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Katrinaki V, Estrada RJ, Mählmann K, Kolokythas P, Lischer CJ. Objective evaluation for analgesia of the distal interphalangeal joint, the navicular bursa and perineural analgesia in horses with naturally occurring forelimb lameness localised to the foot. Equine Vet J 2023; 55:253-260. [PMID: 35488427 DOI: 10.1111/evj.13583] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/20/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The outcome and interpretation of intra-synovial diagnostic analgesia of the distal interphalangeal joint (DIPJ) and the navicular bursa (NB) remain in dispute, and no objective studies have been carried out to establish the percentage of improvement over time from these two analgesia techniques. OBJECTIVES To investigate the qualitative and time-dependent outcome of DIPJ-A and NB-A in naturally occurring forelimb lameness. STUDY DESIGN Case series. METHODS Twenty-three clinical cases with forelimb lameness were evaluated objectively using a body mounted inertial sensor system (BMIS). Lameness was localised to the foot with a palmar digital nerve block and/or an abaxial sesamoidean nerve block on day 1, and analgesia of the DIPJ (DIPJ-A) and NB (NB-A) were performed on days 2 and 3. Improvement following perineural analgesia was measured after 10 min and intra-synovial blocks after 2-, 5- and 10-min. Horses with at least 70% improvement measured objectively after diagnostic analgesia were included in the study. RESULTS There was no significant association between improvement following perineural analgesia and the DIPJ-A and NB-A. The mean improvement in the lameness differed between DIPJ-A and NB-A at 2 min (p < 0.001) and at 5 min (p = 0.04), and it was no longer observed after 10 min (p = 0.06). A positive NB-A produced a high degree of improvement that remained stable, whereas the DIPJ-A improved over time. MAIN LIMITATIONS Perineural and intra-synovial analgesia were performed without contrast medium to assess the diffusion of mepivacaine. CONCLUSIONS Our results suggest that perineural analgesia is not reliable enough to differentiate pain originating from DIPJ and NB. Early evaluation of the DIPJ-A and NB-A can determine the origin of the pain. An improvement following NB-A was constant over time, but an improvement following DIPJ-A varied by up to 10 min.
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Affiliation(s)
- Vasiliki Katrinaki
- Equine Clinic, Faculty of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - Roberto J Estrada
- Equine Clinic, Faculty of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany.,Large Animal Hospital, School of Veterinary Medicine, National University, Heredia, Costa Rica
| | - Kathrin Mählmann
- Equine Clinic, Faculty of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
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2
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Pezzanite LM, Hendrickson DA, Dow S, Stoneback J, Chow L, Krause D, Goodrich L. Intra-articular administration of antibiotics in horses: Justifications, risks, reconsideration of use and outcomes. Equine Vet J 2021; 54:24-38. [PMID: 34459027 DOI: 10.1111/evj.13502] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 07/02/2021] [Accepted: 08/26/2021] [Indexed: 12/11/2022]
Abstract
Antibiotics have been injected intra-articularly by equine veterinarians for decades, either prophylactically when other drugs are administered for osteoarthritis or therapeutically to treat septic arthritis. This route of administration has also more recently gained attention in human orthopaedic clinical practice, particularly as an alternative to systemic antibiotic administration to treat infections following prosthetic arthroplasty. While the rationale for injecting antibiotics intra-articularly has been largely focused on achieving high local drug concentrations, there has been relatively little focus on pharmacokinetic parameters of antibiotics administered by this route, or on the potential for local toxicity. The increasing incidence of antibiotic resistance in veterinary and human medicine prompts reconsideration of off-label antibiotic usage and evaluation of evidence-based dosing strategies. The purpose of this review was to summarise the current literature describing intra-articular antibiotic usage, including specific studies where pharmacokinetics, potential safety and toxicity have been evaluated. This review will advance practitioners' understanding of the use of intra-articularly administered antibiotics, including the overall pros and cons of the approach.
