Thank you, thanks, Bruce. So I just wanted to take 5 minutes just to talk about Milla and the role that we, we, we play in infection control as well before we get on to the main session today. My name is Kate Jones, I'm the marketing manager at Miller, Professional.

We're the commercial arm of the white goods manufacturer Miller, and we've been providing commercial equipment in the UK for over 50 years. For a variety of businesses such as care homes, hotels, laboratories, and obviously veterinary practises as well. Over the next hour, you'll be listening to Louise talk about infection control, and it seemed a really good fit, to briefly talk to you about how laundry can impact on this area as well.

So why does laundry matter when it comes to infection control? Obviously you're dealing with mud, blood, faeces, vomit, etc. As an inevitable part of your day to day working life, and infection can easily spread.

Infections live and spread on scrubs, animal bedding, towels, staff uniforms, and the threat of cross contamination is very real. The type of laundry machines that you use and the temperatures that you wash them, is crucial when it comes to thermally disinfecting items. So when we talk about machines, I obviously am talking about commercial machines and I'm gonna come on to it in a little bit, but obviously commercial versus domestic.

So, what, what are the benefits of having a commercial machine over domestic to control infection in your practise? One of the most important guidelines for the care sector, which should also be applied as best practise for veterinary practises, is the new health, technical memorandum guidelines about decontamination of linen for health and social care. What these guidelines state is that to kill bacteria, linen should be thermally disinfected, using washing cycles that achieve 65 °C for at least 10 minutes, or 71 °C for at least 3 minutes or 82 degrees for at least 1 minute.

There are also other regulations to consider. The main one, which I'm showing here is the, Water regulation advisory Scheme category 5. This states that, for any situation where there's where there's serious health hazard, including animal waste, vets should comply with this standard.

So it means basically it's a, it's a water infill pipe that means that once the water comes into the machine, there's an air gap, so there's no chance of the water going back into the mains water supply. Domestic machines don't have this water park. Commercial machines do, commercials have to have it to to work in a care environment.

So that relates also to the veterinary practises as well. Another factor to consider is the length of the cycle times, . If you have a look at how these compare for a wash cycle, a professional machine generally lasts 49 minutes.

And for our, Little Giant range, we can wash and dry in 85 minutes, a 6.5 kg load. Compared to domestic, you're looking at, approximately 210 minutes for a wash and dry, so a massive amount of difference there, and obviously a lot of extra linen that can be washed during that time.

We, recently undertook a survey, so we surveyed 100 vets to find out more about, their laundry procedures and what their biggest concerns are when it comes to infection control. And what we found out was that almost half of vets are using a domestic washing machine. So this has sparked our debate really internally about how, how can we inform, veterinary practises about best practise for controlling infection using laundry.

I know all there's lots of other different areas to be covered, but you know, our part of being a laundry manufacturer is how we can help in this sense. So I'm gonna come on to at the end, some guides and material that we're creating that that might help as well in that. Again, almost half had a domestic tumble dryer, and 56% of vets, believe that their current washing machine is effective at killing diseases.

So as you see, as I, as I've been saying, you know, our role is to really talk about how a commercial machine can help to to benefit controlling infection. When you're looking at a, a typical laundry room layout, we've mocked up a design here to show you what it could look like. Obviously, in a commercial environment, the reliability of the machines is key as downtime has to be limited.

So, commercial machines are generally a lot more reliable than domestic. Having the correct drain option on the machine will eliminate the risk of blockages due to the buildup of, the buildup that happens in the pipes, so animal fur, etc. What this means for a commercial machines we have something called a drain valve.

It's, it's basically a trap at the bottom of the machine, so it opens and everything flows straight downwards into, into the waste pipes rather than going round bends and, and things. So that means that all of, all of the soiled water, all of the fur, goes straight down into the waste and it stops it clogging up and backfilling and there being a risk of, the water contaminating back into the system. So we've got commercial washing machines, and commercial tumble dryer, and then obviously folding, space for folding tables, racing, and trolleys, as well.

So there should be space for that. And then, oopsie, sorry. Then there should also be, a sink or a facility to, to wash your hands, after handling the sort of linen.

So what are the benefits of Miller? Obviously I'm on here to, we're sponsoring it because of infection control, but also I, it wouldn't be doing my job if I didn't talk to you about, the benefits of Miller over the other commercial machines that are out there. So when we talk about Miller, we're a German company, testing is and quality is very much our business.

So our machines are tested above and beyond, really, so we test them to last 30,000 cycles in our washing machines. And our dryers are tested to 40,000 cycles. What that equates to is 8 cycles a day, 7 days a week, for 12 to 15 years.

So you can really see the the benefit there of, of how reliable our machines are. A domestic machine in comparison is typically expected to last for about 5000 cycles. That's what our, our meal and domestic ones are tested to.

And that's in a domestic situation. So with heavy use, a domestic appliance can last as little as, 18 months, really. Honeycomb drum, this is one of our USPs at Miller, so that ensures linen quality, is preserved.

It's a, it's a, it's a mechanism really to cushion the laundry as it's going round. And that prolongs the linen life. As I talked about, we have a sluice programme option, so, this is where, As we were saying, it's in compliance with the health service guidelines and also where we have the drain valve as well.

Warranty, our machines are supplied as standard with 2 years parts and labour warranty and obviously options to extend it. What you may not know is a domestic machine, in a commercial premises won't be covered by any warranty because it's not being used in a domestic situation. So there's always that to consider as well.

And then, what is key obviously for, futureproofing for future is it being environmentally friendly. So, due to the low operating time, short cycle times, a large amount of electricity and water is saved, again, a lot less than domestic. And then finally, another area that you, you may not know about is that because low energy and water consumption levels are important.

When choosing a machine, one machines which are on the government's water technology list that are proven to be water efficient can enable your practise to write off the whole cost of the equipment against taxable profits in the year of purchase. So it's something else to consider when you're thinking about that. We do have a range of additional, equipment to consider, so obviously having a separate machine for staff, scrubs that aren't in contact with animal waste, or for tea towels or, or anything that doesn't come in contact with an animal, you may, look at having a separate laundry.

We do a range of thermal disinfectants, dis dishwashers even, so they could be used in the animal kitchen. But also for bowls and and things, but also a separate one in the staff kitchen as well. And then washer disinfectants for the operating theatre, the pet room and the laboratory, as well.

So that was, a very quick, look into me, as I said, there is further information available. We do have a dedicated veterinary page on our website. And we're launching this, infection control guide for vets this week.

So that should be up on the website. If you would like to have a copy as a PDF before, you know, during tonight or before the end of, the end of this week, then just give, give me an email and I can send it across to you, to consider. So thank you very much for your time.

Let me know if there's any further questions at the end of At the end of the session in the Q&A session, but I will pass over to Louise now. Thanks, Kate. That was absolutely great.

