Opinion on surgical practices

[ElvisMarie6]

I just wanted to see what you all thought about something I have recently experienced...

I have worked at one veterinary clinic for 6 years. Cleanliness has pretty much been grilled into my brain including scrubbing for every surgery and wearing sterile gowns, sterile gloves and a cap and mask. I thought this was common practice until I started to work at a second clinic over the summer. This new clinic is brand new, with state of the art equipment. I really liked the clinic until I helped with surgery for the first time. I was shocked that the doctor didn't scrub, or wear a gown, or sterile gloves, or even a mask and the technician barley scrubbed the surgery site! I know that a common excuse is that some "old school" doctors don't do this, but one of the veterinarians is a 2005 graduate! It has really been bothering me and I wanted to make sure that I wasn't over reacting... any input would be appreciated.

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[JerseyisCutest]

what type of surgery was it?
I've watched several surgeries where the doctors did nothing but maybe wear gloves and the techs cleaned the site IF it was a laceration...........but I once watched a skin graft and there was no cleaning or anything, but the dr. did wear gloves (but that's all). I know that while I was watching a cat get its fractured jaw wired back together, the dr. told me that he wasn't being very sterile because the mouth is such a dirty place anyway.

 

[birdvet2006]

I'm sorry to hear about your experience. I, too, found out the hard way that this sort of thing is not monitored or controlled in any way. Not only is it cultural (i.e. in the UK it has been traditional for many years to not wear gloves during surgery...and caps/masks/gowns are very optional, whereas most people at least scrub!), but in the USA you will find this in a few places too. Though "the best" is taught in vet school, it is not enforced.

I find it very unfortunate. It's amazing that people get away with poor surgical asepsis and still go on to have few complications. They usually do tend to use a lot of antibiotics though.

The standard/quality of medicine I demand for my own pets and of myself is similar to human medicine. Some people don't feel the same way, apparently.

 

[sofficat]

i worked at a practice where all they did was put on gloves. surprisingly i don't remember ANY post op infections (and rarely did they give antibiotics). occasionally the docs would put on a gown if it was a major surgery (giant abdominal tumor removal, etc). i asked about their protocol once and the doc said that it really doesn't matter if you scrub in or not. he said one of his mentors said you could literally spit in a surgical site and it probably wouldn't effect the animal at all.

 

[VAgirl]

Whereas, for as much as people knock Banfield sometimes, I worked at a Banfield practice where every doc scrubbed in and donned sterile gowns, gloves, masks, and caps for surgery. The surgical techs also wore caps and masks (we were just monitoring the patient and anesthesia).

 

[rexosaurus]

i have had similar experience with vets that are uber-sterile, if you will. i worked in a clinic with "old school" vets that insisted upon sterile everything for surgeries of every sort (except maybe a gnarly laceration or something). in fact, if i came close to even the counter with the open sterile glove pack on it (i.e. pretty much trash) i was ridiculed! so i think maybe it depends on your dr.s really. old, new, fresh out of school or not... for me though, it never hurts to be sterile!

 

[abou]

To be fair, animals have a much more robust immune system compared to humans. Now, that being said, having observed my father and others in surgery the only thing missing was the mask. Other than that there was thorough sterilization, gloves, and antibiotics afterward.

Now, this spitting you speak of...




j/k

 

[ElvisMarie6]

what type of surgery was it?
I've watched several surgeries where the doctors did nothing but maybe wear gloves and the techs cleaned the site IF it was a laceration...........but I once watched a skin graft and there was no cleaning or anything, but the dr. did wear gloves (but that's all). I know that while I was watching a cat get its fractured jaw wired back together, the dr. told me that he wasn't being very sterile because the mouth is such a dirty place anyway.

Several different types of surgery... ohe, neuters, a toe amputation, tumor removals... you name it.

 

[ElvisMarie6]

I guess my opinion is similar to rexosaurus', why not take all the precautions to prevent possible complications. I realize a lot of veterinarians send antibiotics home after surgery, but if it is a routine procedure done in a sterile manner, antibiotics are usually not needed. Anyway- thanks for all of your input!

 

[dyachei]

I guess my opinion is similar to rexosaurus', why not take all the precautions to prevent possible complications. I realize a lot of veterinarians send antibiotics home after surgery, but if it is a routine procedure done in a sterile manner, antibiotics are usually not needed. Anyway- thanks for all of your input!

