Surgical Aseptic Protocols

This pilot study described preoperative patient and surgeon preparation in 10 small animal veterinary clinics. With staff knowledge, wireless surveillance cameras were placed in 10 clinics for 9–14 days. A video coding scheme coded 148 surgical patients with 31 surgeons and 190 preoperative preparations. Data recorded included hair removal method, scrub pattern, and solution contact time.

Hair removal was performed as recommended in a preparation area in 9/10 practices but was routinely done in the OR in one practice; however, the main variation in both patient and surgeon preparation was antiseptic contact time, which was often shorter than recommended. For patients, contact time with soap ranged from 10–462 seconds and with alcohol from 3–220 seconds. For surgeons, hand preparation using soap and water contact time ranged from 7–529 seconds; for alcohol-based hand rub, the range was 4–123 seconds.

Reviewed texts recommended contact times for patient preparation ranging from 0.5–3 minutes, emphasizing adherence to the antiseptic manufacturer’s instructions. For surgeon preparation with soap and water, recommendations were 2–7 minutes. The more recent publications promoted the use of alcohol-based surgical hand rub, with recommended contact times of 1.5–2 minutes. Textbooks also recommended either chlorhexidine or povidone iodine for patient preparation. More evidence-based guidelines for surgical preparation and increased awareness of and adherence to guidelines are needed.

Commentary

How many of us still scrub our hands and patients exactly as we were taught in veterinary school? Most practices studied used recommended antiseptic chemicals. Most also used concentric circle preparation for the surgical site, but not consistently. Contamination of the surgical site was noted in 36% of patients during transport from the preparation area to the OR. Few study surgeons used alcohol-based hand scrub, despite it being recommended by the World Health Organization as superior and cheaper.

Staff members were aware of the cameras and no difference was seen in preparation methods at the beginning or end of the study, so these results are likely accurate. Specific training, per guidelines in current veterinary surgery textbooks, in proper patient preparation for aseptic technique should be performed regularly to avoid complacency.—Jonathan Miller, DVM, MS, DACVS

Source

Observational study of patient and surgeon preoperative preparation in ten companion animal clinics in Ontario, Canada. Anderson MEC, Foster BA, Weese JS. BMC VET RES 9:194, 2013.