What is really unprofessional?

RE: What is really unprofessional?

Rob Loxley — Tue, 03 Oct 2017 13:31:28 GMT

[quote user="Beats"]That intubeaze nozzle and the dental scaling machine would be my biggest concerns.[/quote]

Both disinfectable/sterilisable

RE: What is really unprofessional?

Martin Atkinson — Tue, 03 Oct 2017 10:15:08 GMT

[quote user="Beats"]I do worry about spreading viruses about in cats. That intubeaze nozzle and the dental scaling machine would be my biggest concerns.[/quote]One of the reasons I don't use intubeaze - we use disposable blunt needle on a syringe filled with local anaesthetic. As for the dental scaler - anyone is as guilty as the multi-cat spay set users if they don't sterilise that between uses.

RE: What is really unprofessional?

Bob Russell — Tue, 03 Oct 2017 09:31:44 GMT

Years ago the Radio 2 vet, Eddie Stratton got into really hot water with the RCVS because he talked about spay races on the Jimmy young programme.

At least he was not reusing his kits!

Am I the only one that considers that an undercover investigation such as the Medivet one would create havoc should this practice be filmed? Does not matter if it is one practice or a dozen or one vet or many.

I hope this practice is not widespread nor the attitude that it is acceptable!

RE: What is really unprofessional?

Michael Woodhouse — Tue, 03 Oct 2017 00:24:39 GMT

[quote user="Beats"]I always took a fresh needle for each cow when doing herds for blood sampling - even if brucella/bvd/johnes etc can't be spread from cow-to-cow in this manner (is it really so unlikely?), I simply couldn't bring myself to use the same needle for multiple cattle (though appreciate that I used the same rectal glove happily...)[/quote]

There's a paper showing BVD spread via rectal gloves (it's not a great paper but still).

In most herds I will use a needle a few times for blood sampling, in the same way the farmer would when vaccinating the herd. I wouldn't dream of using the same needle on different farms.

[quote user="Beats"]I do worry about spreading viruses about in cats. That intubeaze nozzle [/quote]

I had similar thoughts - top tip they are NOT autoclavable!

[quote user="Martin Atkinson"]I wonder how BSE and TB are transmitted?![/quote]

BSE was via prions in nervous tissue hence throwing away the brains and spinal cords with the rest of the animal being safe to eat. TB is mainly spread in droplets from cattle (also urine from badgers), reusing a needle on farm not thought to be a risk.

RE: What is really unprofessional?

Beats — Mon, 02 Oct 2017 20:30:48 GMT

It is mere heresay, but I was told during the last outbreak of Swamp fever in ireland that one could plot a neat wee map following a vet around his calls without changing a needle - who needs mosquitos, eh?

I always took a fresh needle for each cow when doing herds for blood sampling - even if brucella/bvd/johnes etc can't be spread from cow-to-cow in this manner (is it really so unlikely?), I simply couldn't bring myself to use the same needle for multiple cattle (though appreciate that I used the same rectal glove happily...)

I do worry about spreading viruses about in cats. That intubeaze nozzle and the dental scaling machine would be my biggest concerns.

RE: What is really unprofessional?

Martin Atkinson — Mon, 02 Oct 2017 15:53:25 GMT

[quote user="Michael Woodhouse"]I'd think nothing of using the same kit to vasectomise a number of rams or use the same scalpel to cut a batch of calves all under the same ownership. Everything starts off sterile.[/quote]I wonder how BSE and TB are transmitted?!

[quote user="Bob Russell"]I would suspect the owners taking their cats in for a £30 spay would still be horrified![/quote]Sadly people who want everything on the cheap haven't heard the adage 'you get what you pay for'. We do loads of £35 cat spay for charity and every single one is treated as though it belongs to a full paying customer: pre mediated with bupragesic/alpha 2, IV propofol, intubated, monitored with capnograph,clearly a sterile set, monitored in heated kennel until fully recovered and coughed tube,post op analgesia. Even at £75 I'm sure if I worked out overheads and my time into that I'm making a loss.

RE: What is really unprofessional?

