Op procedure questions from seeing practice recently

Bit of a potentially stupid question! I've just got back from a couple of weeks work experience at a vets and got to observe plenty of ops. It was interesting seeing how the vets/nurses maintained a sterile environment around the vet: the vet not touching anything not sterile/ the nurses not touching anything sterile; the nurses opening packets and dropping the contents onto the sterile cloth etc.

Is this purely to avoid contaminating inside the animal & causing an infection?
Are there any other reasons?

What are the risks of not doing this?

What are the 'pros and cons' of gowning& gloves vs just gloves? Hat or not?

One of the 2 practices I have seen didn't go to the same lengths as the other- is this difference in education times (older vets vs new, ie, recommended best way to do it having been updated in the 10-20 years between the vets at the one practice graduating and the new grad i was shadowing at the other practice?) or is it something else?

Is it controversial if vets don't do some of the above? Or accepted as you do it your way I'll do it mine?
Is it ever 'mandatory' to do it eg major ops definitely, advisory for minor, or should it always be done?

Basically what I'm trying to get at is the risk of infection and consequences should the sterility be compromised.

Hope someone can help! Thanks

First of all, definitely not a stupid question! To my knowledge, the process of keeping everything sterile is pretty much just to prevent bacteria etc from getting into your surgical site where they shouldn't be, and causing an infection. Off the top of my head I can't think of any other major reasons for why everything will be kept sterile, although someone may well jump in with something I've forgotten!



Well you've said it yourself - infection. Say you're doing a spay, or another intra-abdominal surgery. If bacteria get into there, then you risk the animal developing peritonitis which can potentially be fatal.



Gowns and gloves will be more sterile than just gloves, as there's a risk that if you're not gowned up then your arm above the glove could touch the site, or your sterile instruments/drapes. And even if you've scrubbed up to the elbow, as is best practice, your arm still won't be completely sterile. When I was taught about sterile practice in my third year (last year), we were taught that wearing long sleeved gowns is best practice. Some practices will still use short sleeved gowns, which prevent any contamination from your clothes but not your arms.

Hats is about preventing physical contamination by preventing hair from falling into the surgical area. I also sometimes wear a mask over my mouth and nose when I'm in theatre but this tends to only be when I'm feeling a bit ill and am concerned I'll cough or sneeze on the sterile area. They're also standard PPE to wear during dental procedures and my practice had a policy that everyone in the room, including nurses and students should wear a face mask during dentals.



Well it depends to some extent what these vets weren't doing, and for what procedures. At the practice I've done a lot of placement at, cat castrates typically weren't done under such strict sterile conditions, in that they weren't done wearing gowns, only gloves and they'd be done in the prep area as opposed to taking them through to theatre. That's pretty much the only 'proper' operation that I can think of that has relaxed sterility - on the small animal side anyway. Farm animal operations are often done under less than ideal conditions on farm, but that's a whole other issue!

Anything more involved than a cat castrate, such as dog castrates and anything that involved going into a body cavity such as spays, exploratory laparotomys, should as far as I know be done under full sterile procedure so gowns, gloves, etc. Then from my understanding, although I haven't started this yet, orthopaedics is another level of sterility again! At my university's teaching hospitals, the equine building has two operating theatres I believe, one 'dirty' one for soft tissue surgery such as colics, and then a 'clean' one which is used for orthopaedic surgery. Don't quote me on this because I haven't started orthopaedics yet but my understanding is that if you get an infection in a bone or joint it's a complete nightmare to treat, so orthopaedic surgery should absolutely be done under the most sterile conditions possible.

I hope this helped a bit If there's anything I didn't explain very clearly or if there's anything else you want to ask, please do!

Thank you for the really awesome (and quick!) response!

That's really interesting actually, as a little background information will show:

Practice 1: 2 vets as partners, no one else there. They both did all the ops just in a clean scrub top and no other change- no gloves/gown/hats. Including the female vet with long hair, which I can definitely understand could be an issue even tied up as it was long enough to dangle halfway between her & the animal.