Louise, there we go. OK. Thank you very much.

Good evening, everyone. I hope you've had good days at work. I'm hoping for those of you that are in an appropriate time zone, like you've got a glass of something also appropriate to drink this evening.

So, I'm gonna talk about various different aspects of infection control, really looking across the whole, of the type, the, the clinic that you're working in, because it really is multi-factual. And one of the things, as well as thinking about, you know, infection control from the point of view of infectious diseases and them being passed between our patients. One of the things I really focus on is looking after ourselves as veterinary staff, because I think it's very easy for us to overlook that and forget about some of the contagious diseases that we're dealing with.

Forget about some of those zoonotic diseases. And sometimes we don't even realise patients may potentially. Be carrying something zoonotic until we've been nursing them for a period of time.

So there's lots of things we want to talk about, and hopefully, things that you can go away and apply within your practise and look at, you know, changing, how can you look to improving things for not only your patients, but also you as staff and also potentially your clients as well, cause they're another aspect when we want to think about infection control. So it really is a consideration for the whole of the practise. You know, we need to have everyone on board.

I'm gonna talk about, you know, having protocols in place and all these different types of aspects of infection control. What we really is important is everyone is on board. And I think, for me, it really has to come as a top-down approach, you know.

The practise management, the practise owners, the vets, the nurses, we all really need to set those examples. But we need to think all the way through the, the staff that are working in the clinic. You know, if you have staff coming in as cleaning stuff that aren't veterinary trained, do they have the understanding of how, you know, how disinfectant's meant to be used, how we should be clean in different areas of the practise?

And we're seeing very similar challenges to human healthcare in that we are seeing a number of different multi-drug resistant infections now becoming more and more common in vetary practise. And we really are moving away to. Approach kind of, infection control and certainly asepsis.

We're moving away from using lots and lots of antibiotics. We kind of, I think most of us are now working in clinical environments where everything doesn't get a complimentary antibiotic injection when it goes to theatre because we know that is a major issue when we, when we look at, you know, the emergence of multi drug existence. We want to think about the transmission of infectious agents between humans and animals and animals to animals and vice versa.

And also thinking about those diseases being taken back to the owners, because that's often something that we just really overlook in our practise. And we are beginning to see a lot of the common hospital-acquired infections that they see in humans and our veterinary patients. And a lot of those, again, are things that we can look to having protocols in place just to really avoid, becoming a major issue.

So infectious complications are a significant contributor to morbidity and mortality. I work predominantly, in emergency and critical care and anaesthesia, and we have lots of patients that have, you know, sustained multi, multi trauma. They will come in with fractures following being hit by cars, things like that.

We have a lot of very, very sick patients that may well be neutropenic, and we really need to think about. Looking after those patients and not adding something else on top of them that they've already got when they've already got these major issues. There are so many costs when we look at infection control.

You know, there are obviously direct costs, but everyone is very aware of the, the, the growth of social media and how clients will go onto Facebook pages and all these things and talk about what a bad job people have done. Whether it's your your your your fault or not. Clients are still gonna go out there and talk, talk about it.

And, you know, it really can have a massive impact on a practise reputation. But when we think about some of these infectious diseases, a lot of those risk factors are poorly understood, and we'll look, as I said, through different aspects of infection control today and and hopefully raise some issues that you maybe not even thought about before in your practise. And again, our big focus is trying to move away from that that reliance on an antibiotic resistance because in those critical patients, particularly where they've got lots of catheters in, they've got lots of drains in, this multi-antibiotic resistance really is becoming more and more of an issue.

And there's lots of very simple things that we can do to try and take away that overreliance, but also to make sure we are not spreading. These types of diseases around our clinical environment, from both a patient point of view, but also a staff and a client point of view as well. For me, it's really important that we evaluate every single patient coming into our clinic to assess their infectious disease risk.

I'm sure most of us at some point in our life will have dealt with a patient. And we had no idea that that patient potentially could have had something like leptospirosis because nobody told us. So for me, it's important that we make sure everyone is notified within that clinic regarding patient signalment, their history, what they found on physical examination, the lab findings, particularly suspicious about any sort of contagious disease.

Now, we may have patients come in with things like MRSA and we don't know about it. But again, we have those protocols in place. We look after ourselves, we use things like appropriate PPE personal protective equipment to stop ourselves becoming contaminated and contracting these diseases.

And as I said at the given, it, it really is a team approach that's gonna make sure we've got the appropriate handling of that patient. The proper implementation of cleaning and disinfection procedures for that environment. And one of the things that I think is so useful is to look at assessing biosecurity in patients before they even leave that examination or that treatment room.

So, it's something that makes us just stop and think, what is wrong with this patient? What could be wrong with this patient? How are we gonna house them?

How are we gonna handle them? So we minimise the spread of infection, and we minimise the risk of, of, of staff and patients becoming contaminated. So biosecurity, nutshell is basically a group of principles, how we're going to carry out these things, what actions we're going to take.

It's about having these precautions in place. You know, barrier nursing one of the things that I will say about barrier nursing is it's expensive, you know, the use of appropriate PPE, you know, they are single-use items. We cannot take off an apron or a gown.

You know, without potentially causing contamination to our cells, but you certainly cannot take it off and reuse it without causing contamination. So they are single-use items. And what's also important is having protocols in place.

We'll look at that when we talk about hospital acquired infections, but how we can minimise bacteria and other infectious diseases getting into our patients through things like catheters and drains. So one of the things that we look and look at doing is assign, as I said, a biosecurity status to a patient. This is basically classifying a patient into a certain category, and that helps us think about when we're going to handle these patients and how we're gonna house them, and the way in which we're gonna handle them.

So for us, tier one patients are patients that are at high risk of acquiring infections because they've got poor immune status. So this would be paediatrics, neonatal patients, patients from receiving chemotherapy. You know, patients when we know they already have issues and then they've got a high chance of us giving them something when they enter our hospital environment.

So that these patients are hospitalised, they will be reversed by a nurse. So, again, we would wear appropriate PPE, so we are not giving our patients anything. They also, we would handle these patients first, ideally before we handle any of the patients within the clinic.

Tier two patients are patients when they come in, I've got no evidence of contagious disease at that point in time. So these will be animals coming in for routine nutrients. They, they, you know, they aren't coughing.

We don't think that they've got any, any sort of sort of infectious disease whatsoever. Patients are in tier 3 are patients that have got infectious diseases that are deemed to be mildly or moderately contagious to patients or personnel. Now, yes, these patients have got infectious diseases.

But these are infectious diseases where if we handle them appropriately and use appropriate PPE, we should be able to keep it confined. We could potentially put parvovirus into this category. Parvo virus, we know is transmitted via faecal matter.

