A preliminary study on the use and effect of hand antiseptics in veterinary practice.

OBJECTIVES: To assess use and effect of hand antiseptics in veterinary clinical practice. MATERIALS AND METHODS: Veterinary practice nurses were questioned concerning their use of hand antiseptics, in particular waterless hand rubs. Subsequent clinical trials assessed the effect of single applications of alcohol-based and quaternary ammonium compound-based hand rubs at reducing bacterial counts on the hands of theatre nurses in a neutering clinic. RESULTS: The majority of responding practices used waterless hand rubs (alcohol-based, 67.5% and quaternary ammonium compound-based, 9.5%) as their primary hand hygiene agent and believed them to be effective. 23% of practices favoured an antiseptic hand-wash. In clinical trials, alcohol-based rubs were potentially more effective at reducing bacterial counts than quaternary ammonium compound-based rubs especially in the period immediately after application. However, over 3 hours there was no significant change between these and a control group. There were more adverse skin effects in the group using alcohol-based than in the quaternary ammonium compound-based and control groups. The bacterial counts after application were unaffected by variables such as the number of animals contacted. CLINICAL SIGNIFICANCE: The studies provide useful baseline data for evaluation of efficacy of more frequent applications of the most common antiseptic hand rubs used in veterinary practice.

The role of routine pre-operative bedside echocardiography in detecting aortic stenosis in patients with a hip fracture.

The prevalence and severity of aortic stenosis in unselected patients admitted with a hip fracture is unknown. Derriford Hospital operates a routine weekday, pre-operative, targeted bedside echocardiography examination on all patients admitted with a hip fracture. We carried out a prospective service evaluation for 13 months from October 2007 on all 501 admissions, of which 374 (75%) underwent pre-operative echocardiography. Of those patients investigated, 8 (2%) had severe, 24 (6%) moderate and 113 (30%) had mild aortic stenosis or aortic sclerosis. Eighty-seven of 278 (31%) patients with no murmur detected clinically on admission had aortic stenosis on echocardiography and of the 96 patients in whom a murmur was heard pre-operatively, 30 (31%) had a normal echocardiogram. Detection of a murmur does not necessarily reflect the presence of underling aortic valve disease. However, if a murmur is heard then the likelihood of the lesion's being moderate or severe aortic stenosis is increased (OR 8.5; 95% CI 3.8-19.5). Forty-four (12%) of our unselected patients with fractured femur had either moderate or severe aortic stenosis (with or without moderate or severe left ventricular failure), or mild stenosis with moderately or severely impaired left ventricular function.

An Effective Approach to Improving Day-Case Rates following Laparoscopic Cholecystectomy.

Background. Day-case laparoscopic cholecystectomy (LC) is a safe and cost-effective treatment for gallstones. In 2006, our institution recorded an 86% laparoscopic, 10% day-case, and 5% readmission rate. A gallbladder pathway was therefore introduced in 2007 with the aim of increasing daycase rates. Methods. Patients with symptomatic gallstones, proven on ultrasound, were referred to a specialist-led clinic. Those suitable for surgery were consented, preassessed, and provided with a choice of dates. All defaulted to day case unless deemed unsuitable due to comorbidity or social factors. Results. The number of cholecystectomies increased from 464 in 2006 to 578 in 2008. Day-case rates in 2006, 2007, 2008, and June 2009 were 10%, 20%, 30%, and 61%, respectively. Laparoscopic and readmission rates remained unchanged. Conversion rates for elective cholecystectomy fell from 6% in 2006 to 3% in 2009. Conclusions. Development of a gallbladder pathway increased day-case rates sixfold without an associated increase in conversion or readmission rates.

The efficacy of chlorhexidine gluconate in canine skin preparation - practice survey and clinical trials.

