theatre practice

Re: theatre practice

bongo — Fri, 18 Nov 2011 10:31:47 GMT

i know that people think that asepsis has gone a bit crazy but the fact that we are doing such protocols just gives me peice of mind that we are doing everything we can to stop the potential for infection, yes sometimes you still get the odd one despite everything you do but this is like everything else, things are moving on and you always get people who think its uneccesary but things move on for a reason and I for one am happy to just roll with it.

Re: theatre practice

Vicky RVN — Fri, 11 Nov 2011 16:52:06 GMT

I feel it is such an overuse of antibiotics, if you scrub the patient up well and are careful with asepsis, why give antibiotics? Grrrr it really bugs me!

Re: theatre practice

Julie-Anne Wilson — Fri, 11 Nov 2011 14:42:40 GMT

[quote user="Vicky RVN"]

[quote user="Phrin Vernon RVN"]How many of those animals had a prophylactic abs shot? [/quote]

I hate this, totally unnecessary in my opinion!

[/quote]

I was just talking about this with our new Vet this morning. I think it's silly and he agrees that it's unnecessary. But in his old work place, everything commonly got AB injection, even for routine OVHs/Castrates etc. And when he brought it up to a nurse, he was told "but they need antibiotics." (I feel a nurse should never say this to a Vet but that's a whole other rant!)

We're short on space in our practice, but we have 2 large stainless steel cupboards with sliding doors that hold all our kits and suture materials, they get damp dusted daily at the end of ops. The only other "furniture" we have is our anaesthetic machine (easily wheeled out), operating light (easily wheeled out) and operating table (not so easy to move but possible with 2 people)

Re: theatre practice

Vicky RVN — Fri, 11 Nov 2011 08:28:54 GMT

[quote user="Phrin Vernon RVN"]How many of those animals had a prophylactic abs shot? [/quote]

I hate this, totally unnecessary in my opinion!

Re: theatre practice

Phrin Vernon RVN — Thu, 10 Nov 2011 23:23:51 GMT

I'm with Vicky on this. Yes we have heard of and seen tons of less then perfect theatre practice with no problems reported. How many of those animals had a prophylactic abs shot?

I think that if possible, we should be maintaining an aseptic op room (bosses and LA vets allowing - grr - been there!), and doing everything we can to prevent infection. Just because it has been ok so far doesn't mean that it is good practice to carry on in the status quo.

Just my opinion of course

Re: theatre practice

Nick Shackleton — Wed, 09 Nov 2011 09:39:12 GMT

[quote user="Vicky RVN"]

[quote user="fnewboult"]On the subject of erm interesting practices somewhere I was on placement had the practice of changing into scrubs and white clogs just to be out the back in the prep & kennel area (yes that does include cleaning kennels, dentals etc!) and then wearing these same things in theatre. Something that puzzled me a bit, was wondering if anyone on here could explain the logic behind it or am I right in thinking it's a bit of an odd way to go about it?[/quote]

That does seem entirely backwards and a waste of time in my opinion! You change for clean theatre procedures, not dirty procedures and cleaning kennels!

[/quote]

If only theatre we used to wear scrubs. Used to change shoes for theatre and have separate shoes. When out of theatre we used to wear disposable gowns to cover our scrubs. and avoided kennels and isolation.

Re: theatre practice

Vicky RVN — Wed, 09 Nov 2011 09:14:09 GMT

Just because problems haven't been seen through an not particularly asepsis theatre protocol, doesn't mean we can't try to minimise risks as much as possible? Yes there are times when it's not possible (neutering projects abroad etc), but when there is the chance to do it why not? Make the most of the facilities I say!

Re: theatre practice

Vicky RVN — Wed, 09 Nov 2011 09:05:15 GMT

That does seem entirely backwards and a waste of time in my opinion! You change for clean theatre procedures, not dirty procedures and cleaning kennels!

