Sterile procedures during surgeries

RE: Sterile procedures during surgeries

Anthony Todd — Thu, 08 Sep 2016 17:28:17 GMT

[quote user="Martin Atkinson"]the work experience student and anyone who may wonder in or out, [/quote]

Sorry, couldn't resist the typo! Is it the lack of gloves or the speed of the atraumatic surgery which gives rise to the "wonder"?

[quote user="Martin Atkinson"]This is clear from my experience of virtually no problems.[/quote]

But. as has been dogmatically stated, you are flatulating into a hurricane of dogma based on no evidence at all.

RE: Sterile procedures during surgeries

Martin Atkinson — Thu, 08 Sep 2016 16:25:15 GMT

[quote user="Julian Earl"]If we aren't going to try to keep our hands aseptic, why do we bother to use sterile instruments? Why do we use sterile drapes? [/quote]We are not saying we are not keeping our hands aseptic I scrub mine with chlorhexidine, and using sterile instruments which are in direct contact with the surgical site is just common sense, just that until you are using a totally sterile operating theatre with filtered air and all personnel who are in there, including the nurse doing the anaesthetic, the work experience student and anyone who may wonder in or out, gloves, sterile gowns and masks are not going to lower the risk of wound infection. This is clear from my experience of virtually no problems.

RE: Sterile procedures during surgeries

Hannah Wynne Richards — Wed, 07 Sep 2016 17:51:16 GMT

The immune system may overcome the infection of contaminated wounds..............but this won't always happen.

Wynne

RE: Sterile procedures during surgeries

Julian Earl — Wed, 07 Sep 2016 17:47:19 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Julian Earl"]Evelyn; I know no offence was meant, really I do!, but surely the logic is that dogs have developed innate resistance to their commensal-Staphs var canis that they are exposed to via traumatic skin wounds. Cats against var felis etc. etc. Human commensals are only likely to be opportunistic for the host and so we have innate immunity against our commensals but unless there is marked antigenic simlarity between dog's Saphs and human's Staphs why should dogs have innate immunity for human=based Staphs? [/quote]

Sorry Julian I think I thought you were making the opposite point. Why indeed would a dog have innate immunity to a human-commensal Staphylococcus? All the more reason to try to keep human commensals out of dog wounds.

Not to mention the desirability of keeping human epidermal cells, hairs and incidental contaminant micro-organisms out. Not even to mention that the innate immunity which results in a dog tolerating doggy Staphylococcus in its skin does not necessarily imply an innate immunity which will render that Staphylococcus absolutely inert and unreactive and innocuous when it is inoculated into deeper tissues.

If we aren't going to try to keep our hands aseptic, why do we bother to use sterile instruments? Why do we use sterile drapes?

I I did not Clearly, "generic" pathogens will exist on instruments even on human skin but they are, I thought, less pathogenic than bacterial species from a the usual host I really will stop now, because I cause I feel that I'm digging a difficult hole from which to argue my case! A Lack of EBM indeed?

I cannot be the only one to have seen contaminated and non-aseptically-prepared wounds not sustain post-operative infection? So the body can often cope in any event. Not sure I'd want to go without drapes though or sterile instruments!

[/quote]

RE: Sterile procedures during surgeries

Anthony Todd — Wed, 07 Sep 2016 11:39:11 GMT

[quote user="Martin Atkinson"]One could argue that the reason they interfered with them was because they were infected and sore to start with but as 99.9% don't have a problem this is probably no the case.[/quote]

Last word, and I was hoping it would get to this.

I think it's in this order; wound irritation [99/100 stitches too tight or tissue trauma] cat licks wound, transfers pathogens from mouth, giving wound infection.

Which is why some put collars on C/S, a sure suspicion of "traumatic" tissue handling or stitching

[sigh] yet another single star.....

