What to wear during surgery?

[pigsatuga]

The clinic I volunteer with doesn't require caps or masks during spays or neuters and as of today, I realized they don't wear them for intestinal resection either. However, they do "dress in" for bone plate surgery to fix broken legs and I've seen them in the full outfit in other scenarios.

But, the resident surgeon at the local spay and neuter clinic I volunteered for always wore a full gown, mask and cap, however, he never asked volunteers to "dress in".

Is there a lot of variation among different practices? I assume there are debates on the necessity of full cover during certain procedures, but are there certain procedures that are considered "less risky" and therefore maybe it would be ok to skip the wardrobe change?😕 Just curious to see what you guys had to say on the subject.

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[Dsmoody23]

 

[hopefulinva]

The hospital I work at requires surgeons to scrub in wearing sterile caps, gowns, and gloves - for all procedures. If there's an animal open on the table, there's a surgeon in a fully sterilized gown working on it. I was the hammerer in an FHO and even that required the full process of scrubbing in (including donning a sterile gown).

It's kind of concerning to me that the hospital in which you volunteer doesn't require this, because - as I understand it - it's not so much a matter of protecting you as it is protecting your patient. Then again, I've only worked at the one hospital, so I suppose there are different ways of doing things...

 

[Trilt]

Zodiak23.JPG

More seriously, though, I've seen quite a bit of variance in sterility in the different places I've volunteered/worked, and I'd be curious to see literature on differences in complication rates.

 

[Abnerrs]

I heard the AVMA is making this pretty much standard

 

[WhtsThFrequency]

The clinic I volunteer with doesn't require caps or masks during spays or neuters and as of today, I realized they don't wear them for intestinal resection either.

What in the name of.....no caps/masks, etc for intestinal resection? Ie, open abdominal surgery?? Where the hell are you volunteering at??? No offense to you, but I'm honestly appalled. A neuter, ok, maybe I can see it. But NOT when body cavities are opened. No way. Not even a flank spay.

 

[PetPony]

At the LA Hospital, I have to wear scrubs, a mask, hair net thingy and sometimes shoe covers. If I don't have scrubs, they give me a gown. And I just stand in the corner and watch.

I was really shocked to see that the vet I shadowed in Germany didn't do that. He did a spay in jeans and a polo shirt, no cap and no mask. Just gloves.

 

[wildcatj]

The only surgery the vets at my hospital and the other one I've shadowed at don't gown up for are cat neuters. When I was looking for a job recently there was one hospital I was going to apply to but they had a picture on their website of a Dr. doing abdominal surgery without a gown. Needless to say I did not apply there. I can't think of a reason to not gown up except laziness honestly...

 

[SnowyRox]

I'm surprised at all the people who have to gown up just to shadow. I've never put on a gown or cap and I've been right near the surgeon for several surgeries. The male & female vet where I shadowed both wore gowns for everything, but only she wore a cap. Actually, he started wearing caps when he did orthopaedic stuff. But not for a normal spay/neuter/whatever.

The only time I haven't seen surgeons wearing gowns is at very low cost spay/neuter clinics. Never saw a complication during the 2 months I was there, but ideally they would have liked to be fully suited up.

 

[wildcatj]

I'm surprised at all the people who have to gown up just to shadow. I've never put on a gown or cap and I've been right near the surgeon for several surgeries. The male & female vet where I shadowed both wore gowns for everything, but only she wore a cap. Actually, he started wearing caps when he did orthopaedic stuff. But not for a normal spay/neuter/whatever.

The only time I haven't seen surgeons wearing gowns is at very low cost spay/neuter clinics. Never saw a complication during the 2 months I was there, but ideally they would have liked to be fully suited up.

I've never had to gown up to watch surgery, but I did wear a cap and mask at the hospital where I shadowed.

 

[scb44f]

I was really shocked to see that the vet I shadowed in Germany didn't do that. He did a spay in jeans and a polo shirt, no cap and no mask. Just gloves.

