Hi there. My name is Natasha Summerfield, and I would like to talk to you today about hygiene and infection control in the ER. I am a registered veterinary nurse from the UK.
And I have also acquired my veterinary technician Specialist specialisation in emergency critical care. I've been working in emergency and in IC U So in ECC for about the last 12 years. So I'm hoping I can give you some insight into this topic and effective ways that we can actually do this in practise.
So let's get into it. These are our learning objectives for today. So I want you to be able to define noso chromia infections and effectively, apply hand hygiene methods, identify and identify changes that you can make in practise.
So I thought I'd start off this, this talk with a bit of a why Why are we here? So, I. I asked, an a i website called consensus.
It goes through the literature, it it's really helpful. And it can give you some really good insights if you haven't heard of it already or aren't already using it. And I asked it is the following statement true So are healthcare associated infections the most frequent adverse effect for hospitalised patients.
And it was an astounding yes. So this was based on human literature. So I must just caveat that with that.
But, we do have some literature in the veterinary field as well. To say that we do have problems with our HAIS. So hospital acquired infections or these hospital healthcare associated infections, nomia infections.
We can use these interchangeably. So we know that this is a problem, and this is something that we can do something about Also, one of the points that it had them further down going through the literature was preventable. So it said, despite their high prevalence, these hospital acquired infections they are highly preventable through effective infection control measures such as hand hygiene and other basic infection control practises.
So my point of of giving this talk and and why for me, I'm really quite passionate about something that you might not really think is so related to emergency and critical care of. The hygiene side of it is that it's so important. And then people do say you know, might be the easiest way to save a life and for sure in our place that we're really trying to be hotter on our, hygiene methods and our hygiene mea measures to to try and prevent or minimise the risk, at least for anything that we are then introducing to our patients.
So going now to nose chromia infections, hospital acquired infections just a little bit about this so that you can really define this and you feel comfortable knowing what these are when people talk about this. So basically, this is just something that is acquired in the hospital. There's a few different words names.
So we have the nosocomial infections. We have HAIS hospital. HCAIS.
So, healthcare associated infections as well. And these are just infections that can be caused with contact from contaminated surfaces, contaminated medical equipment, or contaminated or sorry, infected or colonised patients or healthcare workers. So really, on on every corner of our hospital, we have the the risk of of having some of these bugs that we really don't want to have around that, then kind of latch on to our patients.
And whereas our patient may have come in with one problem, then they may then end up acquiring another problem whilst they are staying with us. And this is something that we know is a big problem in human hospitals as well. We are seeing it more and more in in veterinary hospitals and especially the larger hospitals, in universities and referral places is something that we we tend to come across on a on a regular basis.
But, that's not to say that we can't all be doing our bit to try and help minimise the risk of of these of these bugs and of these infections coming onto our patients. So when we talk about measures which measures, so what? What can we do?
What does that mean? So hand hygiene is one of these one of these measures, one of these simple measures very simple, very effective. It is quite hard to do correctly with the right, you know, level of compliance the whole time.
So we're gonna go into the hy hand hygiene in quite a lot of detail in this talk surveillance. So surveillance, we can be talking about swapping our patients or, os also kind of hospital areas as well. And then looking at decolonization if we do find that we've got some bugs in these areas education and training.
Now, this is really, really important. So the we can try and, you know, just say to people that they should be doing better hand hygiene and, better measures. But if we're not giving people the right tools in which to actually, perform this properly in a busy situation, or the information that they need to know how important it is, then this stuff is just not gonna stick.
So education and training in your place in your practise, is really important whether that be you doing the training, whether you're getting that from external sources, you know, different webinars or someone coming in. But these education of of E, you know, even kind of, little bit of theory or potentially like, full on workshops for new starters. When they when they start so that everyone's doing things in the same way they're they're really, really helpful.
And of course, environmental cleaning and and having an isolation as well so that we can kind of put these patients into certain corners, so to say so that they're not then, you know, risking, you know, the spread of infection to to other patients. So what are some of the common hospital acquired infections? So I just tried to pick some that I thought were, really important for us.
There are some others that we've got in the veterinary field or, also in the human field. But I just tried to pick some, which I think we see quite a lot in the in the kind of ER or, in the IC U type situation. So, and what?
We can actually maybe do something about as well. So we have our IV, so our intravenous catheters and kind of the placement of those we have our operation site infections or surgical site infections. They are also known as S, SI S.
And then we have our urinary catheters as well or urine systems. So it depends. What you what you call them, but basically our indwelling catheters, So not just the I mean, the ins and outs.
It's also gonna be something. But the ones that really stay in is the ones that I'm I'm gonna be talking about today. So now getting into hand hygiene.