OBJECTIVES: To determine the use in practice and efficacy of different concentrations of chlorhexidine gluconate for canine pre-operative skin preparation. METHODS: Questionnaires were used to establish which antiseptics and techniques were used for patients undergoing elective neutering. In a clinical study, five different concentrations of chlorhexidine gluconate - 0 per cent (tap water, as a control) 1, 2, 3 and 4 per cent - were tested on 50 dogs undergoing elective ovariohysterectomies and orchidectomies. RESULTS: A variety of preparation practices occurred but only 21 per cent of the veterinary nurses surveyed were aware of the concentration and contact time they used whilst preparing animals. The clinical study revealed there was a significant difference (P<0.001) between the different concentrations used. All concentrations of chlorhexidine were significantly more effective than the control tap water. There was a tendency towards increasing efficacy as concentration increased from 1 to 4 per cent but this was not statistically significant. CLINICAL SIGNIFICANCE: The lack of significant differences in efficacy between the different concentrations of chlorhexidine gluconate means that current practices may be adequate, although if the chlorhexidine gluconate concentrations and contact times used are unknown, they may be lower than those tested here and, possibly, ineffective, especially if contact times are short.

The use of epidural analgesia in a New Zealand tertiary hospital before and after publication of the MASTER study.

We audited the total number of perioperative epidural techniques performed at Christchurch Hospital, New Zealand, for three years, before and after The Lancet published the MASTER Anaesthesia Trial in 2002. We also looked specifically at the number of epidural anaesthetic and analgesic techniques performed in combination with general anaesthesia for colonic surgery over the same period. In both cases we found a statistically significant fall in epidural rate in the years after the publication (P < 0.001). A subsequent survey of local specialist anaesthetists, who have worked throughout this period, revealed the majority (75%) were knowingly performing fewer epidural techniques and that the findings of the MASTER Anaesthesia Trial had influenced their decisions.

Comparison of articaine and bupivacaine/lidocaine for peribulbar anaesthesia by inferotemporal injection.

BACKGROUND: Articaine is a novel amide local anaesthetic with a shorter duration of action than prilocaine. METHODS: In a randomized, double-blind study we compared the efficacy of 2% articaine with epinephrine 1:200,000 with a mixture of 0.5% bupivacaine and 2% lidocaine with epinephrine 1:200,000 for peribulbar anaesthesia in cataract surgery using a single inferotemporal injection. Eighty-two patients were randomly allocated to one of two groups to receive peribulbar anaesthesia with 6-7 ml of articaine or a bupivacaine/lidocaine mixture. Both solutions contained hyaluronidase 30 iu ml(-1). Ocular movement was scored at 2 min intervals up to 10 min, at the end of surgery and at time of discharge from hospital. Time to readiness for surgery and any complications (proptosis, chemosis, pain) were recorded. RESULTS: The articaine group demonstrated a rapid onset of peribulbar block with mean time (SD) to readiness for surgery of 4.2 (4.5) min compared with 7.2 (5.7) min in the bupivacaine/lidocaine group (P=0.0095). The block obtained in the articaine group was dense with eye movement scores at 2, 4, 6, 8 and 10 min all significantly reduced (P<0.01 at each interval). There was also a faster offset of the block in the articaine group (P=0.0009). There was no difference in incidence of minor complications between the groups. CONCLUSIONS: Two per cent articaine is safe and effective for peribulbar anaesthesia by inferotemporal injection and is a suitable alternative to the traditional mixture of 0.5% bupivacaine and 2% lidocaine.

Molecular typing of strains of staphylococcus aureus isolated from bone and joint lesions in lame broilers by random amplification of polymorphic DNA.