RE: Sterile procedures during surgeries

Martin Atkinson — Wed, 07 Sep 2016 09:31:09 GMT

[quote user="Anthony Todd"]Dunno who "Atko" is but it's not me, in that I would regard wound swelling the beginning of an infection and the animal would soon turn any irritation at all into an "infection" and they didn't and we never used a buster collar either....[/quote]Its moi! And I don't ever recall arguing with Malcolm that redness and inflammation of a wound wasn't a possible infection it clearly could be although no doubt Mr Mills will be sad enough to go into the archives and find the post to prove me wrong (he's never going to get the hand of my daughter at this rate), just that despite my appalling hygiene standards the fact that I boasted I apparently got less wound infections than he did pissed him off.

And in answer to your question in another post Anthony, the only wound infections I see are from cat spays that have interfered with their wounds. One could argue that the reason they interfered with them was because they were infected and sore to start with but as 99.9% don't have a problem this is probably no the case.

RE: Sterile procedures during surgeries

Anthony Todd — Wed, 07 Sep 2016 00:38:21 GMT

[quote user="David Mills"]“For me, it is far better to grasp the Universe as it really is than to persist in delusion, however satisfying and reassuring.”[/quote]

And I am, why don't you and others do the same?

RE: Sterile procedures during surgeries

Evelyn Barbour-Hill — Wed, 07 Sep 2016 00:28:35 GMT

If we aren't going to try to keep our hands aseptic, why do we bother to use sterile instruments? Why do we use sterile drapes?

RE: Sterile procedures during surgeries

David Mills — Tue, 06 Sep 2016 23:38:40 GMT

[quote user="Anthony Todd"]Not in "our" cat-spays, what, that's 276, at least, we sure would remember that, even if they were only "red and sore"[/quote]

“For me, it is far better to grasp the Universe as it really is than to persist in delusion, however satisfying and reassuring.”

Carl Sagan

RE: Sterile procedures during surgeries

grumpyoldman — Tue, 06 Sep 2016 22:25:55 GMT

I lost a large chunk of the index finger of my right hand from a Bartonella Henselae cat scratch mess about 20 years ago . Wore gloves for everything ever since . Had to at the start, single handed and did not want to give anything peritonitis but had to earn a living. Just carried on from there.

I just remember how easy it is for some thoughtless twat with a feral cat to get into your consult room without telling you and then laugh their tits off as it shreds you hand and forearm. Before parting with the immortal quip "vets should expect to get bitten and scratched".

RE: Sterile procedures during surgeries

Julian Earl — Tue, 06 Sep 2016 22:06:26 GMT

Evelyn; I know no offence was meant, really I do!, but surely the logic is that dogs have developed innate resistance to their commensal-Staphs var canis that they are exposed to via traumatic skin wounds. Cats against var felis etc. etc. Human commensals are only likely to be opportunistic for the host and so we have innate immunity against our commensals but unless there is marked antigenic simlarity between dog's Saphs and human's Staphs why should dogs have innate immunity for human=based Staphs?

I'm going to finish here; this discussion could go round in circles for ages I suspect [for 50 years or more perhaps?

RE: Sterile procedures during surgeries

Anthony Todd — Tue, 06 Sep 2016 20:47:38 GMT

[quote user="David Mills"]Atko got handed his arse by Malcolm Ness about a year ago on here as he doesn't class swelling along the wound as an infection[/quote]

Dunno who "Atko" is but it's not me, in that I would regard wound swelling the beginning of an infection and the animal would soon turn any irritation at all into an "infection" and they didn't and we never used a buster collar either....

[quote user="David Mills"]infection rate at about 1-3% because of their rigorous criteria. [/quote]

Not in "our" cat-spays, what, that's 276, at least, we sure would remember that, even if they were only "red and sore"; cats would have the stitches out very quickly, wound open. owner back and very "upset"!

RE: Sterile procedures during surgeries

Anthony Todd — Tue, 06 Sep 2016 20:35:52 GMT

Trouble is there just isn't any evidence that not wearing gloves in veterinary surgery causes all these terrible events, just supposition and extrapolation from the human field.

If there is, show me, or quote the reference.

Contrarily there is a lot of anecdotal evidence from back-in-the-day, and even now, that it didn't or doesn't, and was, and is, just fine.

Even today some veterinary surgeons, still do not wear gloves and their results, as far as post-op infection, and as far as I know, are as good as those that do.