This is gonna be quite a big chunk of our talk today. So I'm really gonna try and get through it so I can talk about the other stuff as well. Cos it's also really important.
But for me, hand hygiene, I I'm quite passionate about it. It's it's a really, really important part of our job. And we're gonna talk a little bit about, so hand hygiene.
So the washing versus, sanitising five moments for hand hygiene. And how can we do this properly in an emergency environment? So then the hand hygiene.
So the washing. So when we want to be doing this, before and after our shift starts to end, before and after eating, obviously, when we go into the to the toilets as well, we need to be washing our hands with soap and water, and also when we have visibly soiled hands or after potential contamination with bodily fluids. Now is it better or worse for you than your, for your skin than sanitising?
And and when should I sanitise? Where is washing? So basically washing is only at these times that we spoke about So the shifts the toilets, eating, visibly soiled hands and contamination with with bodily fluids.
The rest of the time, you should be able to use the sanitizer, and a lot of people will say, Oh, it's really dry or it's really painful on my hands. Or that's normally just because you've got a open skin, which you actually get because your skin is so dry normally from excessive, normally from I mean, it could be from also from excessive washing, so the washing won't cause you pain whilst you're doing it. So we think that it's maybe better for our skin, whereas actually it's drying out our skin.
So the sanitising is is really normally better for your skin unless you are allergic to the sanitizer. But it it has some often like an emollient in it or some sort of moisturiser. So then it actually leaves your hands not feeling as dry or being as dried out by washing with soap and water.
That's a really, really important factor that we should consider when we're talking about washing versus sanitising and maybe changing those sort of old fashioned ideas that we've still got in our head and also part to think about is the hand washing How long should we do it for? So the method for hand washing and sanitising they're both gonna be the same either this six step, WHO method or a simplified method, from this other study from this Children and chin and Suter, which has also been shown to be effective and potentially the club compliance is a bit better because it's just, you know, only three steps. Either way, when we are doing these methods for washing, we should be doing it for 45 to 60 seconds.
That is a really, really long time. And I don't think I have seen anyone be washing their hands for 45 to 60 seconds. So if we are not doing it for that amount of time, then we are not having that effective contact time.
We're not having, you know, a good enough, a good enough wash basically, to get rid of that that load of bacteria. So, actually, even even when we are washing our hands, you know, after going, you know, before shift end shift things like that. Potentially.
You you need to sanitise your hands afterwards anyway, because if you're only washing for kind of 20 seconds, then you need to actually then still sanitise afterwards. So point being with this is that it's generally much more effective to be sanitising your hands rather than washing your hands, especially when we start talking about the five moments of hand hygiene. Doing that with hand washing is nearby.
Impossible, I would say so, then to hand Sani hand sanitization or disinfection? The CDC has loads of really good resources. Where they've got these lovely posters that I've just popped on to here, so some really interesting interesting bits, really, and myths and stuff like that.
So a couple of things that's really important is that we need to have enough of the solution. So that's normally around three millilitres, and I don't think anyone is there with their syringe, drawing up three millilitres of disinfectant. But it's around two pumps, and obviously it depends on the size of your hands and things like that.
But it's around two pumps. You need to put that into dry hands, and then you need to rub for approximately 30 seconds and their hands need to be wet that whole time. So you know that you've got enough of the sanitizer.
If your hands are wet for the whole 30 seconds, if they're not wet for the whole 30 seconds, then you don't have enough. And if you if you do see, like, there's lots of videos on this as well of of actually doing it for 10 seconds, 15 seconds, and then doing it for 30 seconds and the coverage that you get and the bits that you've been missing if you don't do it for the the, the the amount of time that you should be doing it for, So that's the reason for that. So that you get really the the full coverage that you're needing.
And on average, it says here, I think this was from the CDC. So healthcare providers perform hand hygiene less than half the times they should, and that's in the human field. So I don't know what our compliance is of, there has been some studies, but I'm not sure what it is off by heart.
But ultimately, we we probably need to be doing it a lot more than we are. And I think for me, I wasn't always aware of the five moments of hand hygiene. And so I wasn't even aware of of of of Of when, exactly I should be doing the sanitization.
So of course I couldn't have been doing it as much as I should have been, because I just wasn't aware I didn't have that education before. This is why also, education is so so important with this type of stuff. So the takeaway really between these two with sanitization is that the sanitizer is generally like it says here, more effective and less drying.
So the this is what we should be using most of the time. These are some of the areas, which can be, missed. So our fingertips, between the fingers, the thumbs, these are areas that we should take special care about.