So if you bury your nurse appropriately, you wear appropriate single use PPE, you're not spreading that around. Your clinical environment. So it's just thinking about how these diseases can be spread.

And again, some of these you're going to have to adapt, depending on the clinical environment you have. I'm very fortunate. We have a barrier nursing ward and we also have an isolation ward.

So we've got areas where we can put all these patients and ours is a a purpose built hospital as well. And then tier 4 patients with patients that are known or suspected to have highly contagious diseases. Our cat flu patients will come into this category.

Yeah. The animals that I've got kennel cough will come into this category. It's airborne.

We know it's going to get spread over a wide environment very, very easily, and it's very difficult for us to contain it. So it just makes a stop. And think.

And the way, when we look at biosecurity, what we actually can look at doing is either colour code in your patient's paperwork. So you either would have different coloured hospital sheets for these different tiers, you could put stickers on there, just so that it's very obvious as to what tier that patient has and staff then know how they're going to deal with them in that clinical environment. When we look at infection control practises, and there's lots of things, as I said, we're gonna talk about, we need to make sure that we are vigilant.

Everyone needs to make sure they are doing things in the same way. People may need to make sure that they pass on all that information. If we have patients coming into the clinic that we think are infectious, we treat them as, as though they are until we, we know otherwise.

So that's looking at housing patients into isolation, and it's looking at appropriate barrier nursing of patients as well. I will come back to some of this later on, but we, as I said, we're going to talk about common hospital acquired infections. So the ones that we most commonly, are gonna encounter in our clinic and in our clinics are things like intravenous catheter infections.

We see, we know these are common in humans. I think we don't see as many of them in our veterinary patients because we have a lot of them routinely in antibiotics. But it's certainly something that we want to think about, particularly if we have patients that become pyrexic.

And we have patients in our hospital that will have central lines and we know that real high risk. And when we think about how bacteria. Get into patients through things like IV catheters, through things like urinary catheters.

They literally migrate over the surface of that device. So again, it's having protocols in place to make sure they are disinfected regularly to stop them getting into those patients. Surgical site infections.

Yeah, we want to make sure we've got good procedures in place of about how we're gonna prep patients before surgery, knowing that we were using an appropriate contact times, knowing that we use an appropriate dilution rates for things like, hey scrub, if that's what we're using. If we're using things like chlorhexidine. And pneumonias again, probably not quite so much in retinary patients but certainly humans and ventilator associated and pneumonias are common.

So in terms of preventing hospital acquired infection infections, we know we are not, we're not gonna be perfect. You know, we're never gonna be able to completely prevent them. We know surgical site infections, we're probably encountering in somewhere between 5 to 10% of our patients, but we could potentially get that down further to 2 to 3% by having those really good protocols in place.

So, it's looking at having those strategies to try and limit infection. And those strategies are hand hygiene, which is a massive factor, environmental cleaning disinfection. Appropriate isolation of patients, appropriate barrier nursing, and looking at what antibiotics we're gonna use and when.

So hand hygiene is a massive factor in preventing hospital acquired infection. We know over the last 1015 years, there's been a massive drive to increase awareness and improve compliance. You know, if we look at human medicine and human hospitals, you go, you go into your GPs now, and they will have touch screens, and they will want you to decontaminate your hands using a hand rub before you touch them.

If you go into a hospital before you visit someone on a ward, there'll be alcohol rubs available, alcohol gels available, because we know it has makes such a difference when it comes to reducing the spread of infectious diseases. What's important is to have regular training programmes in place. You know, you, you kind of have to make the assumption that people do not know what, how to wash their hands, because if I'd done a poll question now, and it was completely anonymous, and if I said, I'm going to put everyone that's listening in a room and test you, a lot of people would say, you know what, I don't actually know how I should wash my hands properly.

For the vets out there that are listening, I apologise, but the same as in doctors and nurses, there is evidence that veterinary surgeons tend to have lower compliance than nurses or technicians. And what we definitely know is when you are busier, there's reduced compliance. There was a study that was done on a human ICU and they found that there was a sevenfold reduction in hand hygiene when people were busy or they were understaffed, because they just didn't have that time to go and decontaminate their hands, which is why we need, need to think about where we station our hand sanitizers to make it easier for people to use.

It wants to be almost unavoidable. And that can be quite a difficult aspect in itself. When we think about the goals of hand hygiene, we are not trying to get our hands sterile.

What we're trying to do. Is reduce the number of microorganisms on the surface of the skin, reduce, reduce the number of transient microbes. We all are going to carry our own bacteria, our own flora on our hands.

And we want to try and reduce those numbers as much as we can so we avoid contaminating our patients ourselves, and also us getting contaminated too. And we're going to carry that out by either hand washing, and we're going to use predominantly those antiseptic hand rub and washes, so things like chlorhexidine. But also, also the use of alcohol rubs and alcohol gels, which have become, become so much more commonly used over the last kind of 1520 years.

When we look at hand washing, what generally is recommended are using chlorhexidine or trilosamla products, and these products are minimally affected by the presence of organic material. We want to make sure they work well and they work quickly as well. We also want to make sure we adhere to appropriate contact times.

And again, hand washing was, is going to take some time, and that's why it makes sometimes it's much, much easier to use things like our, our alcohol rubs. We want to make sure there's protocols in place. We need to make sure that people know when they should be washing your hands because you need to wash your hands probably far more than anyone would expect or decontaminate them.

And we also need to look after our skin. You know, we've all been there where you've ended up with dry hands and cracked and chap hands and dry skin and things like dermatitis. And if that happens, you've not got an intact skin barrier, and having an intact skin barrier is really important in terms of us not contracting things from our clinical environment and our patients.

So, as I said, these antiseptic or alcohol rubs have become more and more popular now. They are more than what we probably think they are. They're a combination of alcohol, antiseptic.

They also can, some of them will contain an emollient as well. So they, again, helps to look after your hands. It stops them getting as dry.

A lot of them, will also contain an antiperspirant. So I'm not really gonna talk about kind of surgical scrubbing up and things like that, but in our hospitals, our surgeons know longer scrub. They just use, an alcohol rub, and the benefit of the alcohol rub is that it contains a deodorant, which means their hands are not going to sweat as much when they're in their gloves.

So if their gloves get punctured, all that hand juice, which is technically a term, glove juice doesn't leak out to that patient's surgical site and be and become a source of contamination. What also is important, and for those that are using these products is making sure they're going to be going to be efficacious against the pathogens we're coming into contact with. For those using products like sterilium, it's important to remember that the standard sterilium that we're probably using theatre is not effective against arbovirus.

You've got an alternative version that you can use. They're coming into contact with certain bacteria and certain viruses. So again, go back, have a look at the product you're using, get in touch with your rep and they will give you lots of advice on this.

