning protocols

Bob Russell — Wed, 14 Nov 2012 14:10:02 GMT

I have been of the view that much of the human theatre practices are to protect the staff from the patient rather than patient from surgeon.

Our operating theatre is kept very clean but is overly cluttered (being sorted at the next revamp). Infection rates are pretty much zero. We do clean procedures first and progress to dirtier (more contaminated!) procedures later.

The progression from a quick handwash after the farm visits to the sterile gowns, masks, gloves etc seems to have been driven more by TV than evidence.

Re: Theatre cleaning protocols

Rob Watkins — Wed, 14 Nov 2012 13:32:29 GMT

[quote user="Gillian Mostyn"]

we induce and prep in the treatment room but then do only a quick wipe and spray in theatre.

[/quote]

I'm intrigued why people persist in using sprays in theatre. Evidence shows that it does little more than soak the area with no significant cleaning action and indeed if the bottle is multi-use, provides an ideal contamination route.

Re: Theatre cleaning protocols

Gillian Mostyn — Wed, 14 Nov 2012 12:39:41 GMT

[quote user="CatherineThomas"]We do have a 2 scrub protocol - the patient is scrubbed in the prep room before we move to theatre and then again once in theatre, which does make sense to me.[/quote]

we induce and prep in the treatment room but then do only a quick wipe and spray in theatre. We did have one nurse who insisted on scrubbing the skin to within an inch of it's life with gauze swabs - using hundreds of swabs and leaving the skin like someone who had been in the sun all day. As I reminded her, you are only ever removing surface contamination as the skin (on the animal and indeed on our hands) can never be 'sterile' - over-scrubbing is likely to lead to far more problems with wound healing and infections. Not least because the animal is far more likely to self-traumatise the area post-op!

IMHO damp dusting in the morning is completely pointless, especially in a room that hasn't been used since it was cleaned the day before!

Re: Theatre cleaning protocols

Rob Reid — Wed, 14 Nov 2012 11:36:44 GMT

[quote user="David Mills"]

The dampdusting thing, like much of theatre protocol, comes from human surgery stuff, much of which was done in the 90s. Its a bit of an oddity, and in the vast majority of cases, I would suspect entirely useless; yet, it is still considered best practice (see BSAVA Principles of Surgery book, for instance).

I covered some of this for my CertAVP stuff and some of its quite interesting. The only things that significantly reduce contamination: hats, gowns and gloves; end of day theatre clean with trigene/virkon/bleach. Theatre scrubs - nothing; clogs - nothing; masks - complete waste of time (breathe around). Theres also a lot of evidence that one thorough scrubbing followed by a quick clean in subsequent ops is equivalent to scrubbing each time

[/quote]

Yeah that's pretty much what I found in my research for A module as well. The WHO guidlines were particularly useful I found, especially on scrubbing techniques.

http://www.jstor.org/stable/10.1086/600379

Re: Theatre cleaning protocols

Evelyn Barbour-Hill — Wed, 14 Nov 2012 11:26:55 GMT

[quote user="Anthony Dennison"]My practice is looking at getting something called sterigel (or something similar) - apparently you apply an alcohol gel up to your elbows, leave it for 90 seconds and then you're sterile (rather than scrubbing for 5 minutes).[/quote]

Disinfected a bit, maybe. Sterile, no.

If immersion in alcohol for 90 seconds sterilises, why do we bother with autoclaves?

Re: Theatre cleaning protocols

CatherineThomas — Wed, 14 Nov 2012 11:09:17 GMT

I do think our nurses take things a bit far sometimes. We also have rules that no one is allowed in theatre unless they are wearing scrubs, shoe covers mask etc this includes when it is not in use. (I often break this rule!)

We do have a 2 scrub protocol - the patient is scrubbed in the prep room before we move to theatre and then again once in theatre, which does make sense to me.

We don't seem to have problems with post-op infections.

Earlier this year my dad had an accident which resulted in a head wound. He had falled onto a dirty garden path and the wound was filled with grit and dirt. The doctor in a+e cleaned, flushed the wound and sutured it without clipping the hair around it. I was amazed that she didn't give him anti-biotics. If I had a patient with a similar wound it would have recieved anti-biotics. My dad didn't have any problems with infection afterwards. It made me think that maybe I give anti-biotics in this kind of situation more than I need to.