Then we have these five moments of hand hygiene. This is from the WHO, and they have lots of different resources on there as well. So CDC and WHO, they are really, really good for getting different resources and pictures.
Posters for your practise. And so we have. And I've tried to just do my little version of that for the veterinary field.
I've got a slide then next, which I'm very happy for you to take a screenshot of, if you if you'd like to to have we have this app as well in in my in our ER to remind people when they should be doing these five moments of hand hygiene so before patient contact and after patient contact. I think this is quite clear. This is probably something that we are quite good at of, you know, going to our patient and disinfecting our hands so that we can protect them and then also afterwards to protect us.
This also stops us from, maybe potentially, spreading around some of those germs some of those organisms that they might have on them onto other surfaces. So that was also, protective mechanisms for our practise and also for us to do this after patient contact. But we also need to be doing it before as septic procedures and that so that could be taking bloods.
Or that could be, placing an IV, for example. And so you may feel like you're clean, you've gone to your patient. But then, actually, before you do another procedure, you should then be disinfecting your hands once more, right before you do that procedure, which is something I think that a lot of us probably don't do or find it quite tricky.
Also, even I would say giving drugs IV if you've got a catheter in, anything time that you're touching the eye, if you've just gone to the patient, you've stroked them. You've maybe done the T PR. Your hands are no longer really clean, right?
And then whatever they may have had on their skin or on their fur, then you could be then transferring that over to that kind of that that clean area on their IV site. So that's also a time that you should be disinfecting your hands before touching after exposure to potential infectious material. I think that's probably something that we're more likely to do.
But maybe we're wearing gloves. If we've got that potential infectious material and then I don't know potentially, we're not actually disinfecting our hands after we've taken off the gloves, so we're gonna talk a little bit about that with P PE in the next few science slides. But this is also something that's important To be doing is to be doing that hand hygiene after any potential exposure, so exposure to potential infectious material and then after contact with the patient's own.
So I would say this is this is the trickiest one, personally. So this is after exposure or touching the cat carrier after touching the dog lead after touching anything in the cage after touching the infusion pump that's sitting on their, their cage, like all of that, is in the patient's zone. So we should be disinfecting our hands every time we do that.
And now every time the pump beeps and you press something, how many of us are really doing that hand hygiene and and and really cleaning our hands with the sanitizer? After those moments, I would say probably not as many of us as we should be. And this is just an area, for we're not going to get perfect every time but through education, through knowing that we should be doing this, then we can think to do it more and more often, and then it just becomes more and more a habit, right?
And so our P PE. So this should be worn before so for infectious or suspected infectious animals. We can also consider wearing P PE for our immunosuppressed patients.
And it needs to be put on and taken off correctly. So this is something that feels like it goes without saying, but there is a really high likelihood of contamination when we are taking off our gloves when we're taking off our gown, we can also we've got these yellow gowns, but they're not waterproof, so we can also consider plastic aprons as well. They may just be considered for a lot of patients, even if they're just having some, diarrhoea that we're not expecting it to be parvo as an older dog, for example.
But we may have some in, you know, kind of infectious organism that's in that diarrhoea or just in general, this diarrhoea is not so nice. We can be considering having these aprons in our practise to be using for those patients that might be a cost effective way, rather than having all these gowns and and stuff like that, for just patients that aren't really, really infectious. But when we are, there are really ways and there are literally instructions of how to take off a gown and how to take off your gloves.
Now, I'm not gonna go into this today, but really trying to remember that when you're taking off your gown, and then you take off your overshoes, you take off, then your gloves last, and try and keep your gloves to gloves and hands to hand like skin to skin and then making sure that you are also, disinfecting your hands afterwards. Because as I talk about in the next two slides, gloves are not a complete barrier. We don't know what is getting through, and we need to make sure that we are disinfecting our hands after we've taken off those gloves as well, because gloves aren't normally completely enough, and we may we have a high likelihood of contamination when undressing ourselves.
And ultimately, that's also for us who have trained. We may have been doing this for many, many, many years, but if you are the one in practise who wants to do the education for this to your students, to your vet students all those new people that are coming around if you work in a large referral place or a or a you know, even or a smaller hospital. We've always got students that we work.
We've always got new people coming in. And just because you can do it And, you know and you were taught by your amazing mentor that you've got to be that amazing mentor now, it doesn't mean that everyone knows just inherently how to do this. But how many owners have we seen come through to visit?
their their patient and put this stuff on and they just have no idea when they should put their own issues on and off, you know? So it's not common sense for everyone. And then that's why I would say that the education in your practise and being also really that person that pushes through to do this education and to, you know, make sure that everyone is really on the same page and have a standardised approach is is really, really important.