Hand hygiene, it's not glamorous. So we need to make sure that we have short nails, no nail varnish at all. It goes without saying no false nails, because false nails are bad enough when you look at people that don't work doing the job that we do.

And it's even more grim when you think about false nails in, in our type of, of, of working environment. In our hospital, we have a bear below the elbow policy, the same as they've adapted in human healthcare. So staff do not wear any jewellery, they don't wear any watches, they don't wear any Fitbits.

They are allowed to wear a plain wedding band, but certainly nothing with diamond diamonds in or anything like that. I've questioned and marked the use of gloves, just because I think sometimes people forget that, or they tend to think that gloves are like some sort of antimicrobial shield, and you can do lots of different jobs with the same pair of gloves on. You can't.

You should change your gloves whenever you wash your hands. And what's important is to have regular training. The use of things like glitter.

Bug that will fluoresce under UV light can show staff where they're going wrong with hand washing. I know the bits of my hands, kind of the heel of my hand, if you like, and down certain nails at the sites where I miss when I'm hand washing. So I make sure I remember to wash that bit of my hand when I'm hand washing.

So said we need to look after our skin. So if you do have open wounds, you want to make sure you keep those covered. If you've got broken skin, if you've got dry skin, you're gonna have a compromised skin barrier.

And that's also, as well as us contracting things for our patients, it's a potential for infection for the, our animals themselves. So again, being really careful and thinking about not just, you know, broken skin on your hands, broken skin anywhere. If people have got psoriasis, And you, you know, go, tucking your hair behind your ears, or if you've got a wind on your arm, you know, it's very easy for all these things to get touched with contaminated hands to come in contact with patients.

And again, the last thing that I want to do is contract something like a RSA or a RSP that I potentially could take back to my house, to my animals, to my family. So we want to look after our hands. Gloves, as I said, I kind of Put a question mark next to that.

Gloves should be removed immediately after you've used them, ideally taking them off in a method that avoids contact between the skin and the outer glove surface. Those gloved hands should only be used to touch surfaces that are going to be or should be, make sure we don't use those gloved hands to touch surfaces that are going to be touched by people with non-gloved hands. So that's avoiding contaminating.

Personal items, but avoiding contaminated things like infusion pumps or multi parameter monitors or even kennel doors, things like that, that someone else is going to go in and touch. When we do take our gloves off, we want to make sure we wash our hands or use a handbas, an alcohol-based sanitizer immediately afterwards. And it's a common misconception that using gloves negates the need for hand hygiene.

You should be washing your hands whenever you take your gloves off. So again, they're not a replacement. So certainly when you're moving from contaminated areas to clean areas on the same patient, moving from dirty clean procedures on that animal, after you do come into contact with body fluids or blood and certainly between patients and probably several times on that same animal.

PPE, as I mentioned earlier on, it's a really important routine aspect of infection control, and the use of PPE is designed to reduce the risk of contamination of our personal clothing, to reduce the exposure of skin and mucous membranes of veterinary staff to pathogens, to reduce the trans. Mission of pathogens between patients by other staff as well. And we should really be using some sort of PPE in all clinical situations.

So even if it's just an apron, when you're coming into contact with animals when you're coming into an environments. And as I said, it does start to get expensive, or you could use, you know, Disposable, you could use multi-use gowns. The problem with multi-use gowns is they're only good for a certain number of washes before the weave becomes too open that they provide no bacterial barrier.

When we look at the hand hygiene, these are the points at which we should be carrying out some sort of hand hygiene, whether it's an alcohol alcohol rub or hand washing. So that's before you even go and touch that patient, before you do any sort of procedure on that animal, be it giving some medication, be it re-wrapping an IV catheter. After you've, carried out any procedure, or you've become exposed to any sort of body fluids, after you've finished touching that patient and after you've finished touching that patient's surroundings.

So it does mean that you almost need to carry some sort of hand rub or something like that with you at all times to be able to do this effectively. And no one's ever going to be 100% perfect. This, I know, is available as a recording so people can go back and look at this, but this just talks through.

When you should be doing it and why you should be doing it. And it's predominantly protecting the patients against bacteria from our hands, protecting our cells, and the clinical environment from harmful bacteria from that patient as well. So it's just thinking about all those actions.

When you think about it, it makes complete sense. Yeah, you deal with the patient, you go in, you touch the clipboard. You'll switch the infusion pump back on and all the time you're contaminating something that someone else is going to come along and touch and contaminate themselves with.

We audit hand hygiene in our hospital and we find lots of reasons why people don't comply. The ones that I've highlighted in red, the ones that I find most commonly happening. So again, sleeves are not rolled up before hand washing shouldn't be an issue because we are bare below the elbows.

People shouldn't be wearing jewellery or watches, but we find people putting in chlorhexidine onto their hands before they've got wet hands. Remember, chlorhexidine is a chemical, and that's likely to cause your dry your hands to dry out if you put it on when it's wet. Being too fast hand washing, using gel when your hands should have been washed.

If you come into contact with organic material, you should be washing your hands, not using alcohol rubs. And hands not being washed after removing those gloves, but lots of other reasons. So we, as I said, we audit hand hygiene within our hospital.

And one of the things that you could look at doing is you find a very poor compliance is look at retraining all staff to make sure people do have that understanding. As I said, PPE is one of the things that we want to be making sure we're using appropriately. So we should be using PPE with every patient, but certainly additional PPE when we're dealing with patients, in isolation, making sure we're using something appropriate.

So at minimum, it's gonna be an apron or a gown. Potentially, We certainly something like disposable examination gloves, also shoe covers or Wellington boots or some sort of foot protection. In addition to that, you may want to use things like masks or have some sort of eye protection.

We in our hospital had a dog in with leptospirosis last week. So again, we keep it in our back of their minds that that's zoonotic. Even if that patient's on treatment and we're still careful.

And as I said, all of this has to be disposable. It cannot be reused. You are not, you're just gonna contaminate yourself and put yourself at risk by trying to use PPE.

So the purpose of this is personnel need to protect themselves from potential transmission of pathogens from soiled linens by wearing the appropriate PPE, so gloves, apron, and gown when you're cleaning and disinfecting patients' environments, when you're handling soil linens, as well as when you're dealing with patients. You should be washing your hands whenever gloves are taken off or if they come into contact with soil linens and not wearing gloves. Having hand hygiene stations and ideally sinks available in laundry areas.

And I think probably the majority of practises are not going to have those, available. As Kate said, she had that kind of ideal setup for a laundry room, and it's one of those features that we really should have in there. You can buy little portable hand, little sinks that you can put into these rooms.

So again, if you've not got that, think about looking after yourselves, or at least making sure you've got gloves in that room that you can put on whilst you're dealing with bedding. The same applies to when we're carrying out cleaning and disinfection. Gloves, appropriate PPE, depending on the type of, of infectious disease you're coming across.