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Affiliation(s)
- Lynn M Pezzanite
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Dean A Hendrickson
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Steven Dow
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA.,Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Jason Stoneback
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Lyndah Chow
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Danielle Krause
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Laurie Goodrich
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
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3
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Krause DM, Pezzanite LM, Griffenhagen GM, Hendrickson DA. Comparison of equine synovial sepsis rate following intrasynovial injection in ambulatory versus hospital settings. Equine Vet J 2021; 54:523-530. [PMID: 34115426 PMCID: PMC8664890 DOI: 10.1111/evj.13485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/25/2021] [Accepted: 06/03/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Frequency of synovial sepsis in horses following intrasynovial injection has been reported, but not compared with respect to the environment in which the injection was performed. OBJECTIVES To describe occurrence of synovial sepsis following intrasynovial injections performed in ambulatory vs hospital settings. STUDY DESIGN Retrospective cohort study. METHODS Records from the Colorado State University were evaluated (2014-2018) and horses receiving intrasynovial injections were identified. Patients presenting for septic synovial structures were excluded. Patient signalment, primary supervising service, medications injected, location (field/hospital), whether synovial sepsis resulted, and at what time sepsis was recognised were recorded. Logistic regression was used to estimate the contributions of covariates to the occurrence of synovial sepsis following injection. RESULTS During the study period, 3866 intrasynovial injections were performed in 1112 horses during 1623 sessions, with 643/1623 sessions performed in the field. The most frequently used medications were hyaluronate (846/1623, 52.1%), triamcinolone acetonide (780 /1623, 48.1%) and amikacin sulfate (684/1623, 42.1%). Four horses developed synovial sepsis (0.2% sessions, 0.1% synovial structures); 3/4 were injected in the field, 2/4 received antibiotics with the injection. The frequency of septic synovitis was 10.4 cases per 10 000 injections, or 1 in 967 injections. All horses recovered following synovial lavage and antibiotic therapy. Performing injections in the field (P = .2) or without antibiotics (P = .7) did not alter the risk of synovial sepsis. MAIN LIMITATIONS Limitations include the retrospective nature of data collection and low rate of infection overall, which prohibited evaluation of individual medication regimes as factors associated with resultant infection. CONCLUSIONS The frequency of synovial sepsis in this population of horses was not higher when injections were performed in the field or without concurrent antibiotic administration. These data may help to inform practitioners and clients regarding the relative potential risk of complications following intrasynovial medication in different environmental settings.
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Affiliation(s)
- Danielle M Krause
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Lynn M Pezzanite
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Gregg M Griffenhagen
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Dean A Hendrickson
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
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Kreisler RE, Douglas ML, Harder KN. Comparison of the effect of isopropyl alcohol and chlorhexidine solution rinses on body temperature of female cats undergoing sterilization surgery. J Feline Med Surg 2021; 23:875-882. [PMID: 33416431 DOI: 10.1177/1098612x20979565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Isopropyl alcohol 70% as a rinse agent for chlorhexidine scrub has been shown to decrease body temperature more quickly than chlorhexidine solution in mice prepared aseptically prior to surgery. For this reason, some high-quality, high-volume (HQHV) surgical sterilization clinics use chlorhexidine solution rather than alcohol. We sought to determine if temperature upon entry to recovery, heat loss per kg and rate of temperature decline during surgery were different between cats rinsed with chlorhexidine solution vs 70% isopropyl alcohol following surgical scrub, and if there were significant predictors of recovery temperature. METHODS Female cats admitted for surgery to trap-neuter-return (TNR) clinics at a veterinary college were assigned chlorhexidine solution or alcohol rinse agents via block randomization. Veterinary students and veterinarians performed spay surgeries using HQHV techniques. In recovery, heat support and reversal agents were available for cats with a low body temperature or that were slow to recover. Baseline values, outcome variables and duration of each stage (preparation, surgery, recovery) were assessed using Wilcoxon rank-sum and t-tests. Recovery temperature was evaluated using random effects multiple linear regression. RESULTS The recovery temperature, heat loss per kg, heat loss per min, need for reversal and need for heat support in recovery were not significantly different between rinse groups. Weight <2.3 kg, body condition score <4, duration of surgery and postinduction temperature were predictors of recovery temperature. The rate of heat loss in the first 30 mins of surgery was slightly lower for cats in the alcohol rinse group and the recovery duration was shorter for cats weighing less <2.3 kg in the alcohol rinse group. CONCLUSIONS AND RELEVANCE There were no clinically meaningful differences in body temperature between chlorhexidine and alcohol rinses. Both chlorhexidine solution and isopropyl alcohol 70% are appropriate rinse agents for aseptic preparation of feline spay surgeries.