So gloves gloves are not enough. So this isn't for me. This is from the CDC.
But I actually had this on my slides before. And then I found this poster. So I was like, Great.
So wearing gloves is not a substitute for cleaning your hands. So you need to clean your hands before you touch those gloves and before you touch those that glove box cos otherwise you could potentially be contaminating that glove box and also contaminating those gloves with your hands that may be dirty just from touching the surfaces. You know, of of your practise where there could just be, you know, bugs that are that are there.
And we have no idea, right? You think it's a clean place, but actually, that may have just been contaminated with something else. Another, fite or whatnot, That is, that is, been placed there by not with someone that's not been thinking about it.
So, your hands can get contaminated whilst wearing the gloves or removing the gloves that we've spoken about. And when wearing the gloves, we can get these micro tears in the gloves. If we sanitise the gloves often we can affect the integrity of the gloves themselves.
So we shouldn't really be doing that with with most gloves, At least and we need to clean our hands after we've removed the gloves. Because, as I say, we could get either contamination from taking off the gloves. Or we could, have these micro tears and the the our hands could be contaminated whilst we're even wearing the gloves whilst we're, you know, doing whatever we're doing with those patients.
So gloves, really, they are useful, but they are not enough. And you still need to disinfect your hands before and after using those gloves. But they're another barrier to give often us as well, protection as well.
So when should we use gloves? So this is kind of depends on your practise as to what your protocols are. And if you if you have a protocol, often what your boss wants you to be doing.
So in the ER, we say that, we can think about these infectious, infectious or suspected infectious patients that come in. You don't know what they've got. Those ones we should be treating with gloves.
You know, those those dogs that were waiting on that parvo test And those are patients that we should be treating with gloves. From the get go potentially immunosuppressed patients. This is something that you could think about.
Not always, but this is one of those things that you can see. What? What you what you wanna do going forward as a practise, When you've got any contact with bodily fluids or infectious materials, it's time to be putting gloves on as well.
Contact with wounds, contact with mucus membrane. So that's a mouth prep. Use vagina.
Also, if you're taking a temperature and stuff like that and having contact with that back end, that's a good time. Also, I would say to put on some gloves, using cleaning products and washing soiled bedding clothing. These are also times, of course, that you can put on the gloves.
One thing I didn't put on here as well, maybe I've mentioned it further down. I'm not sure is that when we are prepping our patients. So if we've got minor ops or major ops, in our ER S, then we can be wearing those gloves to prep our patient when we're doing the surgical.
You know, when we're doing our clip, and then we're doing our our clean that part of it. So once we've actually clipped and got that area too clean, then we can pop our pop on our gloves to be doing that, surgical prep with our swabs, some other tips. So we should be keeping nails short.
I. I think it's better to be wearing no nail polish. But there are different studies now saying that nail polish might not be so bad.
But if you are allowing, nail polish to be worn, then it needs to be not chipped, So that's just really, really important. We want to be wearing our hair up, especially if it's, longer than shoulder length. I just put this in there, although it's not really part of hand hygiene.
But clean that stethoscopes. You really cleaning your material when you're going from patient to patient? So if you have a tray that you take from this patient to that patient or a stethoscope, whatever that you are cleaning that in between those patients and try what we have in our practise, which I think is really useful, is we have this, these wipes that have a really short contact time.
So we have ones that we clean the kennels with. And they have a half an hour our contact time. But we also have a short one.
That only has a 32nd contact time as well. So that is, actually, that's actually doable. It's actually feasible, right?
You can clean something, you can wait 30 seconds. It just needs to be wet for that 30 seconds, and then you can go on to your next patient. By the time you've got everything prepped to go to your next patient, it's gonna be 30 seconds anyway, So that's not normally a problem, but 30 minutes.
That's just gonna be something that people aren't gonna be able to adhere to. Right. Closed toe shoes.
It is always useful for our hygiene side of things and then bear below the elbows. Now, this is something that a lot of places do doesn't, do. But I think it makes so much sense, right?
We have this area here where we are going to our patients, and we are potentially having this kind of contaminated bit of our sleeve going from one patient to another patient to another patient. There's no way we can clean that in between our patients. So having either that pulled up above the elbow or having a rule of of No, you know, no t-shirts that are longer than their elbow.
Underneath the the scrub tops and definitely no watches. No rings, so, like, this is really, really important. And I would say even with the wash watches, if they can be washed, great.
But like we know it's unlikely that we're gonna be doing a full hand wash in between our patients or in between these five moments. So those watches and those knit like if we can't do our hands properly, we can't get to those nitty gritty places. It's unlikely we're gonna be able to get to those nitty gritty places of the watches and everything else.