Remembering what we want to have good protocols in place for how we're gonna clean. Again, I sound like I'm obsessed with, having, standard operating procedures in place, but we need to make sure everyone knows how we're gonna clean kennels, how we're gonna clean certain environments. And gross contamination is going to act inactivate most of the disinfectants, no matter.

How concentrated we use them at. It's also important people understand what dilution should be using in which areas, because we're going to use something very differently in our general reception area, then we're going to use in isolation, dealing with the patient with infectious disease and making sure we use appropriate contact times as well. So with cleaning this infection, we want to make sure if there is kind of any gross contamination with organic debris that's removed first, because that organic debris is going to protect organisms.

And cleaning just, you know, with soap and water in effect will decrease contamination by over 90%. Making sure people are using an effective disinfectants correctly. And you know, throwing a bucket of disinfectant into a kennel is not a substitute for cleaning.

We need to use some elbow grease and making sure we've got waste disposal procedures for used disinfectants as well. We know visual cleanliness is misleading. 50% of all what appears to be a clean surface is going to be contaminated.

And this is why it's so important to have protocols in place and have training and think about all those different areas of your clinic. How often do you clean infusion pumps from patients? How often do you clean downwards parameters?

How often do you clean your clippers? All these things you want to think about, light switches, door handles, all those things, computer keyboards. So, for me, it's really important having these checklists to make sure these things are cleaned regularly.

And we have them laminated. We will take a photo of them whether we're in our CVS hospital, so we need to keep evidence and for the infection control aspects of our practise standards awards to make sure we can evidence for inspectors that we are carrying this out and really think about concentrating on microbiological cleanliness and those high risk sites, things that are touched regularly by lots of different people. Regularly look at reevaluating your cleaning protocols.

So things change all the time. Dilution rates for disinfectants can change. As I said, think about those overlooked areas and think about things like cold sterilising fluids.

I'll mention foot baths later, but making sure we're cleaning things like our foot baths regularly, they just get gross, pretty quickly. So if they're gross with organic material, that's gonna to inactivate that disinfection, disinfectant. And again, think about using, making sure people are using appropriate contact times.

In terms of disinfectant selection, there is no standard disinfection programme that can be used in all veterinary clinics because every environment's going to change, be different. The services that we've got within our clinics different. We've got different case loads.

All these things are going to influence disinfectant choices, but ideally what we want to do is select the disinfectant for a specific purpose, take it into account the spectrum of activity. It's susceptibility to in activation by organic matter, the presence of pathogens that we're coming into contact with in that environment, it's compatibility with soaps and detergents, it's toxicity for personnel and animals, the contact time, it's residual activity, whether it's corrosive to particularly metals in our kennels, and the effects on the environment and the environmental costs as well. So lots of things to think about.

When I think about risks, risk assessing each area of the clinic and each piece of equipment to again to make it easy and effective to carry out disinfectant and doing that risk infection, risk assessment of that individual disinfectant. So, certain health and health and safety considerations are going to be, is it toxic on contact with skin? If it's something that you've got in a spray bottle, is it toxic when inhaled?

Is it corrosive? Is it flammable? And if you're not sure, get that, that's that data safety sheet from the manufacturer, and they will probably already have them provided, on the, on the, the actual packaging themselves on the, the carry themselves.

We want to make sure we're cleaning our cleaning products. It sounds obvious, but often it's things that aren't done particularly well or very often. So mop heads, we want, don't want to see, see that, leave those mops sat in dirty disinfectant solution.

We want to make sure people are cleaning that disinfectants and replenishing it regularly. We've all probably been there where you think, I don't know how long that bucket of disinfectant has been sat there. And I don't know what it's contaminated with because it's sat there all day.

Also cleaning out those mop buckets and, and disinfecting them themselves regularly. What's also worth doing it is looking at colour code colour coding or having a labelling system. So you're only using Certain equipment in certain areas of your practise.

So we're certainly restricting things that are going to be used in theatres, in the isolation area, potentially in, you know, consult rooms, reception, because we're gonna have different requirements. They're gonna have different kind of Concerns, you know, in our clin in our theatre environment, we're hopefully not coming into contact with things like parvovirus. So again, we won't make, want to make sure we're not using equipment that gets used in isolation.

So just looking at having very obvious, so staff know what gets used, which colour piece of equipment gets used in which different area. And then as we said, we want to think about isolation and barrier nursing, we wanna have practise guidelines in that aim to protect staff again from contamination. And from us contracting infectious diseases.

We want to protect that patient from other patients in that clinical environment, and I could add on to there as well. We want to think about protecting owners too, because although it's not ideal to have owners coming and visiting, if we've got patients where we don't know what the outcome's gonna be, we're certainly not going to stop that owner from coming and visiting that patient. So we try to discourage where, where we're at all possible, but if they are going to come in, they will wear appropriate PPE in the same way we would do.

Making sure we've got a well stocked isolation. You don't want to have to keep nipping it in and out of isolation to forget something that you've forgotten. Trust me, when we go into our isolation ward and we have donned all our PPE, the last thing we want to do is have to take it all off again, even though it gets very hot and sweaty in there.

If we have infectious patients, we would continue to bury a nurse them for 48 hours once they're asymptomatic. We try to minimise minimise movement of those patients around the clinic, if absolutely necessary, but patients may well need to go and have X-rays taken. They may need to have dressing changes.

So if that has to happen, we would move them around on trolleys. And again, really thinking about careful hand hygiene. We all work in different clinical environments, and we may not have a, an, a, a, a perfect isolation area, or if you've got very sick patients, putting them in isolation may not be appropriate.

So what you can do is set up kind of a little zone around a kennel if you've got critical ill patients. It may be that you know that actually a part of a patient is better housed in Your ICU because you know you're gonna get a better outcome from intensive nursing of that patient. So again, we can create this improvised isolation as long as you've got really good protocols in place for doing so and everyone knows how it's going to be done.

As I say, we want to think about if we do have those patients, how we're gonna transport them around the clinic. Making sure we have that PPV available, making sure we've got good protocols in place for how we're gonna clean, making sure we're using an appropriate dilution rates for the infectious diseases we're encountering. I've said this already, but foot baths and foot mats, we should be making sure we change those regularly.

They get absolutely grim, and making sure people can use them appropriately. We've all been there where you see people wearing, you know, some trainers, and they don't want to put the whole of their foot into that foot bath because the trainers are going to get wet. That's not going to be appropriate footwear.

Yeah. So again, Think about what works for your clinic. If you allow your staff to wear trainers, can you put some Wellington boots in there that everyone is going to use?

Can you use shoe covers? I'm not a massive fan of shoe covers because I find they rip really easily, and I'm likely to contaminate surfaces when I fall over. Every time I'm wobbling trying to get those shoe covers on cause I'm getting old and I'm not as flexible as I used to be.