I still am saying that wearing gloves, as they do in human medicine and on TV in veterinary programs, is a very good thing and essential for public perception, but do not try to clad it with some scientific justification.

[quote user="Michael Woodhouse"]I've had farm vets tell me they can't calve cows with gloves on due to lack of feeling. They are wrong! Yes its different, but very quickly it comes to the point where handling tissue without gloves feels more wrong.[/quote]

I still remember the difference, and this was with the comparatively heavy PR full length gloves which I used day on day.

You do get used to them, and can palpate with perception, but this was for the benefit of our social life and not of benefit to anything else, certainly not the cow.....

Very similar to hand washing after lavatorial visits, come to think of it, and for "cleansings" [retained placenta] but let's not go there.....

RE: Sterile procedures during surgeries

Michael Woodhouse — Tue, 06 Sep 2016 19:33:49 GMT

Anthony Todd - what effect do you think there would be if we all stopped washing our hands after going to the toilet? We'd probably notice very little effect. Does this make it a good idea?

Some things (sterile gloves for sterile surgery) fall into the no brainer category and there is no justification for not using them. If human surgeons can sew an arteriole back together under an operating microscope - you can handle tissues well enough to separate a cat from its uterus.

I've had farm vets tell me they can't calve cows with gloves on due to lack of feeling. They are wrong! Yes its different, but very quickly it comes to the point where handling tissue without gloves feels more wrong.

RE: Sterile procedures during surgeries

David Mills — Tue, 06 Sep 2016 19:28:25 GMT

[quote user="Anthony Todd"]Martin, when was the last time you had a wound infection and why?[/quote]

Atko got handed his arse by Malcolm Ness about a year ago on here as he doesn't class swelling along the wound as an infection (whereas it is, albeit a very mild self-limiting one). Most surgical papers - done by specialists - have an infection rate at about 1-3% because of their rigorous criteria. Similarly we may all remember the abscesses and spectacular break downs but we're not talking about these, we're talking about all the reddened, sore wounds that sort themselves out - as EBH says, we don't see the walled off infection internally, and yes, most animals are fine, in spite of this. However to transmorgify this into gloves are useless is either dogma triumphing logic (being kind) or a complete absence of logical thought (being honest).

RE: Sterile procedures during surgeries

Evelyn Barbour-Hill — Tue, 06 Sep 2016 19:06:15 GMT

[quote user="Anthony Todd"] It was true then, true now and not silly, just a fact.[/quote]

Sorry, what is not silly, just a fact? Let's be clear about this.

Anthony, what do you believe happens to all the junk that your ungloved hands deposit inside a previously sterile body? And why not wear gloves?

[quote user="Anthony Todd"]Do you really think vets who don't wear gloves, then or now, would still be practising if there were all these infections most keep banging on about?[/quote]

Yes.

You've sewn it up with the muck inside, how would you know what's happening inside unless you get a raging abscess or a septicaemia or something similar and fortunately (a carefully chosen word) rare.

RE: Sterile procedures during surgeries

Anthony Todd — Tue, 06 Sep 2016 17:01:45 GMT

[quote user="Evelyn Barbour-Hill"]But people were saying this sort of stuff fifty years ago It was silly then and it's silly now.[/quote]

Yes we were, and still are. It was true then, true now and not silly, just a fact.

Do you really think vets who don't wear gloves, then or now, would still be practising if there were all these infections most keep banging on about?

Mind you, and it's maybe a factor, we always did the "sterile" ops first and the dentals, abscesses etc last and it was a golden rule.

Martin, when was the last time you had a wound infection and why?

RE: Sterile procedures during surgeries

Evelyn Barbour-Hill — Tue, 06 Sep 2016 16:48:27 GMT

[quote user="Julian Earl"] But there does seem a certain amount of logic in it that Perhaps Staphs that are commensals on human skin[ = human bacteria!] are not opportunistic enough for animal wounds? [/quote]

Not logical at all. Who can say that a few million Staphylococcus commensalis humanis var. barbourhillii deposited in a dog's normally sterile coelom or in the depths of his normally sterile semitendinosus muscle or into a mesh of his normally sterile subcutaneous areolar tissue will be completely inert, cause no reaction whatsoever, not multiply at all, in fact just disappear in a puff of smoke?