Re: theatre practice

fnewboult — Tue, 08 Nov 2011 23:29:28 GMT

I'm another that's a bit iffy about the effectiveness of masks and question their necessity for routine ops (is it bad that I'm a student and thus am supposed to think all this new stuff is wonderful? haha). Last place I was on placement had a little set of plastic drawers on wheels to store suture material / staples and other useful bits n bobs in which worked quite well as they were nice and low to dust and could be wheeled out to make cleaning the floor easier. On the subject of erm interesting practices somewhere I was on placement had the practice of changing into scrubs and white clogs just to be out the back in the prep & kennel area (yes that does include cleaning kennels, dentals etc!) and then wearing these same things in theatre. Something that puzzled me a bit, was wondering if anyone on here could explain the logic behind it or am I right in thinking it's a bit of an odd way to go about it?

Re: theatre practice

supamog — Mon, 07 Nov 2011 20:39:38 GMT

Funny this - im sure some people have been peeping in our back door! so relieved that its not just our practice but i must admit to shooing dirty vets out and i must come across as a bit of a matron because if i am in the prep or theatre areas they retreat forthwith and at least take their boot off!

Re: theatre practice

Katie Mansfield — Mon, 07 Nov 2011 18:00:21 GMT

When I started training we used to lunch in theatre and smoke in kennels cos that was the furthest room fro the reception area. I have even fed an operating vet coffee through a straw!! Mind you we also used to keep the formaldehyde on the window sill.......

I don't think more patients died in the days before H&S and aseptsis. Would be interesting to do a comparison though.

K x

Re: theatre practice

annaschu — Mon, 07 Nov 2011 06:20:11 GMT

Thanks Molladog

Re: theatre practice

molladog — Fri, 04 Nov 2011 08:46:22 GMT

I am afraid I tend to agree with last post, I do feel that we have gone overboard with asepsis. As an 'oldie' I have seen many years of this and have hardly seen any cases of infection due to poor hygiene. Of course i am not advocating dirty areas but I think a lot of it is unecessary and won't make any difference to the outcome. Good basic hygiene,sterile instruments, + clean clothing should be enough for routine ops.

I will also wait for the onslaught of derogatory replies.

Re: theatre practice

annaschu — Fri, 04 Nov 2011 05:54:17 GMT

[quote user="Izzie"]

Listen to this, I work in a mixed practice and most often than not the vet who is on ops usually ends up going out on a farm call/routine before coming back to then operate and they wear the same clothes out on visits and then in surgery, with either a scrub top or white disposable apron over the top.

Brilliant isn't it!!!!

[/quote]

yup - funny how we've got more and more fastidious over the years. Was in Kenya 6 weeks ago on a feral cat neutering project - conditions that would give many of you heart attacks! Cats were in a large 4 storey holding cage over night, 15 to a layer all mixed in together. Just cats, no bedding newspaper, litter. You can imagine the chaos in the morning and also all those cats covered in a mixture of urine and faeces - including all over spay and castrate wounds. We were working on a number of islands and the cats were being caught and trapped by the locals - as the time went on we would get 're-captures' that had been operated on the previous day or some days earlier. Also those that had been neutered on a previous trip by others. No evidence of infections whatsoever in a single one we caught, yes we may have lucked in and missed the infected ones but I think we had a good sample size.

Not that anyone should go smearing poo around their theatres but are we following the human trend of too much asepsis, antibiotic use and not allowing immune systems to be challenged?

I'll await horrified replies!!!!

Re: theatre practice

Izzie — Thu, 03 Nov 2011 21:03:51 GMT

Brilliant isn't it!!!!

Re: theatre practice

jamie — Thu, 03 Nov 2011 09:51:09 GMT

Thank you guys :) really helpful. Can I ask which suture material you use to get the container? We wont be able to build cupboards into the wall but surely if its part of our daily damp dust protocol should be fine?