As I say, we want to think about using fully immersible footwear, closed toes as well. We want to reduce the risk of, of, of equipment being dropped and stabbing staff and, and even just contamination. For me, wearing trainers when you're coming into contact with the things we come into contact with is just disgusting.

We want to make sure we're preventing that contact with infectious diseases and if we know that's likely to be more that's gonna be more likely. So again, patients in isolation. Have a little think about using specific footwear.

As we said, they are multiple multiple use Wellington boots, but at least they're gonna go into that foot bath. They just stay in our isolation area and they just stay in our barrier nursing area as well. Kate, I know, has talked a lot about this, but when we look at laundry for patients in isolation, we would try and use disposable items as much as possible, but remembering.

If that's not a possibility. And for all patients as well, that contaminated bedding, contaminated scrubs is a potential source of microorganisms. It's a potential source of contamination for your clinical environment.

We want to make sure we're ideally washing, as Kate said, at temperatures above 4 above 70 °C. So it's making sure that your your washing machine does get that hot. And again, making sure that you're going to use appropriate lengths, kind of washing cycles, depending on the temperatures which they're gonna reach.

So again, a lot of those domestic washing machines are not going to get that heavy. Some of the, the more modern ones may well do so, but again, it's really worth looking at investing. In a commercial, washing machine.

Tumble dryers, again, another important aspect, I know Kate also mentioned these but tumble dryer is really important in terms of infectious disease control and killing off that bacteria. Another thing that I'm a fan of using these wash bags. So these basically bags dissolve, on contact with hot water.

So I like to put all our bedding into them. And it just tries to minimise contamination of that washing machine seal in itself because we push this, you know, bedding that's coated in, let's face it, diarrhoea. And we risk contaminating that washing machine seal.

If that doesn't get washed effectively, if that's got areas that isn't coming into contact with water, we then recontaminating everything when we pull it back out again. So I'm a big fan of them. They basically are a little bit like the stuff that your washing machine, your washing laundry detergent pods are made from.

So they dissolve when they come into contact with warm water. Also with warm urine. So if you're putting wet bedding into the, they need to go straight into the washing machine.

So as I said, ideally using single use items from the from the, from the aspect of infection control. Thinking about laundry is that really important component in terms of infectious disease control. That soiled lands being that source of contamination, but having these appropriate controls in place can really reduce that risk down as much as is feasible.

And use an appropriate tumble drying, the, the heat and the drying effects of tumble dryers are really important in that laundering process, and they will help to account for a large proportion of that reduction in bacterial counts that we're going to achieve on linens. If we do have infectious disease patients coming into our clinics, we would ideally take them straight into a consult room. They are not going to spend any time in our waiting room.

And that consult room would be appropriately cleaned and disinfected before it was used again. As I said, we really want to minimise the movement of patients with infectious diseases around the hospital. So we tend to use trolleys for that.

Any procedures that we're gonna have to do on them, we're gonna schedule for the end of the day. And that's particularly where we have patients with things like RSA and we know that they're going to need a dressing change. We want to do the last thing and we can properly clean that clinical in the area before it's used for anything else.

The patients doesn't, do you have wounds or anything like that. We want to make sure we keep them covered. So again, we're minimising contamination of our clinical environment as much as possible and isolating these patients as much as we can do.

But again, that's very much going to depend on how sick that patient is. I dealt with the patient towards the end of last year. And this was a very, very sick little dog that we knew had a wound that we had isolated MRSA from.

But that, that animal had to have a feeding tube put in place, so that wasn't appropriate for that animal to then go into isolation. So we, you know, we don't work. It's nothing's ever perfect.

We've got to weigh up all those risk factors. And this is where it's so important to have those SOPs in place to make sure everyone knows how we're dealing with these patients and the infectious diseases that we're, we're encountering. I said to talk about hospital-acquired infections, and I'm gonna whiz through this, as well.

So, urinary tract infections are associated with urinary catheterization, and they're one of the most common hospital archi infections. In dwelling catheters, we know we're much more high risk of developing urinary tract infections associated with those, basically, as I said earlier. Bacteria are going to migrate over the surface of that that catheter and get into that patient's bladder.

So we know it's likely to happen, even when we're doing a really good job, but we still want to have those protocols in place to minimise that happening as much as possible. You have to use a closed collection system. We cannot leave indwelling urinary catheters open because that's definitely going to be a source of bacterial contamination.

Wherever appropriate. We tend to not put these patients onto routine antibiotics because we know within a few days they're going to be resistant to that type of, the type of bacteria that we're dealing with in those patients. So what we will generally do is once we pull that catheter, we would get a urine sample, often via cystocentesis.

So we can send that away for culture and sensitivity to make sure we're then using an appropriate antibiotic, or we will wait to see if that's UTI will often clear up on its own once that catheter's been removed. Surgical site infections and one of the things I was gonna say is, again, we have protocols in place to make sure those urinary catheters are wiped down every 4 hours from urine collection bag down to that patient just to try and reduce that big bacterial load, on the surface of that catheter. Surgical site infections, and another very commonly encountered, hospital hospital acquired infections.

And the reasons why these happen are multiracial. The longer a patient is under anaesthesia for, the higher the risk there is of that patient developing a surgical site infection, and that's because they start to get colder under anaesthesia even when women are doing a good job of keeping them warm, they're likely to start to get cold. That means that patients tissues, or, you know, body cavities have been exposed to it and they, they, the, the environment for a longer period of time.

The degree of wound contamination is gonna make a difference, you know, if we look at patients going in, having nutrients, hopefully. They have got minimal bacteria contamination. These are going to be clean wounds.

But if you've got patients with traumatic wounds, we can already have significant infection, present there. Surgical technique makes a difference. And again, Shorter surgical times, we're gonna see, we, we, we're gonna be optimum because the longer that procedure goes on for, the higher the risk of developing surgical site infections.

Also, I think technique makes a difference in terms of how painful those patients are. Yes, we want to have really good analgesia protocols in place, but I do think good surgeons make a massive difference to how comfortable patients are afterwards. And following on from that, how much attention a patient plays to a wound.

It's about making sure we've got appropriate skin disinfection techniques, prepping patients in separate areas. We can't be prepping patients in the theatre that we're then gonna go and do that procedure in. Making sure we kind of clip for the worst case scenario.

Now, I realised with things like cat space, we're not going to do a big, big, big, big, big clipper of the whole that cat, but generally, for a lot of our patients coming in for major procedures, and that includes neuterines, we would clip and we would do a, a, a 15-ish centimetre clip around that proposed surgical site. And again, clipping for the worst case scenario. For us in our hospital, we can think we're going into a patient's abdomen and we end up going into a, a thorax.

