Surgical prep

RE: Surgical prep

apache — Thu, 22 Mar 2018 21:26:43 GMT

[quote user="Alison Clare Hickman"]

*bump*

Any further answer/input Rob Watkins or apache ???

Thanks

[/quote]

My view would be - do whatever it is you are doing and audit the outcomes. Look into things further if you have any issues with wound infections etc.

We always used to wet cotton wool and squirt Hibiscrub onto that and use it. Seemingly worked fine but no idea what concentration we were using etc. Now make up a roughly 50:50 solution in a kidney dish and use that. We get through loads more Hibiscrub and see no difference whatsoever in wound infection rates. Final spray with spirit.

RE: Surgical prep

Nick Shackleton — Thu, 22 Mar 2018 18:25:24 GMT

It was all very hush hush as hibiscrub isn’t actually licenced for use in veterinary patients

RE: Surgical prep

Alison Clare Hickman — Thu, 22 Mar 2018 18:15:20 GMT

Am trying to get tested evidence on this... So is this empirical evidence? Nick Shackleton

I love bandaging angels and their work is phenomenal. Did they recommend non-mechanical or mechanical methodology with this?

RE: Surgical prep

Nick Shackleton — Thu, 22 Mar 2018 17:20:11 GMT

I had a CPD lecture with bandage angels yesterday. They suggested wetting swabs and squirting neat hibi onto them

RE: Surgical prep

Alison Clare Hickman — Thu, 22 Mar 2018 15:01:39 GMT

*bump*

Any further answer/input Rob Watkins or apache ???

Thanks

RE: Surgical prep

Alison Clare Hickman — Sat, 17 Mar 2018 20:07:12 GMT

[quote user="Rob Watkins"]"rings are for doughnuts"[/quote]

Rob Watkins - um, I am now very confused as (thanks apache ) there is some evidence now that non-mechanical sterile skin preparation is as effective as mechanical (scrubbing). So does that mean the 'rings' can still be considered effective practice? Or have I totally misunderstood??

Thanks for your guidance.

https://www.ncbi.nlm.nih.gov/pubmed/25913145

RE: Surgical prep

Roanneth Slater-Brown — Tue, 13 Mar 2018 18:42:42 GMT

Thank you Apache

RE: Surgical prep

apache — Sat, 10 Mar 2018 21:23:25 GMT

https://www.ncbi.nlm.nih.gov/pubmed/25913145

https://www.ncbi.nlm.nih.gov/pubmed/27838164

https://www.ncbi.nlm.nih.gov/pubmed/8923728

https://www.ncbi.nlm.nih.gov/pubmed/2405580

RE: Surgical prep

Roanneth Slater-Brown — Sat, 10 Mar 2018 18:31:16 GMT

Hi Rob, I am about to start a practical investigation into antiseptics & disinfectants in veterinary practice for my diploma, so testing a range of products in common use. So far I cannot find any documented instructions for skin prep with Hibiscrub, specifically a dilution rate. As my investigation is for a science based project, I need to back up my choices with documentary proof, but all I can find for Hibiscrub is hand washing instructions. Can you help please, maybe with a paper or link to one? Any, input would be appreciated, tx

RE: Surgical prep

Sarah Southworth RVN CertVNECC — Wed, 18 Feb 2015 10:19:25 GMT

Hi Rob,

Sorry for late reply, we have four branches in Kent. I will pass on your details to my nurse manager and we can arrange something.

Gemma Vanns Nurse Manager nursemanager@warrenhousevets.co.uk.

Thanks Sarah.

RE: Surgical prep

Rob Watkins — Mon, 09 Feb 2015 15:12:33 GMT

Hi Sarah

More than happy to come and visit... where is your practice?

We are based in Sussex but we travel the country. If you'd like me to visit you can either phone me on 01403 791313 or email mail@invictavet.com.

Look forward to hearing from you.

Rob

RE: Surgical prep

Sarah Southworth RVN CertVNECC — Sun, 08 Feb 2015 10:01:06 GMT

Hi thanks for the reply, where are you based? I would love to know more and see if we can improve on anything. I will have to chat to my nursing manager and see if we can arrange something.