Anytime you compromise the immune system, there is a high likelihood of infection. Even after coming out of surgery. You can't just keep the animal in a sterile environment until that threat is passed. I guess my point is that even with aseptic procedure, antibiotics are a good idea because the animal has been cut open and pathogens may enter their system.

 

[birdvet2006]

Anytime you compromise the immune system, there is a high likelihood of infection. Even after coming out of surgery. You can't just keep the animal in a sterile environment until that threat is passed. I guess my point is that even with aseptic procedure, antibiotics are a good idea because the animal has been cut open and pathogens may enter their system.

Dyachei, I must disagree. For quick procedures such as spays, neuters and most mass removals - antibiotics are not currently recommended. Longer surgeries and "non-clean" surgeries, also (especially) orthopaedics - antibiotics are recommended (pre-op, possibly intra-op depending on length of surgery, and sometimes post-op). Read Fossum's Small Animal Surgery book.

Antibiotic overuse and subsequent bacterial resistance is a big topic in this day and age.

 

[Kara31191]

The so-called super bacteria and such that everyone is talking about is a REALLY big problem. My Mom, an RNC, got the "super bug" for staff. It was bad. That was slightly off topic. However, I don't think that every animal or human for that matter should be on antibiotics. Years ago, they used to send every human who decided they were sick home with an antibiotic. Now this is being thrown in our faces as new strands of things like Tuberculosis are forming. To me, this is one of the biggest problems people can face. There's only so many times an antibiotic can be used to treat something before it adapts to form a new strand that can survive it.

Sorry for jumping in... HS student here! lol. If you mind me saying anything, let me know!

 

[dyachei]

Dyachei, I must disagree. For quick procedures such as spays, neuters and most mass removals - antibiotics are not currently recommended. Longer surgeries and "non-clean" surgeries, also (especially) orthopaedics - antibiotics are recommended (pre-op, possibly intra-op depending on length of surgery, and sometimes post-op). Read Fossum's Small Animal Surgery book.

Antibiotic overuse and subsequent bacterial resistance is a big topic in this day and age.

I agree with you for the most part. I was talking about more major procedures, mostly. But the spays I've seen are not always quick...and I don't know that you shouldn't give antibiotics in cases where you open the abdominal cavity (even if it is just a spay).

 

[abou]

The so-called super bacteria and such that everyone is talking about is a REALLY big problem. My Mom, an RNC, got the "super bug" for staff. It was bad.

BTW, just so you know, it would have been a staph infection. Staph as in Staphylococcus. The more you know, right?

Actually, these was some recent studies done by the Albert Einstein college that found using older medications on tuberculosis could weaken them and make them susceptible to newer medications. A tandem deal, if you will.

 

[lailanni]

Lack of a sterile environment is a bit scary.

At my clinic, we autoclave everything, doctors always scrub in unless it's dental work or putting in small stiches. The surgical site is shaven and scrubbed. Antibiotics are given afterwards if it was a major procedure with a long recovery. Our new docs are trained to get used to our sterile standards.

What's that saying, cleanliness is next to godliness?

But a few of our docs have done large animal. They frequently have told me that a sterile environment isn't as huge as a deal for large animals.

And some docs tell stories about clinics where surgical instruments are just washed, and docs never scrub in.

I suppose it's the clinics/doc's personal preference. Hearing about a less than sterile environments does make me wince though.

 

[rexosaurus]

so maybe i'm being ignorant here, but this is an honest question and i'm not trying to sound like a jerk, but.... what is it about a large animal's phyisiology that makes them less suceptible to a bacterial infection during/after surgery than a small animal? i don't quite get it.

 

[critterfixer]

so maybe i'm being ignorant here, but this is an honest question and i'm not trying to sound like a jerk, but.... what is it about a large animal's phyisiology that makes them less suceptible to a bacterial infection during/after surgery than a small animal? i don't quite get it.

I'm sure this is not a popular opinion with large animal producers and veterinarians, but the answer, IMO, is that production animals are no less susceptible and feel just as much pain, they just aren't "worth" the cost of additional medications and procedures. Equines seem to get the same level of care as small animals, while cows and pigs do not. Physiology isn't the reason.

 

[julieDVM]

and I don't know that you shouldn't give antibiotics in cases where you open the abdominal cavity (even if it is just a spay).

This is a hot button issue for me...