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Affiliation(s)
- Rachael E Kreisler
- Department of Pathology and Population Medicine, Midwestern University, Glendale, AZ, USA
| | - Michelle L Douglas
- Department of Pathology and Population Medicine, Midwestern University, Glendale, AZ, USA
| | - Karissa N Harder
- Department of Pathology and Population Medicine, Midwestern University, Glendale, AZ, USA
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Lavallée JM, Shmon C, Beaufrère H, Chirino-Trejo M, Linn K. Influence of clipping on bacterial contamination of canine arthrocentesis sites before and after skin preparation. Vet Surg 2020; 49:1307-1314. [PMID: 32519394 PMCID: PMC7586887 DOI: 10.1111/vsu.13468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 05/10/2020] [Accepted: 05/15/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine the influence of hair removal as part of the aseptic skin preparation of canine arthrocentesis sites and to characterize the bacterial flora remaining after aseptic skin preparation. STUDY DESIGN Randomized controlled trial. STUDY POPULATION Thirteen shorthaired beagle-cross dogs. METHODS A coin toss was used to randomly determine to have one carpus, elbow, tarsus, and stifle clipped. The contralateral side was left unclipped. Aseptic skin preparation was performed on all sites with 4% chlorhexidine followed by 70% isopropyl alcohol. The skin of each site was sampled for aerobic and anaerobic bacterial cultures before and after aseptic skin preparation. Bacterial cultures were submitted for laboratory testing to determine the colony-forming units (CFU) of bacteria and bacterial species isolated for each site. RESULTS Each group (clipped and unclipped) included 52 sites. Aseptic skin preparation reduced bacterial CFU in both groups. There was no association between values for CFU per milliliter after skin preparation of dogs and side (P = .07), joint (P = .71), pre-aseptic skin preparation CFU (P = .94), or clipping (P = .42). Staphylococcus spp were the most common of the bacterial species cultured. CONCLUSION In clean shorthaired dogs without visible evidence of dermatological disease, leaving arthrocentesis sites unclipped rather than performing traditional surgical clipping did not result in increased bacterial skin counts after aseptic skin preparation. CLINICAL SIGNIFICANCE In this study we did not find evidence to support that clipping of canine arthrocentesis sites is required for effective aseptic skin preparation. A prospective clinical trial is required to determine whether a change in practice would be associated with increased morbidity.
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Affiliation(s)
- Justin M Lavallée
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Cindy Shmon
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Hugues Beaufrère
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Manuel Chirino-Trejo
- Department of Veterinary Microbiology, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kathleen Linn
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Hann M, Timofte D, Isgren CM, Archer DC. Bacterial translocation in horses with colic and the potential association with surgical site infection: a pilot study. Vet Rec 2020; 187:68. [PMID: 32471957 DOI: 10.1136/vr.105788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/25/2020] [Accepted: 04/25/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Surgical site infection (SSI) is a leading cause of morbidity in horses undergoing emergency exploratory laparotomy for the treatment of acute colic. The exact mechanism by which SSI develops in these cases is unclear. This prospective observational study investigated whether bacterial translocation occurs in horses with acute colic and if there is an association between bacterial translocation and development of SSI. METHODS Peripheral venous blood (PVB) and peritoneal fluid (PF) samples were collected on admission and PF samples were collected at the end of surgery from horses presenting for investigation of acute colic. Any discharge from the laparotomy incision in horses that developed SSI was also collected. All samples were submitted for bacterial culture. RESULTS In total, 7.7 per cent of PVB samples (3/39), 11.8 per cent (4/34) of admission PF samples and 8.7 per cent (2/23) of the PF samples at surgery were culture positive. The prevalence of SSI was 10.2 per cent. No association was identified between a positive PVB or PF culture and development of a SSI or survival to hospital discharge. CONCLUSION Bacterial translocation can occur in some horses with acute colic. However, we were unable to identify any association between bacterial translocation and the development of SSIs following emergency exploratory laparotomy.
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Affiliation(s)
- Michelle Hann
- Institute of Veterinary Science, University of Liverpool, Neston, Wirral, UK
| | - Dorina Timofte
- Institute of Veterinary Science, University of Liverpool, Neston, Wirral, UK
| | - Cajsa M Isgren
- Institute of Veterinary Science, University of Liverpool, Neston, Wirral, UK
| | - Debra C Archer
- Institute of Veterinary Science, University of Liverpool, Neston, Wirral, UK
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7
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Johnston GCA, Wood KA, Jackson KV, Perkins NR, Zedler ST. Evaluation of the inflammatory response to two intra-articular hyaluronic acid formulations in normal equine joints. J Vet Pharmacol Ther 2019; 43:38-49. [PMID: 31660636 DOI: 10.1111/jvp.12818] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 09/22/2019] [Accepted: 10/02/2019] [Indexed: 01/05/2023]
Abstract
Intra-articular (IA) hyaluronic acid (HA) is commonly used to treat equine arthritis. Inflammatory response or "joint flare" is a recognized potential side effect. However, the incidence and severity of inflammation following IA HA injection in horses is not well documented. This study compared the effects of two IA HA formulations of different molecular weight (MW) and a saline control on clinical signs and synovial fluid markers of inflammation in normal equine joints. Eight adult horses each had three healthy fetlock joints randomly assigned to treatment with either 1.4 mega Dalton HA, 0.8 mega Dalton HA or saline control once weekly for three weeks. Clinical evaluation and synovial fluid analysis were performed by blinded assessors. Outcomes of interest were lameness score, joint effusion score and synovial fluid white cell count and differential, total protein, viscosity and serum amyloid A. Joints injected with HA developed significant mild-to-moderate inflammatory responses often associated with lameness and joint effusion compared with saline control joints. The higher MW HA formulation elicited a significantly greater inflammatory response than the lower MW HA after the first injection. In HA injected joints, viscosity remained poor for the entire study. Both IA HA formulations in this study induced an inflammatory response in healthy equine joints. This may have implications for the use of HA in equine joints. The findings in this study are limited to the two HA formulations used. Further investigation of different HA formulations and the use of HA in normal and arthritic equine joints is warranted.