Who can say that my epidermal squames, my little hairs, my sebum and all the non-commensal bacteria, protozoans or virus particles that may be shed from my hands (even though i've washed 'em properly) are similarly utterly innocuous?

Gloves just need a little getting used to - a couple of hours should do it. If anyone finds gloves handicap them, either they are wearing bad gloves or they are wearing the wrong size (and i've tried 'em all).

[quote user="Julian Earl"]Evelyn; I am greatly offended now! I was not at college fifty years ago![/quote]

Absolutely no offence intended!

But people were saying this sort of stuff fifty years ago It was silly then and it's silly now.

RE: Sterile procedures during surgeries

Anthony Todd — Tue, 06 Sep 2016 16:45:19 GMT

[quote user="Martin Atkinson"]And they were probably the ones the owners let them lick the wounds![/quote]

True [you know cat pathogens and all that, [posts passim] but actually traumatic suturing, usually, with local skin ischaemia.

Usually if the vet, or me, was having a bad day or in a hurry.

RE: Sterile procedures during surgeries

Martin Atkinson — Tue, 06 Sep 2016 16:04:41 GMT

[quote user="Anthony Todd"]we did 2764 cat spays between 1997 and 2011 with, at a guess, because of the fuss even one caused, less than 10 "wound infections", in total.[/quote]And they were probably the ones the owners let them lick the wounds!

RE: Sterile procedures during surgeries

Anthony Todd — Tue, 06 Sep 2016 16:02:27 GMT

[quote user="Hannah Wynne Richards"]

If human and animal pathogens are so different, then we can safely tell people to ignore cat bites in future, as cat bacteria can't harm humans

Wynne

[/quote]

No but, logically, we can probably tell cats to disregard human bites, which is the point exactly in this discussion.

This thread continues to amaze me. All this emphasis on EBM yet, when there is none, yet an anecdote backed view or views conflicts with something some lecturer announced as gospel, or gets written in a textbook, it becomes beyond question.

Just to add fuel to the smouldering embers we did 2764 cat spays between 1997 and 2011 with, at a guess, because of the fuss even one caused, less than 10 "wound infections", in total.

Nobody wore gloves.

RE: Sterile procedures during surgeries

Hannah Wynne Richards — Tue, 06 Sep 2016 15:10:32 GMT

If human and animal pathogens are so different, then we can safely tell people to ignore cat bites in future, as cat bacteria can't harm humans

Wynne

RE: Sterile procedures during surgeries

Martin Atkinson — Tue, 06 Sep 2016 11:44:22 GMT

I don't wear gloves, mask, sterile gown, head cover and neither do any of my theatre staff. I don't have a dedicated sterile operating area. I do not use routine antibiosis. I am sole charge and there are no more than 2 other people present in the theatre. I have a vanishingly small number of post-op wound infections (2-3 per annum) and these are usually from animals where the owner has allowed it to interfere with its wound. What does this tell you? Certainly not that I've just got lucky for the past 40 years!

On the other hand, gloves masks and sterile gowns are available for locums if they want them

RE: Sterile procedures during surgeries

Anthony Todd — Tue, 06 Sep 2016 10:40:51 GMT

[quote user="Julian Earl"]animal pathogens [/quote]

As a sort of corollary whenever I, or anyone, had the slightest scratch or hand wound from a cat wound infections in most cat ops, until healing, were almost certain.

RE: Sterile procedures during surgeries

Julian Earl — Tue, 06 Sep 2016 10:30:45 GMT

Evelyn; I am greatly offended now! I was not at college fifty years ago! But there does seem a certain amount of logic in it that Perhaps Staphs that are commensals on human skin[ = human bacteria!] are not opportunistic enough for animal wounds? But I do accept that as a mixed practitioner I may have animal pathogens on my skin, hence the importance of thorough scrubbing up of course!

Regarding gloves, I certainly did find that gloves hindered my sensitivity when I first wore them but I think one has to adapt to it I found knot-tying more tricky/ tissue-texture harder to detect annd so on.