Pulse - September 2022 - 21

PULSE SPECIAL SECTION
3 minutes for chlorhexidine. We alternate
chlorhexidine with alcohol. If the
area to be prepared is flat (i.e abdomen
or thorax), the preparation should start
near the incision area and progressively
circle outwards. Never go back over a
prepared area with the same sponge.
Remember, you are going from cleanest
to dirtiest. For hanging limbs, as liquids
flow downward with gravity, the prep
starts at the top (near the foot) and continues
towards the bottom of the limb.
2: The " Dirty " Scrub
Following clipping, a dirty scrub should
be performed outside of the OR (the
prep table is
fine). This is the scrub
where all the dirt and organic material
should be removed. This scrub should
be continued until the gauze sponges
are clean with no obvious signs of dirt
or debris. If you are seeing dirt on your
final scrub, your dirty scrub was insufficient.
Chlorhexidine alternating with
alcohol is the standard scrub, although
if the patient reacts, povidone iodine
can be substituted. One of the most
common mistakes I have witnessed is
the use of a large communal jar filled
with soaked sponges that keeps getting
refilled over and over. These jars
are likely highly contaminated. Think
of all the fingers that are being dipped
into that stew of sponges and scrub,
contaminating the contents over and
over again. I have cultured pseudomonas
from those scrub jars. If you are
using that system for surgery (or even
wound cleaning or catheters), please
stop immediately. Instead, clean gauze
should be placed in a clean and dry
container and scrub should be poured
on them from the original container
(image 1). Any unused sponges or scrub
should be discarded.
3: The Surgical Prep
Once you move into the operating
room, the final preparation of the skin
can begin. Sterile sponges should be
used, as well as sterile gloves. You can
purchase pre-packaged sterile gauze
(which is convenient as is comes in its
own little container that makes a perfect
prep bowl) or autoclave gauze
sponges in stainless steel bowls (which
you can get on Amazon incredibly
cheaply). You will need two bowls, one
for chlorhexidine and one for alcohol
(image 2). If you completed a proper
" dirty scrub " , the purpose of this step
is ensure bacterial levels are as low as
possible. The minimum contact time is
PULSE
SEPTEMBER 2022
4: Final Prep:
There is one last step that should be
performed after draping and prior to
the initial skin incision. The surgical
site should be painted with a final preparation.
We use Chloraprep, which is a
combination of alcohol and chlorhexidine
(like Avagard) (image 3). There is
a povidone-iodine based product called
Duraprep if you use povidone-iodine.
These come in individual sterile applicators
and are applied by the surgeon
and allowed to dry prior to the incision.
This applies a long lasting barrier
to the skin. Choraprep is a clear solution,
but comes in an orange tinted
version which makes visualization of
the painted areas much easier.
In a recent study by the author of 40
patients whose incisional area was cultured
after clipping, after prepping following
the above referenced protocol,
and at the end of surgery (TPLO),
every patient had a positive first culture
(with 45% being multidrug resistant)
and no patient has a positive second or
third culture. While surgical infection
has multiple causative factors, correct
preparation is a critical step to minimizing
risk. P
Peter Vogel VMD, DACVS
Animal Orthopedic Center
www.aovets.com
21
http://www.aovets.com

Pulse - September 2022

Table of Contents for the Digital Edition of Pulse - September 2022

Pulse - September 2022
Chapter Meetings & Calendar
President’s Perspective
Pulsepoints
SCVMA Profile
COVER FEATURE STORY
Practical Pathology
UC Davis Update
PULSE Special Section
Tools for Success
Angel Fund
The RVT
Industry Insights
Digital Photography for Veterinarians
Resources
Disease Table
From the SCVMA Office
Pulse - September 2022 - Pulse - September 2022
Pulse - September 2022 - Cover2
Pulse - September 2022 - 1
Pulse - September 2022 - 2
Pulse - September 2022 - Chapter Meetings & Calendar
Pulse - September 2022 - President’s Perspective
Pulse - September 2022 - Pulsepoints
Pulse - September 2022 - 6
Pulse - September 2022 - 7
Pulse - September 2022 - 8
Pulse - September 2022 - 9
Pulse - September 2022 - 10
Pulse - September 2022 - SCVMA Profile
Pulse - September 2022 - 12
Pulse - September 2022 - COVER FEATURE STORY
Pulse - September 2022 - 14
Pulse - September 2022 - 15
Pulse - September 2022 - 16
Pulse - September 2022 - 17
Pulse - September 2022 - Practical Pathology
Pulse - September 2022 - UC Davis Update
Pulse - September 2022 - PULSE Special Section
Pulse - September 2022 - 21
Pulse - September 2022 - Tools for Success
Pulse - September 2022 - Angel Fund
Pulse - September 2022 - The RVT
Pulse - September 2022 - Industry Insights
Pulse - September 2022 - Digital Photography for Veterinarians
Pulse - September 2022 - 27
Pulse - September 2022 - 28
Pulse - September 2022 - 29
Pulse - September 2022 - 30
Pulse - September 2022 - Resources
Pulse - September 2022 - Disease Table
Pulse - September 2022 - 33
Pulse - September 2022 - 34
Pulse - September 2022 - 35
Pulse - September 2022 - 36
Pulse - September 2022 - 37
Pulse - September 2022 - 38
Pulse - September 2022 - 39
Pulse - September 2022 - 40
Pulse - September 2022 - 41
Pulse - September 2022 - 42
Pulse - September 2022 - 43
Pulse - September 2022 - 44
Pulse - September 2022 - 45
Pulse - September 2022 - 46
Pulse - September 2022 - 47
Pulse - September 2022 - 48
Pulse - September 2022 - 49
Pulse - September 2022 - 50
Pulse - September 2022 - 51
Pulse - September 2022 - From the SCVMA Office
Pulse - September 2022 - Cover3
Pulse - September 2022 - Cover4
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