So that's why I would really recommend having just a, like AAA rule in the practise of bear below the elbows and that everyone sticks to it. And now we get to the practical changes. So what?
What can you do in the ER? Like what? What can you actually change in these for these?
For the hand hygiene we'll go through for the common hospital acquired infections or the nose croal infections in the next part. But so for the hand hygiene, what we found has been really effective is that you have more hand sanitiser pumps available. So really, and they need to be in practical places.
So we need those also next to the gloves so that people think, OK, I'm gonna get while I'm taking the gloves. I'll disinfect my hands first cos if they're in separate places, people are just not gonna go for them, right that you have them before you get to your kennels or have multiple around. So we have some couple of kennels and then we have a space to put our pumps, and then we have our hand disinfectant there, and it's just stuck onto the wall with, like, a really heavy duty, glue.
And that seems to work for us, have it by the sinks as well. And we have just different spots, you know, kind of high traffic spots where we have these, these pumps situated so that everyone can get to them very, very easily. And you can also consider otherwise, if that's you know, too much of a change and you have fewer staff members.
We have a lot of stuff for us. It doesn't make sense to have those those mini ones. Maybe we'll change that in the future.
But otherwise, getting those mini sanitizers that you clip onto your belt loop and then everyone has those. So then you've really got that always with you and you've got it. What I think is useful about that is that you've also got it in the kennel with you.
So if you go to that patient and you've done your one step of doing their T PR checking them over and then you want to do something with a catheter and then we get into the aseptic technique stuff, right, and you want to res sanitise your hands, you've got it right there. So you can actually really easily do that in between those two steps and I put on here infections, officer. Now, this is probably something that most people would not have in in a smaller practise.
Anyway, In a larger practise, you might have a a whole hygiene committee like what we have, but having someone or multiple people cos probably one person doesn't want to do this all the time and be that the police officer, but having someone who's in charge of the infection control. So though that person might be given time to do some education for new starters for people who've been there a long time, they may do little audits. There's an app called clean Hands where you can kind of do like a a little audit.
Maybe you just do that once a month and see how people are getting on with their hand hygiene. See from that how what changes you could implement and how you could be better. And I don't think this is about someone standing in the corner and pointing at people.
I think this is about taking in seeing how people actually work on a day to day, you know, kind of shift or a day to day time frame and seeing how we can help people to improve standards and rather than kind of, you know, going from a negative place, we can try and come from an open minded and, just a helpful place to to improve standards, standardised approaches. I do think these really help, so excuse me. We'll talk about this in a little bit in the next few steps when it comes to, the procedures that we do and having standardised approaches for that, but also for the the hand hygiene as well.
And which patients do we standardise approach like, you know, use gloves for which patients don't use gloves for, for example, and having this really so that everyone does the same thing. The vets, the nurses, really everyone it has to be. You know that you are a unit as your as your practise, education as well as I said, like having these webinars having these like little pockets of time where you guys can sit together and watch something like this, or or rather, you know, go through actually the hand hygiene techniques so that everyone's actually happy with when they should be doing it.
And they can bring questions like, Well, when I've got this coming through, how do I possibly do that? And in, you know, so that you can maybe talk through, And maybe someone's been there for a really long time, and they can say, OK, you know, I had this situation. The other day, and I actually did XY and Z.
And then I had that 30 seconds where I could, you know, do my hands and that I'm not saying when you've got a CPR coming in. Of course, like you, you're gonna jump on that patient, right? But sometimes there is.
There is a bit of space to to sanitise your hands in between. You know, like maybe not with that CPR, but maybe with the other patient who is emergent. But like, they are not done right in that moment And taking that 30 seconds that could actually be life changing for that patient.
So just really trying to think about what's really the most important thing in that moment and seeing if you can pause just for that second and doing that that hand hygiene in that moment. And and I suppose that comes also with more and more experience of working in the ER of working with these emergent patients and realising that the hand hygiene is also really, really important for these patients. And we can think about from the education side kind of overlaps, but having these posters, So the WHO posters up for the hand washing or the five moment posters up in your practise so that people really think about when I need to be performing these moments of hand hygiene.
So hopefully I've helped there with how to actually bring this into your practise. So now we'll sweep through our common HAIS. So these are, I would say, personally, I think it's something that I would like to look at with is the IV catheters, the operation sites and urinary catheter systems.
So roots of entry for these microorganisms. There's a nice study there stated, and I've done my own little diagram here of Of which ways that those microorganisms come on, into into our patients through placing an IV. So we have 60% of these micro organisms.
