Combating infection in Practice

Presenter – Anthony Chadwick BVSc Cert VD, MRCVS, dermatology referral consultant in the north west and founder of ‘The Webinar Vet’.

Imagine a scenario; a dog comes in for cruciate surgery and post operatively develops an MRSA infection. Could you demonstrate to your, no doubt disgruntled client, that everything possible had been done to prevent this scenario?

‘The Webinar Vet’ organised a veterinary webinar to discuss this increasingly important and relevant topic of combating infections within practice. Advice was also given on how to minimize the risks of a scenario just like the one above actually happening in your practice.

Anthony Chadwick, founder of ‘The Webinar Vet’ headed up this discussion and started by debating the responsibility we have as veterinary surgeons to prescribe antibiotics appropriately in the first instance, to prevent the development of these resistant bacteria. Anthony cited a case of a dog called Rosie who had presented with demodicosis. Unfortunately Rosie had been treated initially with one week of amoxycillin followed by two months of marbofloxacin. Anthony performed a culture and sensitivity on Rosie’s skin which resulted in the growth of E.coli and Staphylococcus pseudintermedius both resistant to marbofloxacin and enrofloxacin. Anthony explained that S.pseudintermedius will quickly develop resistance to the flouroquinolones and this class of drug should always be used with care and ideally prescribed only when indicated by culture and sensitivity. Anthony used this case to ask whether we as a veterinary profession could be and should be better stewards of these products?

Of course we know there are resistant bacteria such as MRSA and MRSP being carried by a percentage of the population without causing clinical disease. However, according to Anthony, small animal vets are 5-6 times more likely and equine vets are a staggering 23 times more likely to carry these infections compared to the general public. So in order to try and prevent ‘cruciate surgery becoming infected with MRSA’, should we be screening our staff? According to Anthony decolonising MRSA and MRSP from carriers is extremely difficult and consequently screening may not be that useful. Anthony explained it may be more beneficial to ensure these bacteria are removed from the environment and this is best achieved by following the FECAVA recommendations.

Anthony covered the FECAVA recommendations in great depth and discussed areas such as the importance of cleaning and disinfecting hands, avoiding the use of jewellery, watches, nail polish and false nails which can all harbour infection. Recommendations also included the laundering of clothing and bedding, with lab coats being a major source of infection. These must be changed regularly, washed at 60 degrees and dried at a high temperature. Training staff with these recommendations at the forefront of any training programme is also crucial.

As this list of recommendations is extensive it is well worth investing time in this veterinary webinar to find out more. However, one point made by Anthony which seemed key was to place a staff member in clear charge of infection control. This person could then ensure everything was being done to implement the FECAVA recommendations and combat infection within practice. With this in place, you should feel confident that everything possible had been done to prevent that cruciate surgery developing an MRSA infection. Of course the more likely scenario is it probably would never have happened at all.

The Stethoscope