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Affiliation(s)
| | - Kelly A Wood
- School of Veterinary Science, University of Queensland, Gatton, Qld, Australia
| | - Karen V Jackson
- School of Veterinary Science, University of Queensland, Gatton, Qld, Australia
| | - Nigel R Perkins
- School of Veterinary Science, University of Queensland, Gatton, Qld, Australia
| | - Steven T Zedler
- School of Veterinary Science, University of Queensland, Gatton, Qld, Australia
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Lioce CG, Davis EC, Bennett JW, Townsend FI, Bloch CP. Scalpel blade contamination and risk of postoperative surgical site infection following abdominal incisions in dogs. BMC Res Notes 2019; 12:459. [PMID: 31345266 PMCID: PMC6659296 DOI: 10.1186/s13104-019-4494-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/17/2019] [Indexed: 11/24/2022] Open
Abstract
Objective This prospective observation sought to determine if scalpel blades used for abdominal skin incisions in dogs are a significant source of bacterial contamination, and if these blades should be changed prior to use in deeper dissection. Results Scalpel blades were swabbed for culture prior to skin incision as a control, and then again following ventral midline abdominal skin incision in a total of 75 dogs. Culture and sensitivity results were compared with review of medical records for any evidence of pre- or postoperative incisional surgical site infection/inflammation (SSI). Of the 75 blades swabbed after skin incision, only 2 (2.7%) had positive culture results. Of the 69 patients that survived to suture removal, there was evidence of SSI in 6 patients (8.7%), only one of which had a positive scalpel blade culture (16.7%). Neither the use of postoperative antibiotics nor positive scalpel blade culture results were good predictors of whether a patient would develop a SSI. Results of this pilot study suggest that there is no bacteriological evidence to support the use of a separate blade for deep dissection in routine surgical procedures. Electronic supplementary material The online version of this article (10.1186/s13104-019-4494-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christina G Lioce
- Surgery Department, New England Animal Medical Center, West Bridgewater, MA, USA.
| | - Elizabeth C Davis
- Surgery Department, New England Animal Medical Center, West Bridgewater, MA, USA
| | - Julie W Bennett
- Surgery Department, New England Animal Medical Center, West Bridgewater, MA, USA
| | - Forrest I Townsend
- Surgery Department, New England Animal Medical Center, West Bridgewater, MA, USA
| | - Christopher P Bloch
- Department of Biological Sciences, Bridgewater State University, Bridgewater, MA, USA
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Kick BL, Gumber S, Wang H, Moore RH, Taylor DK. Evaluation of 4 Presurgical Skin Preparation Methods in Mice. JOURNAL OF THE AMERICAN ASSOCIATION FOR LABORATORY ANIMAL SCIENCE : JAALAS 2019; 58:71-77. [PMID: 30609948 PMCID: PMC6351048 DOI: 10.30802/aalas-jaalas-18-000047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 05/31/2018] [Accepted: 07/02/2018] [Indexed: 11/05/2022]
Abstract
Mice routinely undergo surgical procedures for use in research; however, studies of skin preparation methods to achieve antisepsis are rare. The present study evaluated 4 skin preparation treatments: depilatory agent followed by povidone-iodine and alcohol scrub; depilatory agent followed by povidone-iodine and saline scrub; electric clippers followed by povidone-iodine and alcohol scrub; and electric clippers followed by povidone-iodine and saline scrub. Swabs for bacterial culture were obtained immediately after hair removal and after scrubbing to measure the reduction in bacterial load. Full-thickness incisions were assigned ASEPSIS wound scores and examined histologically on days 0, 1, and 7 after surgery. Neither bacterial load growth nor ASEPSIS wound scores differed among any of the treatments. Histopathology revealed statistically significant but biologically irrelevant differences. Overall all treatment methods achieved acceptable bacterial load reduction and surgical site healing.