This is only what I have seen, but I have only shadowed vets who have been in the field for 30+ years (yes I would rather they keep up to date with their protocols, but I'm assuming more recent graduates tend to err on the side of caution). No gowns, masks, etc. for anything. There was someone I shadowed for less than 2 weeks whose protocols were even worse. Of course, I essentially ran out of there after I put in the time I agreed to do.

 

[dyachei]

Shoe covers are meh - there are studies out that show they don't make a difference.

Cap and mask and sterile gown are definitely needed, IMO unless it is an oral surgery (so dirty in there anyway), a neuter (especially cat netuers), or a simple skin mass removal. And with dog neuters, I definitely still want them.

That being said, always with the sterile gloves.

 

[PetPony]

This is only what I have seen, but I have only shadowed vets who have been in the field for 30+ years (yes I would rather they keep up to date with their protocols, but I'm assuming more recent graduates tend to err on the side of caution). No gowns, masks, etc. for anything. There was someone I shadowed for less than 2 weeks whose protocols were even worse. Of course, I essentially ran out of there after I put in the time I agreed to do.

I only watched a tumor removal on the outside of a leg and the dog spay. I don't know if he does it different for other stuff. No clue.

I really enjoyed being there the whole time. The surgeries were in my last two days and I walked out of there, like 😕.

 

[sunshinevet]

At the LA Hospital, I have to wear scrubs, a mask, hair net thingy and sometimes shoe covers. If I don't have scrubs, they give me a gown. And I just stand in the corner and watch.

Don't forget you're also shadowing at a teaching hospital, they will dot all their i's, cross their t's and do everything absolutely by the book - and so they should - they're a teaching hospital - they should be the epitome of good practice.

I think the gown thing for spey/simple surgery is a questionable issue. Hats and masks and gloves, yep - but the biggest contributing factor to post surgical infection is the time it takes to do surgery. So the experienced vet who can spey a cat in 10min with minimal tissue trauma and a tiny inscision while just wearing a cap, mask and gloves will still have a lower rate of infection than the new grad who takes an hour and causes a lot of tissue damage, yet wears a gown.

EVERYONE should be using gowns for extended procedures though!!! Especially those at high risk of infection.

 

[prevetdreamer]

At all of the clinics I have worked at, the surgeon and any assisting technicians (doing more than monitoring the animal and running anesthesia) were fully sterile including gowns, gloves, mask and cap. At my current clinic, our old policy was that technicians just monitoring didn't have to wear a mask or cap or anything, but that changed last summer. At first I didn't necessarily like this, but now I think it's a really great improvement to our clinic. It's such a little and easy thing, and if it improves the level of care and reduces the chance of post-op infections, why not?! Plus, those lunch lady caps are super stylin' 😀

 

[variegata]

At my old clinic, the surgeon had a cap, mask and gown. Anyone monitoring the patient or observing/shadowing also had to wear a cap and mask. The exceptions being dentals and cat neuters, which were performed out on the wet tables. Cat neuters, though, still got sterile drapes.

 

[Emiloo4]

The two clinics I've worked at wear gowns, masks, gloves, etc. Even the really really really low budget spay and neuter clinic I volunteer at does. I'm honestly rather appalled that there is anyone, anywhere not following sterilization procedures when inside an animal. I mean, is it even "legal" for them to not gown up? Or is it just a matter of ethics? 😕
I have never had to gown up and sterilize for procedures I wasn't helping in. If I am just there to monitor the patient, I am only required to wear a mask and cap, but even then, I stay far away from the sterile field. I do scrub in for TPLOs sometimes. 😍

 

[heylodeb]

The two clinics I've worked at wear gowns, masks, gloves, etc. Even the really really really low budget spay and neuter clinic I volunteer at does. I'm honestly rather appalled that there is anyone, anywhere not following sterilization procedures when inside an animal. I mean, is it even "legal" for them to not gown up? Or is it just a matter of ethics? 😕
I have never had to gown up and sterilize for procedures I wasn't helping in. If I am just there to monitor the patient, I am only required to wear a mask and cap, but even then, I stay far away from the sterile field. I do scrub in for TPLOs sometimes.

Similar at my place. We do have scrub tops that are clean and kept at the hospital that we put over our other scrubs when we are walking into surgery.