They come through the skin so that could be from the star. Or it could be from patient skin and or even a contaminated disinfectant, which is looks quite interesting. The infusion is less likely to be contaminated, but still a percent so that's still something.
And then we could also have tw like, So we've got 12% of contaminated catheter hubs as well, so this is the patient's skin again or on employees hands. So we we know that these are different areas that we could maybe make a a change on. Right?
So we've got the the hubs and we've got the microorganisms. I would say that the the hubs and the the skin, but we could, you know, make some tweaks here and improve our standards. So some actions, What can we do to with the placement?
So what can we How can we reduce the risk? So hand hygiene? As we said, we've spoken about this enough.
I think I don't need to talk about this anymore, and then wearing gloves because we do act, we have here the potential risk of being exposed to bodily fluids. Right. And this is something that can be quite difficult to place a catheter with gloves that needs practise.
And you may decide, as a practise that this is something that you you don't do or you do do. But I think a standardised approach is is a useful, system here. But when you do have potentially exposure to blood, to bodily fluids, end gloves is normally actually indicated, appropriate skin clipping now.
This also is a good, standardised approach that you do a good, nice window for your clip. And if a dog or cat has feathers that you cut those feathers as well because they are so likely to get, swept round, with the tape over to the top of your insertion site. So this is something that you should feel very comfortable in doing.
It should be standard so that everyone feels happy to, to do a good clip. And I would say that you should place importance of doing a good clip with these characters that you know are going to stay in for a few days. So if you have patients that come in just as as day patients and you've spoken to the vet and they don't want to do a large clip or whatever, then there's only so much you can do right with with those vets with probably with those owners, rather so to say.
But ideally, we want to have having a large clip, and ideally, we want to have a standardised approach, and this is especially important for those patients that are having the IVS that are gonna stay in for a couple of days Staff education and experienced staff members placing caf fetters. Now, this doesn't mean that no students are allowed to place catheters. But we should be thinking about, having that education so that everyone is happy placing the catheter and again having like, a standardised way of of doing it, knowing contact times, knowing how, how we want to be cleaning it.
So you're gonna be using this disinfectant or that disinfectant or just alcohol. And how many swabs you want to do if you're gonna be, you know, cleaning it until it comes, the swab comes clear and then doing one more. And then the contacts are so this all takes some education, right?
This isn't someone that everyone knows to. This isn't something that everyone knows what to do from day dot So this is what I mean by staff, education and experienced staff members facing those catheters. And just because people have worked in other places, they may not have the same standards as you want to bring into your practise.
So don't assume that they can do everything perfectly and just write just because they have done it somewhere else. If you want it to be done in a certain way, then you need to educate your staff members on how you want it to be done. So that it is, so you can increase and improve your standards.
And I put it here. Don't touch. After cleaning, I see so many people do this.
So you you ha You have your capture. Sigh. Your clip site.
You clean it nicely. You've already touched it before. You've palpated the vein.
You know where it is, and then what does everyone do before they poke it? They touch it again. And are their hands like, clean?
Have they directly sanitised? Have they even sanitised just before they were cleaning? Probably not.
So you are just Y you've cleaned that area and then you're just poking it again. For me, this makes no sense to do that. You're just introducing potentially more bacteria again to that site.
And we know that's one of the issues of of introducing, infections into these catheter catheter site infections. So, introducing bacteria to these catheter site infections. So don't try to resist the urge of touching that brain again.
It is still there. You know where it is. Trust your instincts.
You you can do this and then other things. If they've got a line in, if they've got an infusion running, you can be cleaning those catheter hubs an infusion hub before injecting medication and also and disconnecting patients. So making sure that you're using those caps, and actually you're meant to be cleaning that with alcohol for 5 to 15 seconds.
Now, I don't know many people that would do it for for so long for 15 seconds. But just to be aware, this is something that we should be doing. And not only just for a second, but ideally so.
12345. So five seconds of that little clean before you inject anything into those hubs and then handling the catheter with as, as little as possible. So it we just check our once a day.
We, like, completely unwrap it. Check it, make sure it's flushing. Make sure there's no redness.
Make sure there's no, blood or other fluids on that tape, because that's a really good medium for bacteria to wander on in. And then we rewrap it, and unless we've got any problems with it, we are just checking that regularly, making sure that we don't have any, you know, mega pause below or any infusions running paraly. And unless the patient is showing us problems with with the IV, they're not happy.
Then we're not gonna unpack it again. Because every time that we sort of mess and play with those that that that catheter, we are potentially introducing bacteria again. So although it may come from a good place, you want to do something good, you may actually be introducing something that you shouldn't be that you don't want to be introducing.