Bob Russell — Mon, 02 Oct 2017 15:40:30 GMT

[quote user="Richard Carter"]

try not mix up opinion with fact.

What is the infective dose of FeLV? What is the infective dose of FIV? Does any virus of any significant number live and survive in the blood stream? Does blood transfer/ contamination constitute a risk? How ill does the 'donor' animal have to be to constitute a risk?

If / when we have answers to these then we can make statements like 'unprofessional'. Having started in a farming/ rural back ground where using the same kit for multiple animals would be normal, do find some of the 'window dressing' to be a bit tiresome. Yes - it is better practice to use fresh sterilised kits between operations and in small animal practice may be the expected norm but as professionals we should be aware of and be able to assess the risk for the species, the situation or procedure (eg supf wounds or inside a body cavity), the diseases prevalent to the area, the methods of cleaning/ sterilising used

Can we have a bit more science please.

[/quote]

So it is acceptable to have a row of anaesthetised cats and move from one to another using the same kit?

It might be cheap and 'efficient' but is it acceptable practice?

Farm animals may be a bit different. Even there I would not use the same kit for more than one procedure (exception might be scalpel blade that only touches tissue to be removed but even then it would go into disinfectant between animals). The farmer would also be very aware of what was done.

Are general surgical standards "window dressing"? I don't know what volume of blood is required to pass on FIV. Pretty unlikely that the vet would be blamed for its transmission anyway as no right minded person would think the same kit was used for multiple animals. Even 30 years ago I did not see this but it seems to be considered OK now?

I would suspect the owners taking their cats in for a £30 spay would still be horrified!

RE: What is really unprofessional?

Anthony Todd — Sat, 30 Sep 2017 14:37:48 GMT

[quote user="Jill Butterworth"]I remember reading an article about MRSA and Kennel Cough, and one of the major factors was that older vets weren't washing their hands properly, and wouldn't be told...[/quote]

Got the reference please?

I made a point of always washing my hands between consults, in front of the client, and, AFAIK, we all did, unlike our medical friends, a consultant opthalmologist told me.

RE: What is really unprofessional?

Michael Woodhouse — Sat, 30 Sep 2017 13:36:16 GMT

[quote user="Richard Carter"]Having started in a farming/ rural back ground where using the same kit for multiple animals would be normal, do find some of the 'window dressing' to be a bit tiresome.[/quote]

I'd think nothing of using the same kit to vasectomise a number of rams or use the same scalpel to cut a batch of calves all under the same ownership. Everything starts off sterile.

I wouldn't chose to re-use the same kit on animals from different households, but I can't see a theoretical problem for littermates for example.

The study linked is very interesting and somewhat at odds with people phoning around to ask how much a cat spey costs. I think some of the owner expectation comes from what they've seen on TV and have no knowledge over the mechanisms of infection transfer. I'd be quite happy getting sutures from a roll that was handled according to aseptic practice.

RE: What is really unprofessional?

Lindsey Edwards — Sat, 30 Sep 2017 13:02:19 GMT

I would be very concerned if they were 'unwashed' but if cold sterilised according to guidelines (pre-cleaned, appropriate concentration and time in solution) then much less so. Bear in mind much endoscopic equipment is prepared in both human and veterinary fields in this manner!

RE: What is really unprofessional?

Richard Carter — Sat, 30 Sep 2017 10:01:45 GMT

try not mix up opinion with fact.

Can we have a bit more science please.

RE: What is really unprofessional?

Jill Butterworth — Sat, 30 Sep 2017 09:11:45 GMT

My God, that's shocking. I haven't seen reuse of kits for over 30 years. To save time/cost of packaging, it can be cleaned and put on the tray and used straight out of the steriiser. Like many things, its a behaviour issue (nurse and vet), not availability of equipment.

I remember reading an article about MRSA and Kennel Cough, and one of the major factors was that older vets weren't washing their hands properly, and wouldn't be told...

RE: What is really unprofessional?

niall morton — Fri, 29 Sep 2017 14:03:55 GMT

Completely agree

RE: What is really unprofessional?