A study was conducted to investigate the relationship between the presence of localized bacterial infection and lameness in broiler fowl (Gallus gallus domesticus). Isolation of bacteria from the proximal femur, proximal tibia, and tibiotarsus from broilers with lameness revealed a probable association between lameness and the presence of Staphlylococcus aureus. Other potential pathogens, including Escherichia coli and DNase-negative staphylococci, were also isolated from sound and lame birds, and their association with pathologies causing lameness was less well defined. After trials with a set of twenty 10-base oligonucleotide primers, a pair of primers giving optimal performance was selected. The S. aureus isolates were typed by random amplification of polymorphic DNA (RAPD) by using the pair of 10-mer primers, and groupings were defined by banding patterns after agarose gel electrophoresis. The putative RAPD groupings may provide a basis for epidemiological studies of S. aureus in broiler production systems.

Assessment of intestinal function in cats with chronic diarrhea after infection with feline immunodeficiency virus.

OBJECTIVE: To identify consistent relevant mechanisms of small intestinal dysfunction in cats with experimentally induced feline immunodeficiency virus infection (FIV) that developed chronic diarrhea during the time they were being used in studies of pathogenicity and transmission of FIV. ANIMALS: 10 cats. PROCEDURE: The following investigative tests and techniques were performed on each of the cats: routine hematologic and serum biochemical analyses; urinalysis; fecal parasitologic and microbiologic examinations; breath hydrogen lactulose (BH2LT) and xylose (BH2XT) tests; intestinal permeability test; endoscopic examination of the intestinal mucosa; bacteriologic culture of endoscopically collected small intestinal juice; and histologic examination of endoscopically obtained intestinal biopsy specimens. RESULTS: Neutrophilia was evident in 3 cats, and lymphopenia was detected in 2 cats. Serum biochemical abnormalities were not observed. Urinalysis results were unremarkable. Fecal bacteriologic and parasitologic results were normal, except for isolation of Campylobacter sp from 1 cat. Abnormal BH2XT values suggestive of D-xylose malabsorption were identified in 2 cats, and BH2LT values indicated evidence of small intestinal bacterial overgrowth in 1 cat. Finally, permeability test results, quantitation of bacterial flora from the proximal part of the small intestine and histologic examination of biopsy specimens did not reveal any abnormalities. CONCLUSIONS: Enteric pathogens did not account for the development of diarrhea in cats with experimentally induced FIV infection, and consistent relevant mechanisms of small intestinal dysfunction were not identified.

Bacterial flora in the duodenum of healthy cats, and effect of dietary supplementation with fructo-oligosaccharides.

OBJECTIVE: To investigate changes in the duodenal flora of healthy cats over time, and evaluate the effect of dietary supplementation with fructo-oligosaccharides (FOS). ANIMALS: 12 healthy, barrier-maintained, specific-pathogen-free cats. PROCEDURE: Duodenal juice for bacteriologic examination was collected via oral endoscopy 5 times from each cat over a 32-week period. Cats were allotted randomly to 2 groups, and a crossover design study, during which they were fed either a replete dry (basal) diet or, for 12 consecutive weeks, basal diet supplemented with 0.75% FOS, was done. Samples (3 from cats fed the basal and 2 from cats fed the FOS diet) were collected for a minimum of 6 weeks after commencement of feeding, and a minimum of 6 weeks apart. RESULTS: Mean aerobic, anaerobic, and total bacterial counts did not differ significantly among sample collection times. After pooling of the results, mean (+/- SD) log10 colony-forming units (CFU) of aerobic, anaerobic, and total bacteria/ml were 5.5 +/- 1.1, 4.8 +/- 1.0 and 5.6 +/- 1.1, respectively. However, individual cats had considerable variation in counts: mean (range) intraindividual coefficients of variation were: 19.0 (6.1 to 34.2), 19.9 (4.8 to 35.5), and 18.1 (5.5 to 32.6)%, respectively. In 1 cat, total bacterial count varied between < 3.0 and 6.3 CFU/ml. Bacterial flora varied qualitatively: only Enterococcus faecalis, Clostridium perfringens, Bacteroides, Pasteurella, and Streptococcus spp, and unidentified gram-negative (aerobic) rods were present in > 50% of the samples. CONCLUSIONS: Wide quantitative and qualitative variation in the duodenal flora of healthy cats was observed over time, which was not affected by dietary supplementation with FOS.