 

[katryn]

I've seen it done lots of different ways from nothing but sterile gloves/mask and the patient is draped in, to the full gown/mask/cap/shoe cover/gloves on every single person entering the room.

For the most part, the variation did seem to be based on the "generation" of the doctors working in the practice (ie. older doc->less strict about sterilization). Now that I've been through a surgical course, it feels like I should be appalled at the lack of sterility of some of the docs I've worked for, but at the same time, in the two and a half years that I worked with someone who never did more than gloves, mask, and draping the patient, we never had any problems with post op infections either.... They do emphasize in class that surgical time is the most important factor though, and that particular set of docs were pretty speedy.

 

[heylodeb]

They do emphasize in class that surgical time is the most important factor though

interesting!

 

[Abnerrs]

My doctor wears a cap, gown, and sterile gloves for everything except oral, cat neuters and lacerations/bites. She just wears normal gloves for those. We don't have to gown up etc. unless it's a long super invasive critical sx, or she needs actual assistance.

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[pigsatuga]

Wow! I think I'm going to have to ask the vets I shadow about it. I had no idea it was so unusual. I myself was surprised at first, but the vets there DO track the number of post-op infections and supposedly their rate is very low.

I guess I should explain that they do use sterile drape, sterile gloves (obviously), the animals are scrubbed multiple times pre-op etc. They just don't wear masks, caps or gowns. Everything else seems to be the same procedure I've seen in the other clinic I volunteer with. To further explain, this particular clinic is an 8 vet mixed practice, pretty state of the art, and not an older generation kinda crowd. I have no doubt that if they had increases in post-op infection, they would change their practices. I will ask them next week when I go back and see if this is something that evolved over time, if they found literature that supports or whatever.

🙂I am VERY curious now!!

Edit: They do wear the whole outfit for certain procedures, I've seen them dressed in for amputations, eye removals, bone plates etc. And the folks who do surgery there are REALLY fast, so maybe that has something to do with it.

 

[sunshinevet]

Wow! I think I'm going to have to ask the vets I shadow about it. I had no idea it was so unusual. I myself was surprised at first, but the vets there DO track the number of post-op infections and supposedly their rate is very low.

I guess I should explain that they do use sterile drape, sterile gloves (obviously), the animals are scrubbed multiple times pre-op etc. They just don't wear masks, caps or gowns. Everything else seems to be the same procedure I've seen in the other clinic I volunteer with. To further explain, this particular clinic is an 8 vet mixed practice, pretty state of the art, and not an older generation kinda crowd. I have no doubt that if they had increases in post-op infection, they would change their practices. I will ask them next week when I go back and see if this is something that evolved over time, if they found literature that supports or whatever.

🙂I am VERY curious now!!

Edit: They do wear the whole outfit for certain procedures, I've seen them dressed in for amputations, eye removals, bone plates etc. And the folks who do surgery there are REALLY fast, so maybe that has something to do with it.

I honestly think speed would have something to do with it. Speed of surgery and tissue damage are such HUGE risk factors of post op infection that, if you are otherwise following principles of asepsis, wearing a gown, cap and mask is comparably neglegible.

 

[hopefulinva]

I honestly think speed would have something to do with it. Speed of surgery and tissue damage are such HUGE risk factors of post op infection that, if you are otherwise following principles of asepsis, wearing a gown, cap and mask is comparably neglegible.

Just out of curiosity, when does speed become an issue? At the point an incision is made, or prior to?

 

[dyachei]

Just out of curiosity, when does speed become an issue? At the point an incision is made, or prior to?

my understanding is total anesthesia time.

 

[katryn]

my understanding is total anesthesia time.

UTK teaches total anesthesia time, because anesthesia lowers body temp, blood pressure, heart rate, etc, it can make the patient more prone to immune compromise the longer they are under.

 

[dyachei]

UTK teaches total anesthesia time, because anesthesia lowers body temp, blood pressure, heart rate, etc, it can make the patient more prone to immune compromise the longer they are under.

👍

But I also meant my understanding of the studies that they (vet world) have performed have been total anesthesia time, not cutting time.