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Affiliation(s)
- Brenda L Kick
- Division of Animal Resources, Emory University, Atlanta, Georgia;,
| | - Sanjeev Gumber
- Division of Pathology, Yerkes National Primate Research Center, Atlanta, Georgia, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Heqiong Wang
- Department of Biostatistics and Bioinformatics, Emory University School of Public Health, Emory University, Atlanta, Georgia
| | - Reneé H Moore
- Department of Biostatistics and Bioinformatics, Emory University School of Public Health, Emory University, Atlanta, Georgia
| | - Douglas K Taylor
- Division of Animal Resources, Emory University, Atlanta, Georgia, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
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Tannahill VJ, Cogan T, Allen K, Acutt E, Busschers E. Efficacy and dermal tolerance of a novel alcohol-based skin antiseptic in horses. Vet Surg 2018; 47:572-577. [DOI: 10.1111/vsu.12793] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 10/27/2017] [Accepted: 11/03/2017] [Indexed: 11/26/2022]
Affiliation(s)
| | - Tristan Cogan
- School of Veterinary Sciences; University of Bristol; Bristol United Kingdom
| | - Kate Allen
- School of Veterinary Sciences; University of Bristol; Bristol United Kingdom
| | - Elizabeth Acutt
- School of Veterinary Sciences; University of Bristol; Bristol United Kingdom
| | - Evita Busschers
- School of Veterinary Sciences; University of Bristol; Bristol United Kingdom
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12
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Xu C, Peng H, Chai W, Li X, Li R, Chen J. Inadvertent Introduction of Tissue Coring Into Joints During Arthrocentesis: An Experimental Study. Med Sci Monit 2017; 23:3571-3577. [PMID: 28733573 PMCID: PMC5536130 DOI: 10.12659/msm.905590] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate whether needles introduce skin plugs into joints during arthrocentesis. MATERIAL AND METHODS In the first part of this study, the arthrocentesis site was scrubbed with a fluorescein sodium swab, and 90 needles were inserted through the joint tissue and collected for examination under a fluorescence microscope. In the second part of this study, the joints were injected using 720 needles of different gauges. Two different randomly assigned needle insertion techniques were used: needle insertion straight through the joint capsule (subgroup 1) or insertion of the needle into the subcutaneous tissue followed by flushing of the needle with 0.5 mL of 0.9% normal saline prior to advancing the needle through the joint capsule (subgroup 2). RESULTS Of the 90 needle tips examined in the first part of this study, 21 had high-grade fluorescein contamination. In the second part of this study, the incidence of tissue, epidermis, and dermis contamination in subgroup 1 was 57.2%, 43.1%, and 25.0%, respectively. There was no significant difference in the incidence among different gauge needles, except for a difference in epidermis contamination between the 21-gauge and 23-gauge needles. Compared to subgroup 1, subgroup 2 had a significantly lower OR for tissue contamination. CONCLUSIONS It is common to introduce tissue coring with epidermis and dermis into the joint during arthrocentesis, which poses a potential risk for septic arthritis. However, tissue contamination of the joint may be reduced by flushing saline through the needle into the subcutaneous tissues prior to entering the joint capsule.
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Affiliation(s)
- Chi Xu
- Department of Orthopaedics, General Hospital of People's Liberation Army, Beijing, China (mainland)
| | - Haiwen Peng
- Department of Orthopaedics, General Hospital of People's Liberation Army, Beijing, China (mainland)
| | - Wei Chai
- Department of Orthopaedics, General Hospital of People's Liberation Army, Beijing, China (mainland)
| | - Xiang Li
- Department of Orthopaedics, General Hospital of People's Liberation Army, Beijing, China (mainland)
| | - Rui Li
- Department of Orthopaedics, General Hospital of People's Liberation Army, Beijing, China (mainland)
| | - Jiying Chen
- Department of Orthopaedics, General Hospital of People's Liberation Army, Beijing, China (mainland)
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Freeland RB, Morello SL, DeLombaert M, Rajamanickam V. Influence of intravenous regional limb perfusion with amikacin sulfate on Staphylococcus aureus
bioburden in distal limb wounds in horses. Vet Surg 2017; 46:663-674. [DOI: 10.1111/vsu.12638] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 11/30/2016] [Accepted: 12/13/2016] [Indexed: 12/27/2022]
Affiliation(s)
- Russell B. Freeland
- Department of Surgical Sciences; School of Veterinary Medicine, University of Wisconsin-Madison; Madison Wisconsin
| | - Samantha L. Morello
- Department of Surgical Sciences; School of Veterinary Medicine, University of Wisconsin-Madison; Madison Wisconsin
| | - Melissa DeLombaert
- Department of Surgical Sciences; School of Veterinary Medicine, University of Wisconsin-Madison; Madison Wisconsin
| | - Victora Rajamanickam
- Department of Biostatistics and Medical Informatics; School of Medicine and Public Health, Institute for Clinical and Translational Research, University of Wisconsin-Madison; Madison Wisconsin
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Fungwithaya P, Brikshavana P, Chanchaithong P, Prapasarakul N. Distribution of methicillin-resistant coagulase-positive staphylococci (MRCoPS) in a surgical unit and cystotomy operation sites in a veterinary teaching hospital. J Vet Med Sci 2016; 79:359-365. [PMID: 27990009 PMCID: PMC5326942 DOI: 10.1292/jvms.16-0146] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study aimed to investigate the spread of methicillin-resistant coagulase-positive
staphylococci (MRCoPS) among veterinary staff, hand-touch sites and surgical tissue during
cystotomy operations on cats and dogs that were patients, and to analyze the genetic
relatedness and antimicrobial resistance profiles of the isolates. Human and environmental
samples were obtained from the nasal passageways of 12 surgeons and veterinary assistants
and from 29 hand-touch sites of instruments in operative units and subjected to bacterial
isolation and enumeration. Swab samples were collected in triplicate from 29 dogs and
three cats at the site of incision, from the incision area, from the peritoneum during
surgery and from the peritoneum before suture. MRCoPS were identified by
mecA gene detection and characterized by their antibiogram profile,
SCCmec type and pulsed-field gel electrophoresis. Twenty-four
staphylococci were isolated, derived from one veterinary assistant, 12 operating room
floor areas and hand-touch sites, three dogs and one cat. Methicillin-resistant S.
