Fighting Surgical Site Infections in Small Animals

Verwilghen, Denis; Singh, Ameet

doi:10.1016/j.cvsm.2014.11.001

Cited by 58 publications

(86 citation statements)

References 174 publications

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“…Surgical site infections contribute to extended hospitalization and higher healthcare costs as well as increased morbidity and mortality rates in both human and veterinary medicine . Measures to control SSI are critical to reduce their incidence and impact .…”

Section: Discussionmentioning

confidence: 99%

“…The WHO guidelines recommend alcoholic hand rubs for surgical hand preparation in human medicine . Recent articles in both human and veterinary medicine have reported that HA solutions are more efficient than traditional medicated soaps for the presurgical hand antisepsis of surgeons . Even though alcohol‐based hand rubs have been demonstrated to be superior to currently available surgical scrubs, their use in surgical site skin preparation has thus far been assessed only in horses …”

Section: Introductionmentioning

confidence: 99%

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Comparison of hydroalcoholic rubbing and conventional chlorhexidine scrubbing for aseptic skin preparation in dogs

et al. 2019

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Objective To compare preparation time, ease of application, and elimination of skin contamination of 3 skin preparation methods for asepsis. Study design Experimental study. Animals Healthy dogs (n = 6) with no clinical signs of skin disease. Methods Three sites on each dog were randomly allocated to 1 of 3 preparation protocols for asepsis: (1) 5 scrubbings with chlorhexidine gluconate and rinsing (CHXG), (2) washing with mild soap prior to 3 rubbings with hydroalcoholic solution (soap‐HAR), or (3) 3 rubbings with hydroalcoholic solution (HAR). The duration of each method of skin preparation was recorded. A Count‐Tact agar plate was placed in the center of each site before, immediately after, 1 hour after, and 3 hours after antiseptic application. Plates were cultured, and colony forming units (CFU) were counted. Results Skin preparation lasted an average of 375 seconds for CHXG, 240 seconds for soap‐HAR, and 190 seconds for HAR (P = .00049). Nine CFU (median) were cultured from the skin prior to preparation, with no difference between sites on any animal or for any method. Colony forming units were not detected at any time on any site in any dog after antiseptic application. Conclusion Rubbing with hydroalcoholic (HA) solution was as effective as CHXG and prevented bacterial growth for at least 3 hours under these experimental conditions. Rubbing with hydroalcoholic solution was also faster and easier to perform. Clinical significance Because there is currently no known resistance to HA solution, preparation of the surgical site with HAR should be considered to prevent the emergence of bacterial resistance to chlorhexidine as well as potential cross‐resistances to antibiotics. Transfer to clinical animals requires additional investigation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of hydroalcoholic rubbing and conventional chlorhexidine scrubbing for aseptic skin preparation in dogs

et al. 2019

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“…Nevertheless, antimicrobial stewardship is important and peri‐operative antimicrobial selection should be tailored to each individual case and type of surgical procedure performed . It is also important to highlight that the development of a SSI is not simply determined by bacterial contamination but is part of a complex interaction between the host, the pathogen and the environment and that many factors determine the outcome .…”

Section: Discussionmentioning

confidence: 99%

Sequential bacterial sampling of the midline incision in horses undergoing exploratory laparotomy