Re: Theatre cleaning protocols

Martin Atkinson — Wed, 14 Nov 2012 10:51:32 GMT

[quote user="CatherineThomas"]

In our practice theatre is fully cleaned down, floors mopped etc every afternoon after all ops are finished. Theatre is then shut up until the next morning. In the morning the nurses then have to "dampdust" theatre before it can be set up for that morning's ops.

We wear scrubs when we go into theatre plus hat and mask and either theatre crocs or shoe covers.

[/quote] Bloody hell! Well I have to say our cleaning protocol is pretty primitive, the op-table gets wiped down with disinfectant, the floor vacuumed and Rotawashed each day and if I nag enough shelves and equipment may get damp-dusted once every blue moon. Like Michael's ours is a long thin building so there is traffic through the theatre all day. We don't have a separate prep room (at least not one we bother using), the theatre is used for clean and dirty ops, X-rays and dentals but I work in order of most sterile first, and animals have to walk through from the kennels to be discharged. I wear non-sterile scrubs (the nurses usually wear just their standard uniforms) I don't wear gloves, mask or cap and scrub for 30-60 seconds with chlorhexidine, the surgical site is routinely cleaned with povidone-iodine 3 times with sterile swabs. I get virtually no post-op wounds infections. What am I doing right? I think there is a danger of being paranoid about sterility over surgical technique, I am convinced if you are a quick, atraumatic surgeon and the number of bodies in the room is limited this is far more important than having ultra-sterile theatre conditions. Despite my apparently lackadaisical attitude locums say that this is the cleanest practice they've been to so how bad are the others?

Re: Theatre cleaning protocols

Rob Watkins — Wed, 14 Nov 2012 10:20:14 GMT

[quote user="David Mills"]

I have wondered about why animal infection rates are so low in theatre practices that are well below the human ideal.

[/quote]

"Surgical site infections (SSIs) are the most common type of nosocomial infection among
surgical patients and are commonly caused by the patients’ own microbial flora."

Florman, et al. Am Journ of Inf Diseases 3 (1):51-61,2007

There has been a large culture change in human theatre protocols recently. Evidence based assesment has shown that the majority of the problems encountered are already present on the patient before they have walked through the door. Therefore the focus has shifted to viewing the patient as the risk to contamination rather than the theatre... SSI rates are falling quite successfully.

Re: Theatre cleaning protocols

Rob Loxley — Wed, 14 Nov 2012 00:19:27 GMT

There are a number of brushless surgical scrubs available and a fair amount of literature / reviews

Re: Theatre cleaning protocols

Anthony Dennison — Tue, 13 Nov 2012 23:40:40 GMT

My practice is looking at getting something called sterigel (or something similar) - apparently you apply an alcohol gel up to your elbows, leave it for 90 seconds and then you're sterile (rather than scrubbing for 5 minutes). Apparently the sterigel bumph includes papers showing amount of aerosols produced during scrubbing...

Anyone had any experience of these types of products?

Re: Theatre cleaning protocols

David Mills — Tue, 13 Nov 2012 23:16:39 GMT

I have wondered about why animal infection rates are so low in theatre practices that are well below the human ideal. Is it because human theatres are poorly evidence based? Or that most ops in veterinary medicine are clean electives on younger animals? Are animals better at fighting off infection? Some suggest the fact they have fur and are dirtier generally helps 'prime' the immune system but how does that help in the abdomen cf the skin? OR is it because we're a different species, different commensals etc?

In any case, I think a lot is made of theatre practice that sounds like good theory but is wholly unnecessary in veterinary practice. It is a great way of marketing yourself as of the highest standards, however, although the extent to which some referral centres go is over the top, and I would wager, has no effect on infection rates whatsoever.

Re: Theatre cleaning protocols

Michael Woodhouse — Tue, 13 Nov 2012 14:22:37 GMT

We are a long narrow building. To get through to our office you have to walk through theatre.

Use the same table to induce and operate. Sometimes take blood samples in there, set up IVs etc.

We wear sterile gloves, Henry to suck stray hair, good autoclave etc and wound infection rate of almost zero.

I know it's not ideal, but it seems to work for us.