So again, on purpose, I should add. So again, we would generally think, what's the worst case scenario? We want to clip, ideally sharp clipper blades, no missing teeth, disinfected clippers, making sure they get done.

I did it before that procedure, but certainly after between patients. Clipping up, if we can do immediately, before that procedure, if you clip up 24 hours before that 100%, get a 100% increase in risk of surgical site infections. Scrubbing up, you want to do a time scrub, making sure you use an appropriate concentration.

Techniques, we've now moved away from that circular technique, but what I will generally do is a circular technique to start off with to get rid of her and gross contamination, and then I do a back and forth technique. So the back and forth techniques recommended because you're going in different directions. If you're going circular, you risk pushing bacteria into crevices, wounds, abrasions in that patient's skin repeatedly in the same direction.

As I said, knowing what concentrations, what dilution rates you're gonna use for things like chlorhexidine for iodine. For iodine, we make it up into bags of saline depending on whether it's gonna come into contact with mucous membranes or whether it's gonna come into contact with eyes, and we will use iodine solution, not scrub. For chlorhexidine, we will use a 2% chlorhexidine, so we dilute it half and half.

We're gonna wear examination gloves when we're doing this procedure. We use sterile sterile swabs, we use sterile kidney dishes, we use sterile water for this as well in our hospital. You can then potentially rinse away with isopropyle alcohol or these, we've got these kind of purpose-made, combinations of chlorhexidine and, alcohol.

So it's a 2% chlorhexidine, 70% alcohol. So these chloroprep sticks which use a non-hand touch technique, you're not coming into contact with that patient's skin and we use those as our final prep. And again, having protocols in place for all these, so everyone knows how things are going to be done.

Everything gets done in the same way. IV catheter-related infections are fairly uncommon, but again, they're associated with a significant morbidity and mortality certainly in humans. And a lot of the time it's associated with catheter placement, a big proportion.

Is that skin not being decontaminated and hand washing not being performed applied to placement. We will probably get been there we see someone give a bit of a wipe with some surgical spirit and they get a dirty finger and feel where that vein is, and then place that catheter through that contaminated site. Of course, you're going to get catheter contamination happening at that point in time.

So, again, looking at how we clip and make sure we can appropriately decontaminate. As I said, the big proportion, so 60% of all our catheter related infections happen because that catheters got contaminated by this microorganisms on that patient's own skin, their own skin flora, our healthcare practitioners' hands, our hands, and contaminated disinfectants. These are people having Pots of kind of swabs with hibita solutions, things like that sat in them.

But things will bacteria will become resistant to everything. Yeah, you should make sure you're, you're decontaminating your cleaning equipment, and that includes things like spray bottles on all of these things, they need to be decontaminated themselves. A large proportion is that catheter have been contaminated.

So again, swabbing these holes before we inject any medications, solutions, etc. Through them. Contaminated infusions of fluids, medications, all those types of things, and a big proportion again, almost 30%, we don't know why they happen.

But again, we want to think about trying to minimise this as much as we can do. So we can look at creating these infection control programmes, and it's really worth putting something together for your hospital. The goal of that infection control programme and your kind of handbook is to decrease the likelihood of exposing patients to infectious agents, to maximise the participation of personnel in those infection control activities.

As I said earlier, everyone has to be on board and optimising the efficiency of infection control procedures and policies. Other things that we can look at as incorporating just very quickly at the end now is surveillance. So the surveillance is a key component of any infection control programme.

Effective infection control is impossible without making sure people are doing what they should be doing without some sort of surveillance, and they should be done with all practises. So much of the time, many clinical aspects are easy to do. They're not expensive, and they can be incorporated into day to day practise.

So we can do things like passive surveillance. So that's looking at how many patients do we have coming in with diarrhoea? How many patients do we have coming in with kennel cough or cat flu?

So if we don't have an ongoing infectious disease outbreak, that's generally gonna be adequate for most clinics. As I said, easy, practical to do, easy to do, cost effective. And it's looking at data that's already available.

It's looking at bacteria culture and sensitivity testing. It's looking at things like hand hygiene. It's looking at surgical site infections.

You can put codes onto your computer screens that allow you to go back and see how many patients developed surgical site infections and see are we seeing an increase in trends and you can flag it up when you're concerned. Common things are common. You're gonna see the same types of bacteria coming back on cultures sensitivity testing.

So you can match up the antibiotics that you're using routinely in your practise to make sure you're covering those types of things. So as I said, easy things like monitoring surgical site infections, monitoring that bacterial culture and sensitivity and using that to guide our antimicrobial therapy. So the same people are gonna use the same thing for skin diseases.

They're gonna use the same thing for respiratory diseases. Routine recording of specific syndromes, so vomiting and diarrhoea, as I said, coughing and sneezing and monitoring things like hand hygiene. It's really worth looking at adapting just so that we can avoid this over-reliance on antibiotics and we can look to see are we doing a good, good job.

Post-discharge surveillance can be more problematic, but as I said, it's really important for things like surgical site infections because a lot of these things are not going to develop until these patients are discharged from the hospital. And so it can consist of direct examination that patient in the hospital. If you're not seeing these patients back, it could be following up with a phone call or an email or something, either with the owner themselves or with the referring practise, if you work in referrals to see actually did that patient have any any issues postoperatively.

So in terms of surveillance, the keys to passive surveillance are centralising that available data and having someone in charge of it. So having a designated infection control practitioner, practitioner whose job is responsible for compiling and looking at that data on a regular basis. There is no point putting it all onto a spreadsheet, having those codes there unless someone goes in and looks at it.

So as we said, simple things like surgical site infections and looking at what we're getting back on our culture and sensitivity testing. And then we could look potentially active surveillance. So this involves gathering data specifically for infection control purposes.

It's gonna be more expensive, more time consuming, but it's gonna give you high quality data. Most of us are not going to do this, and this will be things like collecting nasal or rectal swabs from patients when they come into the hospital to see if they've got signs of, of infection. So screenings for things like MRSA.

If we go into hospital, that would happen to us. I think for most of us, that's never going to be practical. For those emergency patients, that's not going to be realistic.

So again, most of the time, passive surveillance is going to be appropriate. So in conclusion, we want to look at adapting best practise protocols, protocols. Best practise really starts with focusing on how we can reduce the use of antibiotics because we said, We really need to switch away from having that antibiotic dependence.

And the way we're going to do that, we have to do that is by having really high standards of asepsis and cleanliness, having good protocols in place for cleaning and disinfection, having promoting that optimal hygiene and hand washing. For protocols for all staff, no matter who they are. In a hospital, if we're aware that someone hasn't washed their hands, anyone can go up and tell them, no matter who that person is.

