and I paid out of pocket to culture scrub samples from a hospital that we don't own and it turned out to pay off. But, I am positively beside myself. 😢
As many of you know, my surgeon and I travel hither and yonder performing surgery at a variety of different hospitals. Some of these facilities are privately owned, government funded, corporate and venture capitals. We go in, complete the necessary #surgery
and leave. (Its a little more involved than that, but you get it.) Over the past year, I've noticed a trend in patients needing to have their implants removed because of chronic draining, irritation, etc. Now, out of the thousands of surgeries we perform a year, we maybe get 1 pet that needs implants removed due to chronic infection a year. Why do we have 6 patients who need implant removal for 2018? We culture the implants, always and every single patient has come back as Serratia Marcescens.
Poor scrub storage, cross contamination and sewer water are to blame.
we go to has a different scrub for surgery. A majority of them use chlorhex scrub +/- solution, +/- iodine, +/- alcohol. Some dilute their scrub and some do not and when it is diluted, many individuals will dilute it with good old sink water as a substitute for sterile water which is below the standard of care and here's why: Just because the scrub is designed to be antiseptic, doesn't mean it can't be a hot bed for bacterial growth. Case and point. Changing the scrub once a month and rinsing out the container isn't enough. It's never been enough.
I try my best to not challenge protocols, but I made an assumption that standards were being followed and for that reason I feel as though I failed my patients. Take a note from me.
New scrub for each pet and frequent culturing to ensure appropriate patient advocacy is key.
Serratia Marcescens is a gram negative rod that loves damp environments and feeds off of phosphorous, creating pesky biofilms. It equates to roughly ~1% of nosocomial infections annually and cannot be eradicated by chlorhexidine, but bleach or obvious gas or chemical sterilization can.
What is your scrub protocol? Is there room for improvement?💔😭