Unless you are a careless surgeon (ie - break in aseptic technique), you get contamination of your surgical field by nicking intestines or the like, or your surgery is going to last longer than one hour, there is absolutely no indication for the use of antimicrobials when doing spays, neuters or other routine procedures like that. Often the only time when antimicrobials are indicated is when you are dealing with pre-existing infections, or pathology (like in the case of compromised bowel) that has an increased risk of contamination, bacteremia and/or sepsis. In some cases where we know we are going to get some level of contamination by virtue of the procedure being a 'dirty surgery' we will often elect using prophylactic antimicrobials - one dose 30 min before we cut, and then another bolus intra-op if the procedure lasts longer than 1 hour. Usually, the antimicrobials stop the minute we close the skin.

Careless use of antimicrobials is a huge problem - and bacterial resistance is everybody's problem. Veterinarians are often guilty of throwing antibiotics at something hoping it will resolve (or using them 'just incase'). As a profession we need to be more responsible with our drug use.

 

[jfitzpatri8]

OK, I hate to burst your bubble, but some aerosolizible viruses, bacteria, or fungi have such low infective doses that just having an opening of the abdominal cavity to air will allow enough settling to cause an infection. While I agree that AB's need to be used judiciously, I also can make a fairly strong argument for prophylactic ABs with even a clean procedure. Ever seen the air in a stream of light? Any one of those tens of thousands of dust motes could be carrying a pathogenic organism. So, unless the surgical suite has extensive air filtration systems and negative pressure, there is a chance of infection.

Now, that said, unless you are working on an immunosupressed animal, or you are going to be placing said surgical case on immunosuppressive drugs (cortisone, anyone?), their acquired immune system should be more than capable of handling any such infection. That is why the immune system exists.

 

[birdvet2006]

I'm with Julie. Julie is doing a residency - is it in surgery? Anyways, this was my experience as an intern (working with board-certified surgeons), and also as a veterinary student. Cefazolin IV upon induction of anaesthesia. Another dose in surgery *only if* the procedure was long (>1 hr). Rarely would we continue antibiotics afterwards, unless the animal had pathology that supported it.

I would take the experience of internship-trained veterinarians over the word of a pre-vet or vet student...sorry to burst bubbles!

This is a hot button issue for me...

Unless you are a careless surgeon (ie - break in aseptic technique), you get contamination of your surgical field by nicking intestines or the like, or your surgery is going to last longer than one hour, there is absolutely indication for the use of antimicrobials when doing spays, neuters or other routine procedures like that. Often the only time when antimicrobials are indicated is when you are dealing with pre-existing infections, or pathology (like in the case of compromised bowel) that has an increased risk of contamination, bacteremia and/or sepsis. In some cases where we know we are going to get some level of contamination by virtue of the procedure being a 'dirty surgery' we will often elect using prophylactic antimicrobials - one dose 30 min before we cut, and then another bolus intra-op if the procedure lasts longer than 1 hour. Usually, the antimicrobials stop the minute we close the skin.

Careless use of antimicrobials is a huge problem - and bacterial resistance is everybody's problem. Veterinarians are often guilty of throwing antibiotics at something hoping it will resolve (or using them 'just incase'). As a profession we need to be more responsible with our drug use.

 

[julieDVM]

OK, I hate to burst your bubble, but some aerosolizible viruses, bacteria, or fungi have such low infective doses that just having an opening of the abdominal cavity to air will allow enough settling to cause an infection. While I agree that AB's need to be used judiciously, I also can make a fairly strong argument for prophylactic ABs with even a clean procedure. Ever seen the air in a stream of light? Any one of those tens of thousands of dust motes could be carrying a pathogenic organism. So, unless the surgical suite has extensive air filtration systems and negative pressure, there is a chance of infection.

Now, that said, unless you are working on an immunosupressed animal, or you are going to be placing said surgical case on immunosuppressive drugs (cortisone, anyone?), their acquired immune system should be more than capable of handling any such infection. That is why the immune system exists.

1. Viruses do not respond to antimicrobial therapy.
2. Your claim that you can make an argument for prophylactic antimicrobials in clean procedures contradicts pretty much all the evidence out there regarding post surgical infections in healthy patients for routine procedures- not withstanding nosocomial infections, which are typically highly antimicrobial resistant anyways. Human surgeons do not routinely treat patients with antimicrobials unless there is a good reason to do so. Veterinarians practicing good medicine should subscribe to the same philosophy.

Hate to burst your bubble, but according to most of the research out there, and current practice methodologies - you're dead wrong.

Incidentally, for the record, i'm a surgical resident.

 

[Kara31191]

BTW, just so you know, it would have been a staph infection. Staph as in Staphylococcus. The more you know, right?