Sarah RVN.

RE: Surgical prep

Rob Watkins — Thu, 05 Feb 2015 09:56:40 GMT

Hi Sarah

Apologies for the delay in replying but I've been busy handing out doughnuts to practices...

It's not that the method of concentric or spiral motion is outdated. It is more that there is no evidence to support it. However there is evidence to support prepping "with friction". This translates into using a back and forth motion over the site.

The practice of spraying the surgical site with spirit prior to incision is also not evidence based and is unlikely to reduce the bacterial count on the skin.

It is also worth pointing out that no matter how well you apply the antiseptic solution... you need to choose the right solution at the right dilution rate.

More than happy to come to the practice and show you an evidence based method of prep.

Rob

RE: Surgical prep

Sarah Southworth RVN CertVNECC — Mon, 02 Feb 2015 12:51:14 GMT

Hi Rob,

I would be interested in finding out more about the 'doughnuts' etc, Are they saying now using circular action is outdated ?

thanks Sarah RVN

RE: Surgical prep

Rob Watkins — Fri, 30 Jan 2015 17:09:08 GMT

Thanks Jill

Although I'm starting to blush now with the positive comments.

So thrilled you remembered "rings are for doughnuts" (I think every training session should be cake based!!!).

If anyone else wants me to do what I did for Jill's practice you can just message me through Vetnurse with your practice details and I'll get back to you.

If nothing else... you get free doughnuts as part of the training!!!

RE: Surgical prep

Jill Macdonald — Fri, 30 Jan 2015 16:26:22 GMT

I'd like to recommend Rob - he came into our practice to give us an update, and it's really helped to clarify what we do when prepping, got us all up to date, and got us all doing the same thing.

We now use 50:50 chlorhex/water, swabs, the to-and-fro scrub (circular is for donuts) and hope to be able to order/use use some of the Chlorahex skin prep applicators too.

Rob also put us together a really useful skin prepping protocol for practice (laminated and everything!)

We all feel much more confident that we're 'doing it right'.

And no, I don't work for Rob either! :)

RE: Surgical prep

Rob Watkins — Fri, 30 Jan 2015 12:19:42 GMT

Thank you Mark!

The use of spray bottles to apply disinfectant agents (in the human side) is now not accepted. They were identified as a large risk of contamination. As a result there is a growing trend for veterinary theatre staff to stop using them. The bottles are rarely cleaned and are used on a high number of patients before (if ever) being disposed of. Instead they have moved to using sterile, pre-filled applicators.

As Mark says... I have an ever growing list of papers relating to this but a good starting point is to look at the website http://www.invictavet.com/chloraprep.html and in particular the surgical update.

More than happy to answer further questions.

RE: Surgical prep

Mark Hedberg — Fri, 30 Jan 2015 10:19:11 GMT

You may want to drop Rob Watkins of Invicta AH a line - he's got some excellent papers from the human and vet side about disinfection. (I don't work for him or with him but he knows his stuff!)

Cheers,
Mark

RE: Surgical prep

Moodle — Fri, 30 Jan 2015 09:09:03 GMT

Thanks for replies - it is the spirit spraying afterwards I'm wondering about - I have always done so but where I work at the moment they don't but can't remember what CPD told them not to!?!

RE: Surgical prep

Nick Shackleton — Thu, 29 Jan 2015 20:55:40 GMT

I have always used 50/50 hibiscrub and water for routine ops. Followed by spraying with hibitan/water/spirit mix.

for open wounds I've used non foaming iodine diluted or saline or hartmanns Depending on surgeons preference

for opthalmic procedures ive used diluted non foaming iosine or just saline. depending on surgeons I've worked with

RE: Surgical prep

Karen Carver — Thu, 29 Jan 2015 15:21:50 GMT

Hi Moodle,

We used Hibiscrub 50:50 dilution, we dont spray with surgical spirit afterwards, as it dilutes and deactivates hibiscrub. (Or so im told)