pseudintermedius (MRSP) was found on an electric clipper and rebreathing
circuits in the operating room. Three dogs were positive for MRSP during surgery, and one
methicillin-resistant S. aureus (MRSA) was detected in a cat. All MRCoPS
were resistant to doxycycline, erythromycin, clindamycin and enrofloxacin, but no patients
developed surgical site infections. According to their genotypic patterns, the clones
obtained from the environment and human sources differed from the animal clones. Despite
intensive hygienic management, a variety of MRCoPS clones were present within the surgical
unit and during surgery.
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Affiliation(s)
- Punpichaya Fungwithaya
- Department of Veterinary Microbiology, Faculty of Veterinary Science, Chulalongkorn University, 10330, Bangkok, Thailand
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Gillespie CC, Adams SB, Moore GE. Methods and Variables Associated with the Risk of Septic Arthritis Following Intra-Articular Injections in Horses: A Survey of Veterinarians. Vet Surg 2016; 45:1071-1076. [PMID: 27696461 DOI: 10.1111/vsu.12563] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 07/22/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine common methods for intra-articular injections and variables associated with the risk of septic arthritis following intra-articular injection in the horse. STUDY DESIGN Cross-sectional survey. SAMPLE POPULATION Equine veterinarians. METHODS A link to an online survey was distributed to equine practitioners in 2014. Responses for descriptive data were tabulated. Data on infection rates obtained from medical records were analyzed. Variables associated with the risk of septic arthritis were determined using χ2 or Fisher's exact tests and logistic regression. RESULTS Common current methods for intra-articular injections were determined from 241 surveys. Sixty-four of 241 surveys (26.6%) contained data with numbers of joints injected and number of infections obtained from review of medical records. Eight different injection methods were used by more than 2/3 of responding veterinarians. A total of 67 out of 319,760 injected joints reported became septic following injection, giving an incidence of 2.10 septic joints per 10,000 intra-articular injections. Based on multivariate analysis, infection rates were significantly lower when veterinarians prepared their own injection sites (OR=0.10) and had <20 years of practice experience (OR=0.025), whereas infection rates were significantly higher when hair was removed at the injection site (OR=19.70). CONCLUSION There is a low incidence of septic arthritis following intra-articular injection and a large number of injection methods reported by responding veterinarians. The low reported incidence of infection may be related to the large number of practitioners frequently using common methods.
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Affiliation(s)
- Caroline C Gillespie
- Department of Veterinary Clinical Sciences, Purdue University, West Lafayette, Indiana.
| | - Stephen B Adams
- Department of Veterinary Clinical Sciences, Purdue University, West Lafayette, Indiana
| | - George E Moore
- Department of Comparative Pathobiology College of Veterinary Medicine, Purdue University, West Lafayette, Indiana
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16
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Barker W. Equine distal limb diagnostic anaesthesia: (1) Basic principles and perineural techniques. IN PRACTICE 2016. [DOI: 10.1136/inp.i567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Davids BI, Davidson MJ, TenBroeck SH, Colahan PT, Oli MW. Efficacy of Mechanical versus Non-Mechanical Sterile Preoperative Skin Preparation With Chlorhexidine Gluconate 4% Solution. Vet Surg 2015; 44:648-52. [DOI: 10.1111/vsu.12335] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Benjamin I. Davids
- Department of Animal Sciences; University of Florida; Gainesville Florida
| | - Megan J. Davidson
- Department of Animal Sciences; University of Florida; Gainesville Florida
| | | | - Patrick T. Colahan
- College of Veterinary Medicine; University of Florida; Gainesville Florida
| | - Monika W. Oli
- Department of Microbiology and Cell Sciences; University of Florida; Gainesville Florida
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19
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Guimarães T, Miranda C, Pinto M, Silva E, Damásio L, Costa AL, Correia MJ, Duarte JC, Cosinha C, Lopes G, Thompson G, Rocha A. Effect of breeding activity on the microflora of the external genitalia and in the semen of stallions, and the relationship between micro-organisms on the skin and on the external genitalia. Reprod Domest Anim 2014; 49:926-33. [PMID: 25219398 DOI: 10.1111/rda.12403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 07/17/2014] [Indexed: 11/30/2022]
Abstract
A possible role of breeding activities in the composition of the microbial population in stallions' external genitalia (EG) and the relationship between micro-organisms colonizing the skin of the abdomen and the ones colonizing the EG have not been studied. In experiment 1, EG microbiological samples were collected from 41 stallions used for both natural cover and semen collection (BST) and from 18 non-breeding stallions (NBST). A higher (p < 0.05) frequency of isolation of potentially pathogenic species was found for BST. Age did not influence number of micro-organism species isolated both in BST and NBST. In experiment 2, the microbial content of the EG and semen was compared in 23 BST. Most micro-organisms isolated from the EG were present in semen, albeit with a numerically lower prevalence. In 7 stallions, six microbial species isolated from semen were absent from