Re: theatre practice

sisterscope1 — Wed, 02 Nov 2011 18:28:10 GMT

Keep the amount of furniture in theatre to a minimum but you do need to make sure you have adequate access to supplies, ie suture, swabs and the basics. The more you move in and out of a theatre, the more turbulent air flow there is resulting in higher levels of contamination in the air - good practice not to go in and out of theatres once a case has started. Remember all of the microorganisms within theatre are from the people working in there and the patient, it's quite easy to clean and disinfect a theatre once empty but very difficult to maintain the same conditions during use - unless you have positive pressure ventilation or clean air canopies. Pass through cabinets are an excellent idea and can work well.

I would agree that masks are not terribly useful and can potentially be a source of contamination if worn incorrectly or inappropriately - ie constantly handled, worn all day etc. If you don't wash your hands after handling a worn mask then you are essentially covering your hands (which are in more direct patient contact) with all of the bacteria filtered out of your mouth.

As Catherine says, the focus of wearing a face mask within human theatres is entirely on protecting staff from fluid splashes, not the patient.

Re: theatre practice

Catherine Goulding — Wed, 02 Nov 2011 18:16:59 GMT

We keep suture materials in a container that was supplied by the suture company, it just gets cleaned twice daily when damp dusting. Its probably best to keep it in theatre somewhere as it will be used more often.

Re: theatre practice

Catherine Goulding — Wed, 02 Nov 2011 18:13:33 GMT

Sorry Nick but I disagree with you there, masks are only effective for about 30 minutes, so changing shoes is actually more effective. We only wear masks in the NHS when actually part of the scrub team, circulating staff never wear masks but then its more for our protection than for the patients

Re: theatre practice

Nick Shackleton — Wed, 02 Nov 2011 17:51:13 GMT

Masks are more effective than a change of shoes

Re: theatre practice

Honeybadger — Wed, 02 Nov 2011 17:23:55 GMT

We keep all our materiels (kits, swabs, suture material) in cupboards with doors which we wheel out of theatre when cleaning. We currently wear hair net/hats and masks in theatre but unfortunatly our practice layout (no changing area) makes changing in to whole scrub suits impossible. The Vets wear scrub tops over their normal clothes. I would personally like to have the nurses at least wearing scrub tops and theatre shoes rather than masks which I doubt the effectiveness of.

Re: theatre practice

Nick Shackleton — Wed, 02 Nov 2011 17:21:32 GMT

We had one box of each size and then kept a large stock else where. try and ensure your cupboard is built into the wall. at least then you won't have another surface for dust to settle on.

Re: theatre practice

jamie — Wed, 02 Nov 2011 17:18:44 GMT

Thats such a good idea! I might try and push for a cupboard on the wall, it wont have the pass through but then its somewhere to store suture material just think its not great a million boxes of Vicryl on the trolley

Re: theatre practice

Nick Shackleton — Wed, 02 Nov 2011 17:12:50 GMT

We had a cupboard in both theatre walls with glass doors on both side where we stored suture material, staplers, some needles and several sizes of syringes. much like a pass through and it could be accessed from theatre and our theatre prep room (where instruments where stored and cleaned). Its hard when its a converted practice. But think you are going in the right direction. I prefer to have everything to hand so that you don't have to keep going in and out as this minimises air movement. We used to put the required instruments in pass through too.

Re: theatre practice

jamie — Wed, 02 Nov 2011 17:01:28 GMT

Yeah thats what I think and what im trying to do:) We dont wear any outside clothes in work anyway, ie we change into uniform and crocs when we get to work and before we leave. Then we change into scrubs when operating. The theatre has a door in one side from a corridor and then another door from/into prep. People are pretty good about not entering theatre when they shouldnt. We have piped O2 so anaesthetic machine is on the wall along with a PC monitor that is part of our monitoring equipment. We have ops table and a small instrument trolley that the vet uses and then a larger trolley which holds thermocautery and the ventilator. As we are very new (converted drs surgery into vets) we are still putting the finishing touches to cupboards etc. So I am hopeful that we can store stuff in hallway cupboards when finished. Gave a nudge today :) What about suture material etc? I think that they should be stored in prep, and aquired as necc throughout the procedure. Others want to store them in theatre, but i dont think leaving them on a trolley is good? thanks