The effect of nail characteristics on surface bacterial counts of surgical personnel before and after scrubbing.

OBJECTIVE: To determine the influence of nail characteristics on bacterial counts on the fingers of surgery personnel. STUDY DESIGN: Randomized nonblinded controlled crossover study design. SAMPLE POPULATION: Veterinary students, small animal surgery technicians, small animal surgery interns/residents, and small animal surgery faculty in a veterinary teaching hospital (n = 21). METHODS: Subjects were randomized into one of 2 groups; group 1 wore nail polish (P) for 1 week and group 2 (control) had nonpolished (NP) fingernails. Each subject changed groups the following week. Fingernail lengths were measured each day and fingernail samples were collected before and after presurgical scrub and after surgery. Total bacterial counts (TBC) and suspected staphylococci were counted on blood agar media and mannitol salt agar. The association between bacterial counts and nail biting, position of the volunteer, duration of the surgery, whether the nail polish was chipped, duration of nail polish application, type of surgery, and handedness was tested. Log-transformed CFU counts were compared with a Student's t test and presence or absence of bacteria were compared using Fisher's exact test. RESULTS: TBC, quantities of staphylococci, other gram-positive organisms, and gram-negative bacilli did not differ between P and NP personnel. The only variable associated with higher bacterial counts consisted of nail lengths greater than 2 mm. CONCLUSION: Nail polish did not influence bacterial counts and types of isolates, but nail length is a risk factor for increased bacterial counts. Based on our results, we recommend that nail length be kept under 2 mm.

Surgical retrieval of a guide wire lost during central venous catheterization in a dog.

OBJECTIVE: To report a case of successful surgical removal of a guide wire lost during central venous catheterization. CASE SUMMARY: A 28 kg, 4-year-old female neutered mixed breed dog presented to the primary care veterinarian with diabetic ketosis. During the process of central venous catheterization, the guide wire was accidently released and the entire length of the guide wire slipped into the jugular vein. Due to the absence of nearby interventional radiology facilities, surgical intervention was proposed. An ultrasound was used to determine that the guide wire was located in the caudal vena cava extending caudally into the right internal iliac vein. Rommel tourniquets were placed around the iliac vein cranial to the bifurcation of the common iliac vein into the external and internal iliac veins. A venotomy was performed in the right common iliac vein and the guide wire was grasped with hemostats and gently removed while alternately relaxing the cranial then caudal tourniquets. During anesthesia, ventricular premature contractions were noted that varied in frequency with the dog's positioning. Postoperative color flow Doppler ultrasound evaluation of the caudal vena cava, right common, internal and external iliac veins, and right femoral vein was normal with no evidence of thrombosis. Several days postoperative the dog's diabetic ketosis and ventricular premature contractions had resolved and color flow Doppler ultrasound evaluation was normal with no evidence of thrombosis. NEW OR UNIQUE INFORMATION PROVIDED: To the authors' knowledge, this is the first reported veterinary case of loss and subsequent surgical retrieval of a central venous catheter guide wire.