Then we have our other, ho, like, sort of common hospital acquired infection. So we've got these contamination of surgery. So, surgery on minor ops, these S SI S, surgical site infections, and we can have contamination during surgery.
Or we could have contamination of the surgical wound. So some of the actions of what we can do, So, we can do things, you know, Like like clearly, like giving buster collars and stuff to prevent the patient introducing bacteria into the site. We can have.
We're making sure that we're trying to keep that cage as clean as possible, trying to get that patient, not to lay on the floor, where as much as possible make sure that the bandage is clean, that there's no strike through, that it's clear of urine or other fluid from the wound. That's like, you know, going through so we don't want to have those things. I think those things are quite, obvious and and these things that we're striving to be doing every day as nurses.
But other things that we can be thinking about is also reducing the time under anaesthesia and avoiding hypothermia. Because this can actually affect the immune system so that it's not working as well as it's as as it should be and impairing the function. So that's what I just thought was quite an interesting thing, and and I think we're We're quite good at trying to avoid hypothermia as much as we can, but when we know that it could also infect the patient's immune function, then it's like another reason that we don't want to be exposing them to these these low temperatures, so we're gonna be Prew warming them before surgery and warming them afterwards, keeping a close eye on it, reducing the time under anaesthesia as much as possible.
As much as as as as we can control, we wanna be giving doing a large clip. Using sharp clippers and trying to avoid cuts. A good scrub technique as well.
And making sure that so the scrub technique that we can be using circular or back and forth, concentric circles or back and forth So both of those are are are good and that we are giving enough and, antiseptic contact time as well. And you need to check on whatever you're using as the contact time, making sure that it's all obviously coming back clean and then doing those last few swabs and leaving that contact time. Before then, you're going through to your surgical to to your theatre or wherever you're doing that that either surgery or that minor op thinking about ideal versus necessary.
If you have, like a a real emergency, that's like, you know, needs to get open Now that you are still clipping as much as you can. Still cleaning as much as you can and and trying to get that that contact time as best as possible. I understand that some situations we we just we can't do the best possible, job that we would that we would want to be doing.
Like, you know, if we've got an open chest that we need to open straight away, you're not gonna have the best, ster, you know, sterile field in that situation. But we can do do the best that we can in with with what we've got right and and often is the case is that we we tend to have one or two minutes more than than what we we might think, and and we can use that time to do get a better scrub and to leave that contact time. The contact time is so, so important and then thinking about doing pre or per, antibiotics, depending on the patient, depending on their needs.
And there's some nice resources out there for this as well as to see whether, it's necessary for your patient. and what type of antibiotics should be given, But this isn't normally the job of the nurse, but I thought I would just put this in there because it is the job of the nurse to do the reminders and to do those checklists. So we have our urine catheters as well.
So this is a big one that we can have our infections and our hospital acquired infections. So how do we get infections? For our urine catheters.
So we have the intra, Len. So we have these little bugs going up the the lumen and we have lumen as well. So they're just wandering along the the lines up into up into the bladder.
And these are quite, I'd say, quite a common one. That that we see. And actually to the point where we we rarely place urine catheters in our male dogs.
Now, even if they're recumbent because, we are so concerned about them getting a hospital acquired infection. So unless they really, really need it, then we try to avoid these. So actions hand hygiene and gloves.
So we're gonna probably have, contact with with, bodily fluids, right? With dealing with the urinary ater. So the gloves, I would say is is A is a must in these situations, and then correct patient preparation.
So that's if we when they when the place when the catheters be in place so that we are even doing, you know, a good clip and making sure that we're doing a good clean leaving on that that contact time as well using the, the the appropriate, disinfectant as well if you're needing to clean the mucus membranes and aseptic placement and a clothes system. So hopefully people are using a clothes system for these patients and for our, our block cats and things like that as well, and then disinfect the tube from the catheter to the bag regularly. So this should be happening like once to twice a day.
Often with the cats, we're not gonna get close enough to the catheter with the dogs. We actually can. And we can often actually even clean and flush the prep use, which we should be doing because sometimes it gets a bit lucky.
But going from the catheter all the way down in one swoop, to the bag, with your, with your disinfectant of choice so that we are getting rid of any of those bugs that are wandering along the line going up into into our bladder, some more action. So the bag must be placed lower than the patient. And that is just to stop that urine being flowed back up to that patient.
Which can happen when they're maybe taking them for a walk, which is probably unusual if they've got a catheter. But, if you're taking them to X-RAY or somewhere else on a trolley, then these are situations where maybe that bag gets sort of put somewhere where it could flow backwards. And so we want to make sure that that urine doesn't flow backwards and we can do that by either closing it off.
