Preventing SSIs
Patient risk assessments
In recent years , the use of anaesthetic risk assessments for patients undergoing a surgical procedure has become more commonplace . In human medicine , it is also common to perform a risk assessment of the perioperative phase and patient journey [ 9 ] , which should perhaps be a consideration in veterinary practice . There are numerous risk assessment models available , with many following grading systems similar to those used by the American Society of Anesthesiologists ( ASA ).
The primary purpose of an interactive postoperative wound dressing ( Figure 2 ) is protection . Ideally , it should also prevent contamination , maintain a balanced , moist wound environment , minimise the risk of peri-wound skin damage and stay in place until it is intentionally removed [ 12 ] . Additionally , the dressing should be flexible and not hinder a patient ' s movement , have good adherence but be skin-friendly ( including at the point of its intentional removal ), be able to manage exudate or draining fluid , and be waterproof to prevent external contamination [ 12 ] .
Surgical safety checklists
Like risk assessments , surgical safety checklists should be used before any surgical procedure to help minimise errors and maximise patient safety . Checklists have proven successful in human surgical theatres , with their use achieving a 47 % decrease in deaths , a 36 % decrease in overall postoperative complications and a 48 % decrease in infections [ 10 ] . The success of checklists has , in part , been attributed to the way they slow down the team and allow for debriefs , which improve team communication and promote a culture of safety [ 10 ] .
The World Health Organization ( WHO ) Surgical Safety Checklist [ 11 ] can be adapted to the veterinary environment , or veterinary-specific guidance can be found in the RCVS Knowledge Surgical Safety Checklist Manual [ 10 ] . The author recommends discussing and developing a checklist within the practice team , then trialling and tailoring it to the individual practice before its implementation [ 10 ] . Surgical safety checklists will also be covered in the October 2024 issue of VNJ .
Postoperative wound dressings
The primary closure of a wound via apposition of the skin is the fastest closure method and allows a shorter migration of new keratinocytes and blood vessels [ 2 ] . Surgical wounds progress through the same three phases of healing as an open wound – starting with inflammation , then proliferation and finally maturation , with a scar forming after 10 days [ 2 ] . Around 3 days postoperatively , the superficial epidermal layers start to restratify , forming a barrier against contaminants and microbes , so the incision line may appear to be ‘ sealed ’ but can be susceptible to external mechanical forces [ 2 ] .
The WHO guidelines on SSI prevention recommend that a postoperative wound dressing is applied aseptically after surgery , and remains in place for 3 – 4 days while the skin barrier repairs [ 2 ] . Several factors determine the type of dressing used ; low-risk patients often require only a basic interactive dressing but , in certain circumstances , a more advanced dressing may be needed .
Figure 2 . Leukomed T Plus , a waterproof film dressing , on a dog ' s thorax .
The length of time a dressing is in place will be determined by the surgical procedure and the clinical judgement of the VS . Often , the surgical incision site will require assessment 3 – 4 days after surgery . A transparent postoperative wound dressing ( Leukomed Control ) is available , which can aid the visualisation of the surgical incision site , therefore reducing the need to remove the dressing and the potential for contamination ( Figure 3 ).
Figure 3 . Transparent postoperative wound dressing ( Leukomed Control ) on a cat , following a lumpectomy .
22 Veterinary Nursing Journal