the EG cultures, suggesting contamination by the operator. In experiment 3, a numerically higher number of micro-organism species was isolated from the EG of 31 stallions, than from their skin of the ventral abdomen in contact with the penis or from the skin of the thorax. With the sole exception of Escherichia coli, potentially pathogenic bacteria were only isolated from the EG but not from the skin. Results suggest that breeding activity increased the number of species colonizing the EG; most species isolated from the EG were also found in semen even if with a lower frequency, and additional semen contamination seemed to occur during its manipulation. Many micro-organism species of the skin were also isolated from the penis, but independently of being or not in contact with the penis, skin did not seem to provide an adequate environment for the growth of potentially pathogenic bacteria that were isolated from EG, with the sole exception for E. coli.
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Affiliation(s)
- T Guimarães
- ICBAS, University of Porto, Porto, Portugal; Centro de Estudos de Ciência animal (CECA/ICETA), University of Porto, Porto, Portugal
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20
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Waxman SJ, Adams SB, Moore GE. Effect of Needle Brand, Needle Bevel Grind, and Silicone Lubrication on Contamination of Joints With Tissue and Hair Debris After Arthrocentesis. Vet Surg 2014; 44:373-8. [PMID: 24702649 DOI: 10.1111/j.1532-950x.2014.12179.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 02/08/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Sarah J. Waxman
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine; Purdue University; West Lafayette Indiana
| | - Stephen B. Adams
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine; Purdue University; West Lafayette Indiana
| | - George E. Moore
- Department of Comparative Pathobiology; College of Veterinary Medicine; Purdue University; West Lafayette Indiana
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21
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Steel CM, Pannirselvam RR, Anderson GA. Risk of septic arthritis after intra-articular medication: a study of 16,624 injections in Thoroughbred racehorses. Aust Vet J 2014; 91:268-73. [PMID: 23782019 DOI: 10.1111/avj.12073] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2012] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The aims of this study were to determine the risk of septic arthritis after intra-articular medication (IAM) and to identify potential risk factors for this complication. DESIGN A retrospective and prospective descriptive study of prevalence, and matched case-control study for risk factors. RESULTS Of 16,624 joints injected in 1103 horses at 6695 horse-visits, septic arthritis occurred as a complication in 13 joints (13 horses). The risk of septic arthritis following IAM was 7.8 cases per 10,000 injections or 1 case per 1279 injections. Veterinarian and type of corticosteroid were identified as risk factors. CONCLUSIONS Septic arthritis is an uncommon complication of IAM in horses, yet the risk is substantially higher than that reported in humans. The risk was higher for some veterinarians; identifying the reason for this was beyond the scope of this study, yet we presume they may have paid less attention to strict aseptic technique. A larger study may be needed to clarify whether the risk is greater with certain types of corticosteroids and to identify additional risk factors.
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Affiliation(s)
- C M Steel
- The Equine Centre, Faculty of Veterinary Science, University of Melbourne, 250 Princes Highway, Werribee, Victoria, 3030, Australia.
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22
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Wahl K, Adams SB, Moore GE. Contamination of joints with tissue debris and hair after arthrocentesis: the effect of needle insertion angle, spinal needle gauge, and insertion of spinal needles with and without a stylet. Vet Surg 2012; 41:391-8. [PMID: 22380793 DOI: 10.1111/j.1532-950x.2011.00969.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess fetlock joint contamination with tissue debris and hair after arthrocentesis. STUDY DESIGN Experimental. ANIMALS Fetlock joint tissues (n = 10 horses). METHODS Soft tissue flaps including the joint capsule were dissected from the dorsal fetlock joints of 7 anesthetized horses leaving an intact proximal base. Needles inserted through the tissue flaps were flushed into tissue cell culture plates and examined for debris. Studies were repeated on excised fetlock tissue preparations after being stored for 5 days. Variables included gauge and type of needle, insertion of spinal needles with and without a stylet, angle of insertion, length of hair, and ante- and postmortem needle insertion. Tissue fragments collected from 3 horses were cultured for bacteria. RESULTS Compared to 20 g disposable needles inserted perpendicularly through unclipped skin, the odds ratios (ORs) for hair contamination were significantly greater for 20 g spinal needles without a stylet, and significantly less for 22 g spinal needles inserted with a stylet and for angled insertion of disposable needles. Tissue contamination OR was significantly less for 20 g spinal needles inserted without a stylet, angled insertion, and clipped hair. Bacteria were isolated from 2.6% of tissue fragments. CONCLUSIONS Angled needle insertion reduces joint contamination with tissue and hair. Spinal needles should be inserted with a stylet in place and 22 g spinal needles are preferable to 20 g spinal needles. Joints may be contaminated with bacteria after routine surgical preparation of skin.
