Page 21 - Equine Matters - Spring 2014

Basic HTML Version

HOSP I TAL INFECT IONS
Veterinary surgeons, further bypass
the horse's body defences by:
l
the placement of intravenous catheters
The main way of controlling these
opportunist pathogens is with good
hygiene. This starts with hospital
protocols to keep hygiene routine.
l
Basic hygiene with washing hands can't
be emphasised enough. Soap and
water or alcohol gels can be useful.
l
Equipment and drapes are autoclaved
(sterilised) or used as disposables,
whilst suture materials and implants
are designed to minimise the chances
of infection taking hold.
l
Positive pressure operating facilities,
where clean air forces out potentially
dirty air can help to reduce airborne
pathogens but is less practical in equine
hospitals than small animal hospitals.
l
Proper patient preparation with
pre-operative clipping of hair, cleaning
and spirit swabbing to reduce exposure
to skin bacteria. Hoof coverings to
prevent dirt being brought into surgery.
Vets and nurses washing/showering
and wearing gloves, gowns and masks.
l
Correct waste disposal is important to
remove contamination.
l
operation wound sites
l
intubation for anaesthesia (Figure 2)
l
urinary catheterisation
l
stomach tubing
l
injections (in veins,muscles, joints etc).
SPRING 2014 ISSUE
EQUINE MATTERS
20
Isolation facilities
Ideally a hospital will have a separate
isolation facility but if not barrier-nursing has
to be used as a less effective option. Patients
with infections such as salmonella produce
billions of bacteria that rapidly contaminate
the environment and do not readily disappear.
The isolation and restriction of these patients
should be done as soon as possible, but even
then it may be too late to prevent a serious
breakdown of infection.
Hand washing is essential; gloves and gowns
are ideal, but alcohol sanitizers can be used
as a lesser option. Waterproof footwear and
disinfectant foot dips should be used to
Post-operative wound care is nearly as
important as the operation. Vets will dress
wounds to reduce exposure to environmental
organisms but horse behaviour and their
anatomy can make it hard to keep bandages
and dressings in place.
Antibiotics are used where needed, but there is
pressure to reduce their use and emphasis on
hygienic operation. There has been an increase
in the number of resistant strains of bacteria
such as E.coli, salmonella, clostridia and MRSA
and as such, 'second line' antibiotics are being
held back from use unless absolutely warranted.
Where wound, joint, respiratory, gastrointestinal
or other infections occur, swabs are taken
and sent for culture or PCR to identify the
organisms involved.
For animals with shock or septicaemia, it is
routine to provide intravenous fluids, antibiotics
and anti-inflammatories via an indwelling
catheter in the jugular vein. This may also
apply to horses that are off their food or not
drinking. If intravenous catheters are in place
too long they can also act as a source of
infection. With some conditions infection can
develop several days after treatment by which
time the patient may already be discharged
from the hospital. With these cases
post-operative checks or reporting can reduce
the chance of these problems developing.
All equine hospitals strive to reduce the risk of
infections and improve the outcomes of all
treatments; however as with human hospitals
the increasing number of resistant bacterial
strains provides a constantly evolving challenge.
Opportunist infections
Many uninfected horses will attend the
hospital for treatment or diagnosis of
problems. This can all prove stressful and
reduce their immunity, making them more
susceptible to infection if they are challenged.
There are a variety of 'opportunistic'
organisms that survive on healthy horses,
staff and in the environment that can cause
disease if given the right opportunity.
minimise shoes spreading infection around the
hospital. The isolation unit should be treated
and cleaned last after other routine patient
and room cleaning to reduce spread from
dirty to clean rooms. Different staff should be
used if possible for the isolation patient, as
well as different water and feed buckets and
hay nets. No equipment should be shared
between patients.
With certain zoonotic infections staff ought
to be wearing additional personal protective
equipment (PPE): masks, glasses and
coveralls. Food and drink precautions must
be enforced as there is a potential for staff
to suffer from these infections.
Contamination protection
l
Schedules are put in place for thorough
cleaning and disinfecting equipment
and rooms.