Veterinary Surgical Nursing

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Veterinary Surgical Nursing

• PRINCIPLES OF ASEPSIS

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Asepsis

• A-sepsis
• To be without infection
• But not necessarily without presence of all
  infectious organisms
• Doing enough to prevent routine infections

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Varying degrees of asepsis

• Antiseptic
• Degree of kill achieved on living biological
  surfaces
• Povidone iodine
• Chlorhexidine
• Disinfectant
• Degree of kill achieved on inanimate surfaces
  (floors, walls, equipment)
• Bleach
• Quaternary ammonium compounds
• Sterilising agent
• Full kill achieved with sterilising agent (if
  properly used)
• Steam heat
• Dry heat
• Ionising radiation
• Ethylene oxide
• Glutaraldehyde

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Introduction

• Wounds of all types are prone to contamination
  and the eventual development of sepsis or
  infection.
• Nowadays, most people expect to survive surgery,
  however until this century the mortality rate for
  even simple procedures was high due to wound
  infections and shock. 

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Antisepsis

• Antisepsis means the killing of micro-organisms
  within living tissue.  (eg treating a
  contaminated wound).
• In 1865 the surgeon, Lister, introduced the
  concept of antisepsis by applying  a mild
  solution of carbolic acid (phenol) to wounds and
  dressings circumventing, in many cases, the need
  to amputate limbs because of infection. 

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1865

• Joseph Lister
• Reduced surgical mortality ratesfrom 50 to 15
• Sprayed carbolic acid around operating theatres
  and onto wounds

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Aseptic technique

• Aseptic technique means establishing conditions
  that prevent the contamination of surgical
  wounds. As a veterinary nurse you play a crucial
  role in its implementation and maintenance.
• In practice it is not possible to totally
  eliminate micro-organisms falling into the wound.
  However, there is a level of contamination which,
  when exceeded, will lead to infection. This level
  will vary between animals and is dependant on the
  competency of their immune system. This may be
  impaired by factors such as concurrent disease
  (eg renal failure, drugs, stress and tissue
  trauma at the site of the wound).

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Sources of infection

• Environment (incl equipment)
• Patient
• Personnel

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Environmental Sources

• Room and its contents
• Atmosphere
• Surgical equipment

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Patient Sources

• Skin
• Cavities
• Alimentary tract
• Respiratory tract
• Urogenital tract
• Patient-sourced infection may be
• Direct (via contact)
• Indirect (via blood or lymph stream)

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Personnel Sources

• Clothing
• Hands, Hair
• Exhaled gases

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Sterile Field

• Any areas draped
• e.g. anything green
• But also paper/plastic drapes
• Gowns
• Also gloves, instruments, swabs, saline
• Includes areas vertically above these fields

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Wound contamination
Clean A surgical wound made under aseptic conditions. There is no break into a contaminated area such as the respiratory or gastrointestinal tract.
Clean-contaminated Where a contaminated area is entered but without spillage or spread of contamination (i.e. respiratory, gastrointestinal or urogenital tract)
Contaminated Where there is spillage from a viscus or severe inflammation is encountered, but no infection present. Open fresh traumatic wounds e.g. HBC or animal bite.
Dirty Infection where there is pus present or viscus perforation spilling pus. Traumatic wound containing devitalised tissue or foreign bodies
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GOLDEN RULESOF ASEPSIS
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Confinement

• Surgical team members remain within sterile area
• Movement out of the sterile area may encourage
  cross contamination
• The entry of personnel into operating theatre
  greatly increases (x100) the number of air borne
  particles

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Talking

• Talking is kept to a minimum
• Talking releases moisture droplets laden with
  bacteria

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Movement

• Movement in the operating room or by personnel is
  kept to a minimum
• Only necessary personnel should enter the
  operating room
• Movement may cause turbulent airflow and result
  in cross contamination

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Areas Over sterile field

• Non-scrubbed personnel do not reach anywhere over
  sterile fields
• Dust, lint or other carriers of bacteria may fall
  on sterile field

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Face each other

• Scrubbed team members face each other and the
  sterile field at all times
• A team members back is not considered sterile
  even if wearing a wrap-around gown

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Sterile equipment

• Equipment used during surgery must be sterilised
• Unsterile instruments may be a source of
  cross-contamination

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Handling sterile equipment

• Only scrubbed personnel handle sterilised
  equipment
• Risk of cross-contamination

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Doubtful instrument sterility

• If sterility of an item is questioned it is
  considered contaminated

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Table height

• Sterile tables are only considered sterile at
  table height
• Items hanging over the table edge are considered
  non-sterile because they are out of the surgeons
  vision

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Gowns

• Gowns are sterile from mid chest to waist and
  from gloved hand to 5 cm above the elbow
• Back of a gown not considered sterile even if
  wrap-around

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Moisture proof drapes

• Drapes covering instrument tables and patient
  should be moisture proof
• Moisture carries bacteria from a non-sterile
  surface to a sterile surface (strike-through
  contamination) can happen within a minute

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Packet edges

• If a sterile object touches the sealing edge of
  the pouch that holds it during opening, it is
  considered contaminated
• Sealed edges are not sterile

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Damaged or wet wrappers

• Sterile items within a damaged or wet wrapper are
  considered contaminated
• Contamination by perforation or moisture strike
  through

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Body posture

• Do not fold hands into the axillary region or
  dangle on sides
• Rather clasp hands in front of the body above the
  waist

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Seating

• If the surgical team begins surgery sitting then
  they should remain seated until surgery
  completion
• Surgery field only sterile from table height to
  chest movement from sitting to standing may
  bring bacteria onto sterile field

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Scheduling

• Schedule contaminated surgery last
• Abscesses
• Bite wounds
• Dentals

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More ideal principles

• Staff shower before surgery
• Scrub suits used
• Positive pressure ventilation of theatre
• Sterile air flows away from sterile field

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The End