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Affiliation(s)
- Kevin Wahl
- Veterinary Clinical Sciences, School of Veterinary Medicine, Purdue University, West Lafayette, IN 47907, USA
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Johns IC, Baxter K, Booler H, Hicks C, Menzies-Gow N. Conjunctival bacterial and fungal flora in healthy horses in the UK. Vet Ophthalmol 2011; 14:195-9. [DOI: 10.1111/j.1463-5224.2010.00867.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Monitoring bacterial contamination in equine platelet concentrates obtained by the tube method in a clean laboratory environment under three different technical conditions. Equine Vet J 2009; 42:63-7. [DOI: 10.2746/042516409x455221] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Johns I, Tennent-Brown B, Schaer BD, Southwood L, Boston R, Wilkins P. Blood culture status in mature horses with diarrhoea: a possible association with survival. Equine Vet J 2009; 41:160-4. [PMID: 19418745 DOI: 10.2746/042516409x360208] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
REASONS FOR PERFORMING STUDY The incidence and implications of positive blood cultures in mature horses with diarrhoea is unknown. The diagnosis of bacteraemia may alter treatment and prognosis. HYPOTHESIS The proportion of horses with diarrhoea that are blood culture positive is higher than previously assumed and a positive blood culture has a negative impact on survival. METHODS Blood cultures were taken at admission and 24 h after admission from 31 mature horses with diarrhoea. RESULTS Nine (29%) horses were blood culture positive within 24 h of admission. Organisms isolated included Corynebacterium spp. (n = 6), Streptococcus spp. (n = 2), Pantoea agglomerans (n = 1), Gram-negative rod (n = 1), Bacillus spp. (n = 1) and yeast (n = 1). Horses with positive blood cultures were significantly less likely to survive. Prior treatment with antimicrobial drugs had no significant effect on blood culture status. Horses with positive blood cultures had a significantly higher heart rate, packed cell volume (PCV) and plasma potassium concentration at admission, and a higher PCV and lower total plasma protein concentration 24 h after admission. CONCLUSIONS Positive blood cultures occur more frequently than previously reported, and may have a negative impact on survival in horses with diarrhoea. POTENTIAL RELEVANCE Results of blood cultures may be useful in formulating a prognosis for horses with diarrhoea. Further research is required to determine the effect of antimicrobial treatment on outcome.
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Affiliation(s)
- I Johns
- Section of Medicine, Department of Clinical Studies-New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, 382 West Street Road, Kennett Square, Pennsylvania 19348, USA
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Geraghty TE, Love S, Taylor DJ, Heller J, Mellor DJ, Hughes KJ. Assessing techniques for disinfecting sites for inserting intravenous catheters into the jugular veins of horses. Vet Rec 2009; 164:51-5. [PMID: 19136685 DOI: 10.1136/vr.164.2.51] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The sites of insertion of catheters into the jugular veins of six horses were investigated to determine common isolates and to assess the effectiveness of two disinfection protocols with the hair coat left long, clipped or shaved. Skin commensals (Staphylococcus, Streptococcus and Micrococcus species) and environmental contaminants (Bacillus, Enterobacteriaceae, Aspergillus and Mucor species) were the microorganisms most frequently isolated. Chlorhexidine gluconate and povidone-iodine-based skin disinfection protocols resulted in significant reductions in the number of bacterial isolates from clipped sites. With chlorhexidine, there were no significant differences between the reductions observed at sites with the hair coat left long, clipped or shaved.
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Affiliation(s)
- T E Geraghty
- Division of Companion Animal Sciences, Institute of Comparative Medicine, Faculty of Veterinary Medicine, University of Glasgow, Glasgow
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Abstract
Basic principles of surgery are important to review, even for experienced surgeons. Although aseptic surgical principles are not always applicable in the field, we have to respect some guidelines. Recent research will influence the way that we do things, based on what we have been taught and our experience. Respecting those simple principles can make a big difference in the final outcome.
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Affiliation(s)
- André Desrochers
- Food Animal Medicine and Surgery, Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, 3200 Sicotte, Saint-Hyacinthe, Québec, Canada J2S 7C6.
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