Isgren

Salem

Townsend

et al. 2018

Equine Veterinary Journal

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SummaryBackground: There is limited information about bacterial isolates that are present on the equine midline incision during and following exploratory laparotomy. Objectives: To investigate the bacterial species cultured from the ventral midline pre-, intra-and post-laparotomy, whether particular bacterial isolates are associated with the development of surgical site infections (SSIs) and to report the antimicrobial resistance phenotypes of these isolates. Study design: Prospective cohort study. Methods: The ventral midline of 31 horses undergoing exploratory laparotomy was sampled for bacterial culture at set time-points pre, intra and postoperatively. Inclusion criteria were that horses must have undergone exploratory laparotomy within 90 min of the initial colic examination upon hospital admission and must not have been placed in a stable prior to surgery. SSI was defined as any purulent or serous discharge from the laparotomy incision of >24 h duration. Results: Seven horses (22.6%) developed a SSI. None of the variables tested were associated with the altered risk of SSI. The prevalence of a positive bacterial culture from the incision increased progressively over time and a variety of bacteria were isolated. A positive intra-operative culture was not a predictor of SSI; and when a SSI did occur, it was due to a different bacterial isolate. MRSA and ESBL-producers were identified in the post-operative period in one and four different horses respectively, but none of these developed a SSI. Main limitations: Sampling was limited to hospitalisation and no culture results were available for horses developing SSI following hospital discharge. Conclusions: A variety of bacterial species may be isolated from equine laparotomy incisions peri-operatively without development of SSI. SSI does not appear to be solely related to bacterial contamination of the incision peri-operatively and other mechanisms such as bacteraemia merit further investigation.

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“…Theoretically, the use of DLP could have both deleterious and beneficial effects on the development of SSI. Use of additional foreign material, increased soft tissue dissection, and prolonged surgery time in DLP could, in fact, lead to a higher SSI rate . In contrast, increased rigid fixation of the two tibial segments could protect the delicate vascular network that is forming in the postoperative period and reduce dead space and hematoma formation, lowering the risk of SSI .…”

Section: Discussionmentioning

confidence: 99%

Risk of infection after double locking plate and screw fixation of tibial plateau leveling osteotomies in dogs weighing greater than 50 kilograms

Tuan¹,

Solano²,

Danielski

2019

Veterinary Surgery

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Objective To compare surgical site infection (SSI) rates after double locking plate and screw fixation (DLP), standard locking plate and screw fixation (LP), and conventional nonlocking plate and screw fixation (NLP) in dogs weighing >50 kg undergoing tibial plateau leveling osteotomy (TPLO). Study design Retrospective study (January 2003‐October 2017). Animals Two hundred seventy‐five dogs weighing >50 kg with cranial cruciate ligament disease treated with TPLO. Methods Medical records of dogs weighing >50 kg that underwent TPLO by DLP, LP, and NLP with a minimum follow‐up period of 12 months were included. Data collected included signalment, details of any concurrent surgical procedure, type of implant used, use of postoperative antibiotic therapy, occurrence of perioperative complications, and presence of postoperative infection. The probability, risk difference, and relative risk of SSI were estimated for each fixation with a marginal model. Results Nonlocking plate and screw fixation was used in 114 (41.5%) dogs, LP was used in 128 (46.5%) dogs, and DLP was used in 33 (12%) dogs. Surgical site infection was diagnosed in 48 of 275 (17.5%) dogs. Postoperative antibiotic therapy was used in 74 (64.9%) dogs, 62 (48.4%) dogs, and 32 (97.0%) dogs in the NLP, LP, and DLP groups, respectively. Dogs with NLP, LP, and DLP had postoperative infection rates of 24.5%, 13.3%, and 9.1%, respectively. There were no risk differences for the three groups (Holm‐adjusted P > .05). Conclusion No difference in infection rates was detected between DLP, LP, or NLP for TPLO in these dogs weighing >50 kg. Clinical significance Fixation of TPLO with DLP in dogs weighing >50 kg does not seem to increase the risk of SSI compared with LP and NLP.

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Fighting Surgical Site Infections in Small Animals

Cited by 58 publications

References 174 publications

Comparison of hydroalcoholic rubbing and conventional chlorhexidine scrubbing for aseptic skin preparation in dogs

Comparison of hydroalcoholic rubbing and conventional chlorhexidine scrubbing for aseptic skin preparation in dogs

Sequential bacterial sampling of the midline incision in horses undergoing exploratory laparotomy

Risk of infection after double locking plate and screw fixation of tibial plateau leveling osteotomies in dogs weighing greater than 50 kilograms

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