Читать книгу Surgery of Exotic Animals - Группа авторов - Страница 21

The goal of surgeon aseptic preparation is to reduce the incidence of SSI. In human medicine, SSI has been shown to delay wound healing, increase antibiotic use, increase hospital stay, and increase costs, and can result in fatal consequences. Minimizing the risk of SSI in exotic animals is essential for many reasons. Surgeons should wear a cap, mask, gloves, surgical gown, and shoe covers for all surgical procedures (Figure 1.1). Procedures should be done in the cleanest environment possible. A dedicated operating room is ideal, but avoid doing surgery in rooms where abscesses are treated, dirty procedures are performed, or there is fecal contamination.

In one study, glove perforation occurred in 67% of surgeries underscoring the need for hand antisepsis to reduce skin flora before gloving (Verwilghen et al. 2011). Scrubbing is not recommended because it removes protective mechanisms on the skin surface and exposes more potentially pathogenic bacteria. Additionally, it causes small abrasions and excoriations damaging the surgeon's skin and increasing the risk of colonization by pathogenic organisms.

Alcohol‐based hand rubs are recommended because they have rapid action, are faster to use, and cause less skin damage compared with antiseptic soaps. Alcohol‐based hand rubs do not require water. It has been estimated that on average 20 l of water are used per hand when using antiseptic soaps. Additionally, many water faucets and municipal water sources are contaminated with Pseudomonas sp. and other Gram negative organisms that can recontaminate the hands. There is no reason to do a one‐minute hand wash with a neutral soap before applying the hand treatment, and it has been shown that omitting hand washing prior to applying Sterilium® (Medline Industries, www.medline.com) increases its efficacy (Verwilghen et al. 2011). The World Health Organization recommends alcohol‐based hand rubs over antiseptic soaps because of their superior efficacy both in vitro and in vivo, better skin tolerance, lower environmental impact, and no risk of recontamination from rinsing with contaminated water.