Effect of dietary supplementation with fructo-oligosaccharides on fecal flora of healthy cats.

OBJECTIVE: To investigate changes in the fecal flora of healthy cats after dietary supplementation with fructo-oligosaccharides (FOS). ANIMALS: 12 healthy, barrier-maintained, specific-pathogen-free-derived adult cats. PROCEDURE: Fresh fecal samples for quantitative and qualitative bacteriologic examination were collected from each cat after ingestion of a replete dry (basal) diet for a minimum of 8 weeks. The diet was then supplemented with 0.75% FOS, and another fecal sample was collected after 12 weeks. RESULTS: Mean +/- SD fecal aerobic, anaerobic, and total bacterial counts (log10 colony-forming units per gram of feces [CFU/g]) did not differ significantly between diets (8.3 +/- 0.8, 9.2 +/- 0.6, 9.4 +/- 0.4, respectively, for the basal diet; and 8.4 +/- 0.8, 9.7 +/- 0.7, and 9.8 +/- 0.7, respectively, for the FOS diet), although there was a trend for higher numbers of anaerobes and total bacteria associated with the FOS diet. Members of the genus Bacteroides, Clostridium perfringens, Escherichia coli, lactobacilli, and Plesiomonas shigeloides were the most prevalent bacteria isolated. Compared with samples from cats fed basal diet, there was a trend for increased mean counts of lactobacilli (P = 0.02) and Bacteroides spp (P = 0.05) after FOS supplementation, and a trend for decreased mean numbers of Escherichia coli (P = 0.03) and Clostridium perfringens (P = 0.08) to be associated with the FOS diet. Supplementation of FOS resulted in a median 164-fold increase in numbers of lactobacilli, 13.2-fold increase in Bacteroides spp, 98% reduction in numbers of C perfringens, and 75% reduction in numbers of E coli. CONCLUSIONS: Supplementation of the diet with FOS resulted in alteration of the fecal flora of cats.

Assessment of the bacterial flora of the proximal part of the small intestine in healthy cats, and the effect of sample collection method.

OBJECTIVE: To investigate the bacterial flora of the proximal part of the small intestine of healthy cats and determine the effect of sample collection method on results of bacteriologic culture. ANIMALS: 25 healthy barrier-maintained specific-pathogen-free-derived cats. PROCEDURE: Aspirated, undiluted samples of proximal small intestinal juice were obtained via oral endoscopy (UEA), and a second sample was collected after instillation of 1 ml of sterile saline solution (diluted, DEA). Undiluted juice also was obtained by direct needle aspiration (NA) from the intestinal lumen. Samples for quantitative and semiqualitative bacteriologic examination were grown aerobically and anaerobically. RESULTS: Mean (range) log10 colony-forming units of total bacteria/ml were 6.2 (2.0 to 8.3) for NA, 6.0 (2.0 to 7.9) for UEA, and 4.9 (2.0 to 7.5) for DEA samples. One cat had no growth (< or = 2.0 colony-forming units/ml) for samples obtained using all 3 methods, and another cat had no growth for the DEA sample only. Mean total aerobic, anaerobic, and bacterial counts were not significantly different between NA and UEA methods, but these techniques yielded significantly higher mean counts than did DEA samples (P < or = 0.002, ANOVA). As a percentage of the total bacteria isolated, anaerobes constituted a median 35, 32, and 50% of the NA, UEA, and DEA samples, respectively. Good correlation was found between the NA and UEA samples for total bacteria, aerobes, and anaerobes (r > or = 0.830). CONCLUSIONS: Compared with human beings, healthy cats carry high numbers of bacteria in the proximal part of the small intestine. By comparison with NA samples, UEA samples accurately reflected bacterial populations in the small intestine, whereas DEA samples significantly underestimated these populations.