Actually, these was some recent studies done by the Albert Einstein college that found using older medications on tuberculosis could weaken them and make them susceptible to newer medications. A tandem deal, if you will.

So my knowledge of the virus isn't so great LOL. My Mom has talked about this topic since I was little... She's so upset that people just giver antibiotics for everything! This was just an example she always tells me about.

 

[ElvisMarie6]

Good...From what I'm reading, I'm not over-reacting about being completely uncomfortable with their surgical procedures. Thanks again for all the input!

 

[Electrophile]

So my knowledge of the virus isn't so great LOL. My Mom has talked about this topic since I was little... She's so upset that people just giver antibiotics for everything! This was just an example she always tells me about.

Erm...I'm not a microbiology wiz or anything, but staphylococcus is a bacteria.

 

[pressmom]

I agree with birdvet2006 and julieDVM. Antibiotics are not necessary in sterile procedures with a few exceptions. Having gone through 11 major surgeries myself, the only time I've ever had antibiotics hung was during my spinal fusion. (And that was simply because the disc space has such a low blood supply that if an infection set up, it would be really difficult to beat.) The only time I've ever seen antibiotics given by the last vet I worked for was in particularly bloody dental procedures. And that was because there is just so much bacteria in the mouth as it is.

 

[handh02]

So, I'm in a similar situation with my previous employer having very strict guidelines for surgical proceedures (as well as everything else from cage cleaning to mandatory hand washing between patients) and my new employer, while they use sterile instruments, the vet rarely scrubs in or gowns up. How do I ask about the differences in these procedures without causing offense to my new employers?

I mostly ask because I really have had it drilled into my head that communicable diseases can be held to a minimum in hospital just by following a few simple rules and the new place doesn't seem too concerned about it.

Let me mention that the previous clinic was a routine clinic with 3-5 vets on duty at any given time and very few emergency cases, whereas the new place is mostly an emergency clinic with few routine cases and only one doctor on duty at any given time. Would that make up for the differences I've observed?

 

[chris03333]

I also agree vet Julie and Birdvet.

 

[hoodle]

I also agree vet Julie and Birdvet.

I second. or is it third? or fourth?

 

[rexosaurus]

let's just call it "nth" oh, and count me in!

 

[wivet2011]

Count me in! ( Not to get too off topic, but we we also over-vaccinate, which at least right now, is a bigger problem with human vaccs, than animals, but still...)

 

[sofficat]

Count me in! ( Not to get too off topic, but we we also over-vaccinate, which at least right now, is a bigger problem with human vaccs, than animals, but still...)

please elaborate!

 

[wivet2011]

please elaborate!

I assume you're refering to over-vaccinating humans...

There are just so many more vaccs for humans than there are for animals (flu, chicken pox...). Think about the flu vacc given every year. It's a combination of the 3 strains thought to be most common/viralent for that year. Last year, the vaccs wasn't even the correct combination. (Besides that, IMO, combining three viruses in one vaccs just seems like you're asking them to recombine into some new strain!)

Same might be suggested for TB...there's new resistant strains that we aren't protected against. Now, I'm not saying all vaccs are bad...look at the polio vaccs...as far as I'm aware, there haven't been any new strains found, and the few cases that have occurred recently in the US have been in unvaccinated kids.

I really think that over vaccinating and the over-use of antibiotics goes hand in hand... not everyone is going to be protected by the vaccine, and by throwing antibiotics at every little infection, we are helping promote the mutation of the virus, making less people protected. So, like I said, I'm not an expert, but right now due to the sheer volume of vaccs that we have available for humans, I just think it's a bigger problem than in animals. (Besides that, I'm not sure the animal vacc change much from year to year like the human flu vacc) Not sure if any of my explanation made any sense (it does in my head!)

 

[sofficat]

thanks, it did make sense.

 

[wivet2011]

thanks, it did make sense.

no prob. It's nice to know I can still organize my thoughts after a long day of studying so that at least one other person can understand them!!

 

[bakaduin]

As far as human vaccines go I really dont think its a problem at all. Unlike animal vaccines (which most are given yearly), humans usually get a series and that is it.

In my life as a US citizen I have had my series of Hepatitis, MMR, DPT, and now I get my 10 year Tetanus. I've never received a flu shot and will get my Rabies series when the time comes.

Vaccinations have eradicated diptheria, polio, and many others. Pertussis is the leading cause of vaccine preventable death world wide. MMR has caused the incidence of measles to fall to less than 1% and even though it is endemic world wide it has been largely eradicated from the US. Mumps and Rubella also were once widespread and now almost nonexistent.