 

[Minnerbelle]

UTK teaches total anesthesia time, because anesthesia lowers body temp, blood pressure, heart rate, etc, it can make the patient more prone to immune compromise the longer they are under.

Yep we were told poor perfusion was the major factor, and thus total anesthesia time

 

[Trematode]

I volunteered at an AAHA accredited clinic.

Surgeon and assisting wore sterile gown, cap and mask. The shoes they wore were indoor shoes only.
As an observer, I did not have to wear a sterile gown, but I did have to wear the cap and mask. If I did not have indoor shoes, I had to wear shoe covers.

I have been told that some of what you see in human hospitals is overkill. I doubt something like having every single person who enters the room scrub up and dress in sterile clothing is going to decrease chances of infection by a significant amount. Aren't there articles out there that state that gloving up for surgery is the same or worse than not gloving up?

 

[Jamr0ckin]

I honestly think speed would have something to do with it. Speed of surgery and tissue damage are such HUGE risk factors of post op infection that, if you are otherwise following principles of asepsis, wearing a gown, cap and mask is comparably neglegible.

This.👍👍👍

 

[LetItSnow]

Aren't there articles out there that state that gloving up for surgery is the same or worse than not gloving up?

I don't know the answer to that, but I do know that even if it's not necessary for patient safety, I'm certainly going to continue to glove and mask for MY safety.

 

[prevetdreamer]

I don't know the answer to that, but I do know that even if it's not necessary for patient safety, I'm certainly going to continue to glove and mask for MY safety.

Agreed. Especially with dentals.There can be a serious grossness factor and I definitely don't want all that junk flying onto my face or all over my hands without a mask or gloves. Maybe I am just messy when I do my dentals lol but I remeber this one time I did a dental without a mask because it was going to be quick and it wasn't really bad. I ended up getting a spray of water/dental junk in my face. NOT PLEASANT! It's safe to say I learned my lesson 😉

 

[katryn]

Agreed. Especially with dentals.There can be a serious grossness factor and I definitely don't want all that junk flying onto my face or all over my hands without a mask or gloves. Maybe I am just messy when I do my dentals lol but I remeber this one time I did a dental without a mask because it was going to be quick and it wasn't really bad. I ended up getting a spray of water/dental junk in my face. NOT PLEASANT! It's safe to say I learned my lesson 😉

With you on that one! I refuse to monitor dentals without a mask. Tartar shrapnel is nasty.

 

[zanydogz]

With you on that one! I refuse to monitor dentals without a mask. Tartar shrapnel is nasty.

Agreed.

 

[StartingoverVet]

What to wear for surgery? I wore a hospital gown when they did surgery on me.

Oh, not what you meant....sorry.

 

[krist]

What to wear for surgery? I wore a hospital gown when they did surgery on me.

Oh, not what you meant....sorry.

 

[Spinach Dip]

I have been told that some of what you see in human hospitals is overkill. I doubt something like having every single person who enters the room scrub up and dress in sterile clothing is going to decrease chances of infection by a significant amount. Aren't there articles out there that state that gloving up for surgery is the same or worse than not gloving up?

Ah, but now you're talking about human medicine. And the problem with sterile procedure is this:

It's NOT really necessary. But imagine you are a surgeon who doesn't wear a cap to some minor procedure and your patient (horror of horrors!) comes away with some bacterial infection. If this patient (or their lawyer) hears that you DIDN'T wear your sterile cap, you will be facing a massive lawsuit (which they will probably win).

So... a lot of what we see in ORs is just redundancy heaped upon redundancy in an effort to cut down on litigation.

 

[LetItSnow]

Ah, but now you're talking about human medicine. And the problem with sterile procedure is this:

It's NOT really necessary. But imagine you are a surgeon who doesn't wear a cap to some minor procedure and your patient (horror of horrors!) comes away with some bacterial infection. If this patient (or their lawyer) hears that you DIDN'T wear your sterile cap, you will be facing a massive lawsuit (which they will probably win).

So... a lot of what we see in ORs is just redundancy heaped upon redundancy in an effort to cut down on litigation.

Thank goodness we have someone with legal AND medical expertise around to dissect this issue!

 

[PetPony]

 

[Spinach Dip]

👍