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INTRODUCTION |
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Biosecurity and Infection Control initiative
in the Veterinary Practice |
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During the winter of 2007 Health and Hygiene
embarked on a Practice Biosecurity initiative with the
aim of assisting staff in veterinary practices
countrywide with the formulation and implementation
of hygiene and infection control policies through staff
training, visual aids and the selection of products fit for
the purpose. Training certificates were issued to all
staff attending the awareness and training sessions
and a self-measurement system was put into place to
monitor compliance. A number of practices achieved
the high levels necessary for accreditation and now
proudly display the Accreditation Certificate as
recognition of the efforts made by staff in the practice
and as an assurance to clients of an ongoing
commitment to the Best Practice Model as endorsed
by SAVC.
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Hand Hygiene a serious risk |
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The overwhelming success of this campaign
prompted Health and Hygiene to continue with the
level of assistance to ensure that infection control
standards are maintained, but also to assist those
practices that have not yet adopted a hygiene policy.
Our commitment to this process is clear through our
innovative problem-solving policy. During last year's
campaign we identified a serious lack of proper hand
hygiene amongst staff members in veterinary facilities
and subsequently launched a Hand Hygiene initiative
addressing this serious issue through training
sessions and posters to encourage compliance. |
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Cold sterilization the 3 leg of infection
control |
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Another area that was identified as requiring attention
regarding proper guidelines and operating
procedures is the practice of cold sterilization.
Surprising little has been written about this subject in
recent times. In addition medical and veterinary
instruments and devices are becoming increasingly
complicated and, therefore, more expensive. Many of
these are heat-sensitive and cannot be sterilized by
means of high pressure steam/temperature as found
in autoclaves. |
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The common practice of leaving surgical instruments,
blades, urinary catheters, ET tubes, fibre optics,
otoscope connectors, surgical drains and left-over
pieces of suture material immersed in a disinfectant or |
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sterilant for indefinite and prolonged periods of time
inevitably leads to the damage of these items. Reused
contaminated solutions, incorrect dilutions and
incorrect procedures also create a false sense of
security that whatever is pulled from the container is
safe to use. In the context of the continuing creation of
resistant super bugs these common practices take on
a new dimension. |
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COLD STERILISATION |
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Definitions |
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Sterilization is a process intended to kill all micro
organisms and is the highest level of microbial kill
that can be achieved. |
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Disinfection is the use of a chemical procedure that
eliminates virtually all recognized pathogenic
microorganisms but not necessarily all microbial
forms on inanimate objects. |
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Best Practice is DO NOT DISINFECT WHEN YOU
CAN STERILIZE (Centres for Disease Control and
Prevention, Atlanta, USA). Many arguments are
found in the literature whether semi-critical devices
(that come into contact with mucous membranes
and non-intact skin) require sterilization or high-level
disinfection (Gurevich 1991). A high-leve
disinfectant is capable of destroying all organisms
except the most highly resistant spores, but why take
the chance if today it is possible to select a product
that will sterilize safely and rapidly? |
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Best Practice Model for Cold Sterilization |
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Devices in veterinary practice that require
cleaning
and sterilization: |
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Surgical instruments |
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Urinary catheters ( i/v cathers, syringes and needles
should be single use only) |
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Endotracheal tubes Flexible endoscopes/
Arthroscopes/Gastroscopes/Bronchoscopes etc |
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Biopsy punches/needles |
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Speculums |
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Devices labeled “for single patient use only” should be
discarded properly after use and NOT re-used |
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BASIC PRINCIPLES |
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Cleaning |
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Cleaning is the first basic step of all
decontamination. |
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Devices that require disinfection or sterilization must
be thoroughly cleaned to reduce organic material or
bioburden before being exposed to the sterilizing
solution. |
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Care must be taken not to allow blood or any matter
to dry on instruments. If time is a consideration the
instruments can be soaked in a safe
disinfectantdetergent until it is possible to scrub
properly. Do not keep instruments in a pre-soak for
longer than necessary for the longer they remain
wet, the greater the chances for damage. |
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Cleaning can be done through hand scrubbing or
ultrasonic cleaning. |
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It is important to follow manufacturer's instructions
closely. Items that have been wet for several hours
may have developed biofilm, a complex colony of
bacteria “plus possibly fungi and viruses” protected
by “slime” which could protect the micro-organism
complex from contact with disinfecting chemicals. All
surfaces must be exposed and total immersion is
essential when using a disinfecting contact agent. |
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For cleaning use nylon brushes and warm (not hot)
solutions. |
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| Corrosion Control (Lubrication) |
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All moving parts such as hinges should be well
lubricated after cleaning. Be sure to use surgical
lubricants and not industrial oils. Allow lubrication to
dry before placing instruments in a sterilant. |
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| Sterilization |
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The most important issue is to follow manufacturer's
instructions closely. |
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Only thoroughly cleaned items can be placed in a
cold sterilant. |
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Recommended contact times should achieve at
least a log6 (1 x 1,000,000 kill) reduction of ALL |
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