But then you need to remember to open it or, to be making sure that it's always placed lower than the patient and that we are emptying it also acceptably. And what I mean by that is that when you're opening this, little, valve here, that you are cleaning it with alcohol before and after, because when you're pushing it through the you're getting some exposure from the outside to the inside, right, so we need to clean that with alcohol and then push it through. You get rid of that urine, you measure it out, and then you know you're gonna push that back through.
So you you clean it as well before you do that. And you you're making sure that you're going to do that with clean hands as well. And I would also advocate wearing gloves whilst you're doing this.
Then we have so some training and checklists. So this is to bring some education into your practise again. So some protocols and training, I would say, are necessary if you want to improve your your hygiene standards in your in your practise.
And so having some checklists for daily, weekly and monthly cleaning are really, really useful, so that you know, when it's been done and what still needs to be done that month, these these checklists should include these high risk sites that are the lights, the door handles, the computer keyboards and also the drip pumps. These are really like high risk and high traffic areas as well, and checking that you've got the right dilutions for your solutions as well. So these are for your disinfectants, making sure that they are made up correctly rather than just, you know, kind of eyeballing it.
We can also think about having some SOPS for, the common emergencies or suspected emergency, suspected infectious diseases. So these would be our pups and kittens in general because we don't want them to be getting anything from us. And this is less about the nasochrom stuff.
This is more just about the general, patients that come in, in emergency, that that you know, the diarrhoea puppy, the cat flu. And then we've We've also got these patients that may have We know that they've got a multidrug resistant organism so that we've got a protocol for these patients, and we everyone knows which door they should come in. If they're allowed out for a walk, if they if there is a special place for these cats to be placed, if they need to be put into a special consulting room for their first check if the owner is allowed to visit on the weekends, These are all things that you can talk about beforehand.
And have these SOPS already made up for these patients that everyone is happy with. And you can also add these to your training, right for your new starters or even just the training that you do once every three months, that people are really happy with their their hand hygiene of when they should be doing it, and that they know what to do when these emergencies come in. Because often it's the case that you're by yourself, right?
And when these things come come down and if you're relatively new or maybe you have locums and things like that, then it can really easily happen that you have then, like a massive contamination of your practise. And that is so hard to rectify afterwards, it takes so much work. So putting in a little bit of work in at the start and putting in these SOPS for these emergencies will be really, really beneficial for you and for all of your staff and for your practise as well, I would say so.
I am bang on time in the 45 minutes. I'm quite proud of myself, and I thought we'd just summarise by going back through the learning objectives. So I'd like to kind of see if I've really covered my points.
So define those chromia infections. So I think we've gone through it. We know what those are.
We can define those apply effective hand hygiene methods to your practise. There's a bit that I'm missing there. I hope that you feel more comfortable about when to apply these these hand hygiene methods.
What to do, how to maybe, improve the standards in your practise. Improve. How to do that in in the emergency room as well.
Just by having more education, maybe some posters having more, sanitizer available and knowing when you should be doing it. And I think you know, these are these are the small things that we can be making quite a big difference with every single day. And and the more that we we know of how important it is to do the, the more likely are we are gonna take that time 30 seconds to actually do it correctly, right?
And these and then identifying changes that you can make in practise. So we've gone through, talking about education, talking about surveillance, having maybe a little, officer that you, you know, or a few people that you you say, right, you're gonna be in charge of of hygiene and making those SOPS seeing about adherence and compliance. This is quite difficult to do.
Of course, when you are on, like a 24 hour one or you it just it's just one be one nurse who are doing these things. If it's in a a daily emergency practise, this is something that's probably easier to do. But maybe that hygiene infection control person could also be in charge of making sure that SOPS are written, making sure that they're up to date and so that everyone knows what they should be doing in certain situations with those different emergencies, and also when they need to be disinfecting their hands and how they should be disinfecting their hands as well, so that people are trying to do this standardised approach also to those emergencies.
To placing those IVS to clipping your surgical sites to, anaesthesia times to, urinary catheters and how we manage those. And those are some things that we can I think make quite a big difference in, by, you know, hopefully not too much massive change and cost to your practise. I thought I'd just end on that in case you wanted to, use it at all.
You know, feel free to. And if you need any other resources, do you have any other questions? Or need any of the sources for any of the information that I've put on on these slides you are Welcome to to reach out.
I I haven't put my email address on here, but, I will see that it's somewhere in the comments for you guys to reach out. Otherwise, it's just Natasha dot summerfield at UZH, dot CH. Thank you so much for your time.
And I really hope that you could take something away from this lecture.