So again, we're kind of removing that hierarchy in terms of nurses being afraid of telling vets that they should have done something that is part of that protocol for that clinic. Hopefully that was useful. I want to thank Mila again and Kate for sponsoring this session, and I will hand back over and see if we've got any questions.

Louise, that was incredible. It's, it's just, you, you never let me down with your intro. You lived up to it, so thank you very much.

And I know that you have stimulated a lot of thought in a lot of people, myself included, just to think of situations when you're going through and you think, oh yes, I remember that. I should have maybe could have. And, it, it's good.

That's what this is all about. It's about, getting us all to think better. Yeah, and nobody's perfect.

We are, we know we're not, we're not, we'd work in a, in a, a clinical environment that stops that from happening. You know, if, if we're doing a CPR on a patient, hand hygiene really goes out the window, but it's about doing the Best that we can do the vast majority of the time. I think that's absolutely true and and there's another great saying that says what gets measured improves.

So your surveillance, your surveillance is really, really good because if you're not, if you're not looking at it or monitoring it, you're not really going to know whether you've got a problem or not. Certainly not, definitely not. Right, Louise, we've got a couple of questions that have come through for you.

Sarah wants to know how long is a cold, sterile and active without having to be changed? How often should it be changed? I would, it, it's gonna vary.

It's gonna vary from whatever solution you're using. So the manufacturer's instructions will have that on there. But a lot of the time, you know, it certainly wants to be changed at least once a day.

And I think we've probably moved away from using lots of cold sterilising solutions now, but there's lots of things that people don't think about. If people still have those little pots with thermometers in them that go back in each time, like we all have seen it done, and they've got this dried up bit of chlorhexidine in the bottom, that's really not appropriate. Especially not using thermometers, especially not using thermometers, yeah, it doesn't even bear thinking about.

We have an anonymous question which says, how often should environmental swabs be taken for practise standards, plus how many is ideal or effective to what is happening around the practise. We practise the RCVS practise Standards scheme doesn't ask you to carry out environmental swab, and it's not one of the requirements, or it certainly wasn't when we threw it went through, inspection kind of more or less a year ago. No, it's less than.

Yeah, around a year ago. So it wasn't a requirement at that point in time. It isn't something that we actually routinely do in a hospital.

It was something that we would do if we saw an outbreak, or if we saw patients with more surgical site infections, but it probably very much depends on your clinic. I know that we have really good protocols in place for how we clean, how we disinfect. Our staff come to work in their own clothing, they get changed at work into scrubs.

If the scrubs get contaminated, they're going to change those scrubs. We have specific scrubs for theatre. So it's gonna very, very, really vary, but we have, it's really a big focus in our hospitals.

So, unless we had a, a, an issue in terms of outbreaks of certain things, or we saw, again, problems in terms of surgical site infections, only then will we start doing it. And we, we've, we've had cases referred over to us with things like a RSI and ultimately, all the multi-drug resistant infections and Because we are really good in terms of compliance, it's not been an issue. But again, I think it would really vary.

It's something potentially people could look at doing monthly. They could do it as a one-off out of interest and see what they find. Yeah I think prevention is way better than trying to put a name to a bug, just prevent the bugs as best possible.

Emily wants to know and I like this one because it was one of my questions as well. What protocol do you use for disinfecting and sterilising clipper blades? So we basically like the clipper blaze after use, they would get they get soaked in our kind of a standard disinfectant that we use within the hospital, but you can buy specific clipper washes.

I know this has been sponsored by Miller, but the company that, distributes the lora prep, kind of final prep swabs have some really good protocols, that if you look at using their products, they'll be very happy to share with you, and they may well be on their website as well. Excellent. We've got another question coming through, about resources and information.

So this one specifically says, please could you provide an article for the back and forth technique for me to provide with other nurses in my practise and possibly given a, a good visual guidelines. I don't have one off the top of my head, but I know if people have access to the veterinary nurse, the journal, I know there have been several articles that are Looked on the back and forth technique, and a lot of this comes from human medicine. Yeah, a lot of what we do, we adapt from human medicine because we don't have the, we don't have the research there for veterinary patients.

We don't have those guidelines already in place. But I certainly know that they will have had their well referenced articles that will have mentioned the back and forth technique in the, and everyone, if anyone's really wants to find out, I can, I'm sure I can find a copy of the paper somewhere. Excellent.

Lisa's got a good question and I'm presuming that her answer is not just a big stick. But she says, how, have you got any good tips for getting staff on board for compliance with new protocols to improve infection control? I, it's a really difficult one.

I'm very fortunate and I work for a company where it is, it is top-down, a top-down approach. So it comes from management. So I think that makes life much, much easier.

But I think, you know, go back, do a little presentation to your clinic based on this presentation and talk through all those things. And, you know, like I said, think about the impact that it has on your practise reputation. You can use that, you know, we all want to be proud of where we work.

We want, we want to be proud of the job that we do, and just thinking about the impact that Something going wrong, you know, a patient going home with, you know, that's contracted, that's got a surgical site infection that we could have maybe prevented. We, as we said, we know we're never gonna get down to zero. But certainly, you know, we are reaching a point with things like, you know, multi-drug resistant infections, where how many of us go and talk to owners?

If you've got an animal on RA, how many of you go to an owner and say, is there anyone immunocompromised in your household? Because what we risk is that animal taking something home to an owner or a relative and it potentially being fatal. You know, we never say, do you have someone that, who's receiving chemotherapy when we have animals that have got these, you know, infectious diseases, but it's something that we need to think about because it could come around and bite us.

Yeah, I think, I think the the the single word that pops into my mind there is education. Because people are not going to do anything that they don't understand or don't believe in and it doesn't matter how many times you go and tell them to do something. They need to understand why they need to do it.

You need to educate them rather than try and force them to do something. Yeah. Claire wants to know how often do you, well, put my false teeth back in.

How often do you do your hand washing audits? Monthly. There you go, Claire, Simple.

Folks, that's all we have time for tonight. I have to say to you, Louise, that we could probably go on all night with this because it is really, really such a a great topic and you have stirred our minds to think of a lot of these things. So, thank you so much for your time and your effort.

I can see why you are invited to lectures all over the place. Thank you very much. You're very kind.

And also to Kate from Mille, I thank you so much for your sponsorship tonight. We really do appreciate it and I, I think there's those of us that have your machines in our practise, what do they say we would never go back. So they really are worth looking at.

To everybody that attended tonight, thank you for your time. And when we leave the webinar on the page that you logged in on, there's normally a survey monkey that pops up. Do us a favour, give us some answers, just take a few minutes to look at that.

It's really important to us to know what our audience wants us to be talking about. And if you just take the time to give us some feedback, we really do, listen to those and we would appreciate it. So from my side, thank you very much and to my controller Paul in the background for making things happen seamlessly.

Thank you to everybody and goodnight.