Anthony Todd — Fri, 29 Sep 2017 13:49:41 GMT

CLINICAL SIGNIFICANCE:

These results suggest that attempts should be made to understand and improve the disparity that exists between small animal pet owners and veterinary surgeons in Great Britain.

"Clinical" is a massive stretch, but PR as I've always maintained, is even more important.

I suspect that clients' frequent question "aren't you going to give it an injection", well understood by most dinovets, would achieve similar results if polled.

RE: What is really unprofessional?

niall morton — Thu, 28 Sep 2017 23:33:28 GMT

Thanks Malcolm

RE: What is really unprofessional?

Malcolm Ness — Thu, 28 Sep 2017 23:31:20 GMT

JSAP 2009 Sep;50(9):478-87. doi: 10.1111/j.1748-5827.2009.00787.x.

Survey of pet owners' expectations of surgical practice within first opinion veterinary clinics in Great Britain.

Demetriou, Geddes and Jeffery.

Abstract

OBJECTIVES:

The expectations of small animal pet owners in Great Britain were evaluated on a number of issues regarding aseptic practice and clinical management and compared with final year veterinary students' assessment of actual veterinary practice.

MATERIALS AND METHODS:

A survey was completed by 328 small animal pet owners and 56 veterinary practices in Great Britain. Questions from the pet owner survey related to expectations and opinions on a number of surgical issues and questions from the veterinary surgeon survey examined veterinary practice in relation to the same issues. Comparisons were made to determine whether there were any differences between pet owner expectations and veterinary student assessment of actual practice of small animal first opinion clinics.

RESULTS:

In the majority of issues examined there was a significant mismatch between client expectation and provisions made. Of particular importance was the discrepancy regarding the use of surgical gloves and administration of analgesia.

CLINICAL SIGNIFICANCE:

These results suggest that attempts should be made to understand and improve the disparity that exists between small animal pet owners and veterinary surgeons in Great Britain.

RE: What is really unprofessional?

niall morton — Thu, 28 Sep 2017 23:01:06 GMT

Don't suppose anyone has a link for that one?? Sounds like a good read

RE: What is really unprofessional?

Malcolm Ness — Thu, 28 Sep 2017 13:52:15 GMT

It shouldn't happen and it certainly shouldn't happen without the full knowledge and consent of the client.

A few years ago, Nick Jeffery and some others (students, I think) published a paper in I think JSAP that looked at routine bitch spies in primary care practice and compared client expectations (i.e. what they assumed was being done) with reality. Interesting reading!

RE: What is really unprofessional?

Bob Russell — Thu, 28 Sep 2017 13:45:30 GMT

Not sure how recently this was but story was not from someone entering their dotage so cannot have been too long ago!

I would like to believe it never happened anywhere!

RE: What is really unprofessional?

Iain Richards — Thu, 28 Sep 2017 12:59:19 GMT

Assuming that, "the same kit" means "the same kit, uncleaned and sterilised between procedures" I'm struggling to find any justification for this behaviour, so I'd say that, yes it is unprofessional. I'd go further, if the pratice is in the UK then the behaviour is such that it could bring the professsion into disrepute. Even a pan of boiling water would help, which I've done on farm before now. A colleague had their instruments in a pressure cooker in their car to re-sterilise between ops.

RE: What is really unprofessional?

Martin Atkinson — Thu, 28 Sep 2017 12:54:37 GMT

Sadly clients who are attracted there in the first place won't care if the outcome is the same, they just think those of us who do things properly are charging excessively for the same procedure. And if something goes belly up the practice will be well versed in charm and bovine faecal matter to fob them off.

RE: What is really unprofessional?

Neil Wheadon — Thu, 28 Sep 2017 12:51:38 GMT

[quote user="Bob Russell"]Assuming that some patients will be infected with FIV and or possibly FeLV is this professional and should owners be made aware of this practice?[/quote]

Yes, but I have worked in 'budget practices' and haven't seen this recently.

The only place was 20 years ago, and was in London (the only time I've ever worked in the capital) I was presented with 10 cats in cat cages in a pyramid and asked to neuter them all with 4 kits. I had them sterilised, but suspect that wasn't the norm.

Neil