Most people who argue against overvaccination in animals do so because of the frequency of vaccination and not the amount of viruses/bacteria vaccinated against. What your argument was mostly against is the flu which in itself is just a difficult virus to vaccinate against. Its a virtual crapshoot which is why they reccomend for only those at high risk get the vaccination. If your going to argue against human vaccinations its really more of an exception to the rule compared to all the others.

 

[julieDVM]

As far as human vaccines go I really dont think its a problem at all. Unlike animal vaccines (which most are given yearly), humans usually get a series and that is it.

In my life as a US citizen I have had my series of Hepatitis, MMR, DPT, and now I get my 10 year Tetanus. I've never received a flu shot and will get my Rabies series when the time comes.

Vaccinations have eradicated diptheria, polio, and many others. Pertussis is the leading cause of vaccine preventable death world wide. MMR has caused the incidence of measles to fall to less than 1% and even though it is endemic world wide it has been largely eradicated from the US. Mumps and Rubella also were once widespread and now almost nonexistent.

Most people who argue against overvaccination in animals do so because of the frequency of vaccination and not the amount of viruses/bacteria vaccinated against. What your argument was mostly against is the flu which in itself is just a difficult virus to vaccinate against. Its a virtual crapshoot which is why they reccomend for only those at high risk get the vaccination. If your going to argue against human vaccinations its really more of an exception to the rule compared to all the others.

I agree.

 

[banditalfi]

this is a really interesting topic... and along the lines of antibiotics, apparently much of the reason that we are seeing these resistant strains of bacteria has a lot to do with animals in the food industry being over-prescribed antibiotics just as a precautionary measure. does anyone have more insight on this matter?

 

[dvm'08]

this is a really interesting topic... and along the lines of antibiotics, apparently much of the reason that we are seeing these resistant strains of bacteria has a lot to do with animals in the food industry being over-prescribed antibiotics just as a precautionary measure. does anyone have more insight on this matter?

Research looking into bacterial isolates coming out of feedlots doesn't support this claim. The highest use of antimicrobials in feedlots are for metaphylaxis against the BRD pathogens, whose susceptibility profiles do not demonstrate a high degree of antimicrobial resistance. In fact, most of the bacterial isolates (enteric isolates, respiratory isolates and the like) out of feedlots do not demonstrate bacterial resistance to any significant degree.

The bacterial pathogens that are of concern (the MRSA, VRE and the like) are typically nosocomial infections that are selected for as a result of the high use of antibiotics in hospital settings. Although community acquired MRSA is not found within a hospital, the source definitely isn't the food chain.

 

[ri23]

Great post. I think a lot of it has to do with treating the parent or the patient in a psychological way. I think that a lot of doctors prescribe antibiotics because patients expect antibiotics. I've seen physicians prescribe antibiotics for viral infections because of the expectation of the patient (and sometimes the insistence) that they receive them.

Research looking into bacterial isolates coming out of feedlots doesn't support this claim. The highest use of antimicrobials in feedlots are for metaphylaxis against the BRD pathogens, whose susceptibility profiles do not demonstrate a high degree of antimicrobial resistance. In fact, most of the bacterial isolates (enteric isolates, respiratory isolates and the like) out of feedlots do not demonstrate bacterial resistance to any significant degree.

The bacterial pathogens that are of concern (the MRSA, VRE and the like) are typically nosocomial infections that are selected for as a result of the high use of antibiotics in hospital settings. Although community acquired MRSA is not found within a hospital, the source definitely isn't the food chain.

 

[rexosaurus]

so just to play devil's advocate, there are also those doctors that prescribe antibiotics when they are absolutely not necessary, and they are not insisted upon by the patient. (i have actually just been in this situation and refused the antibiotics, good thing because my issue wasn't bacterial ). anyway, i think there are several reasons for antibiotic resistant strains of bacteria and their lurkiness!

 

[Truth74]

I was under the impression that feed animals do not get the same kind of antibiobtics that humans are prescribed(Unless, you have an allergy, like me.), It's not as prevalent to just dose an animal as it is for humans.
Also, there is a period of time that the milk from cows that have been treated would have to wait for reintroduction into the tanks. They just dump the milk or give it to calves. If residue is found in the tank in miniscule amounts, that place is shut down.
I would assume that there is the same kind of a wait time for actual harvest.

 

[david594]

I would assume that there is the same kind of a wait time for actual harvest.

There is a waiting period after antibiotics are given before an animal is able to be brought to slaughter for similar reasons.