Practice 2: actually a chain, so in the branch clinic I was there 2 weeks and every op (except the cat castrate in prep) was done in theatre but only with gloves/ clean scrub top. No gowns, hat/ crocs were optional depending on the vets choice. Nurses didn't change.
Same chain but in the hospital rather than the smaller branch, suddenly everyone had to wear clean scrubs/hat/crocs including me and the nurses, and the vets all wore gowns as well.

Is this common for vets practices to not enforce best practice? Or have I by sheer luck found the only 2 in area that do it this way!?

What's the likelihood of infection then if best practice is followed in regards to gowns etc? Are there studies/ statistics to back it up that there's a reasonable risk? Or is it low enough that individual vets/ practices can't be bothered to enforce it fully and therefore they hopefully wouldn't see the consequences?

Hmm that's interesting. I don't know if similarly to you, this is due to my limited practical experience at this stage but I've not been to a vet practice where they don't at least wear gloves! Now I think about it, one of the partners at my foster practice wouldn't wear gloves for cat castrates, but that was it. Everything else was gloved and gowned.

Out of interest, I've had a look back through my lecture slides on surgical asepsis, and it says that all people in theatre, including nurses etc, should be wearing scrubs, cap, mask and designated footwear. And then surgeons go one step further and also wear gown and gloves. Knowing that this is how we've been taught, I would be personally very reluctant to do surgery other than something like cat castrates without gloving. And in fact when I did my first cat castrates a couple of weeks ago, I did wear gloves.

I'm afraid I don't know of any studies relating to likelihood of infection relating to whether gowns and gloves are used. And I'm not sure why different practices do it differently. It could well just be down to how they were taught, as things may well have changed since they graduated.

If a surgeon scrubs up really well and does an operation quickly then historically in vet practice gloves, sterile gowns, hats, masks etc were not worn and there didn't tend to be many problems with post op infections. However most cases were given a long acting antibiotic at the time of the surgery or possibly a short acting antibiotic injection and tablets to continue.

As time has passed most vets began to wear sterile gloves for surgery, and then more started to wear sterile gowns although in a lot of practices that was restricted to long abdominal ops or orthopaedic ops. The use of prophylactic antibiotics has decreased with the increase in sterility.

Less experienced vets tend to take longer to do a particular procedure. Sterility becomes more important the longer the operation takes.

Have the two vets from practice one been qualified longer than the vets from practice two?

As Bristolvet94 says above operations on farms tend to have limited cleanliness let alone sterility and yet the animals usually do ok

Bit of a potentially stupid question! I've just got back from a couple of weeks work experience at a vets and got to observe plenty of ops. It was interesting seeing how the vets/nurses maintained a sterile environment around the vet: the vet not touching anything not sterile/ the nurses not touching anything sterile; the nurses opening packets and dropping the contents onto the sterile cloth etc.

Is this purely to avoid contaminating inside the animal & causing an infection?
Are there any other reasons?
What are the risks of not doing this?
What are the 'pros and cons' of gowning& gloves vs just gloves? Hat or not?

One of the 2 practices I have seen didn't go to the same lengths as the other- is this difference in education times (older vets vs new, ie, recommended best way to do it having been updated in the 10-20 years between the vets at the one practice graduating and the new grad i was shadowing at the other practice?) or is it something else?

Is it controversial if vets don't do some of the above? Or accepted as you do it your way I'll do it mine?
Is it ever 'mandatory' to do it eg major ops definitely, advisory for minor, or should it always be done?

Basically what I'm trying to get at is the risk of infection and consequences should the sterility be compromised.

Hope someone can help! Thanks

Thank you -the historical aspect is interesting, and I hadn't thought about the length of time of the procedure affecting this.

Yes practice 1, both vets were partners and one qualified in early/mid 80's, the other in '94. I don't know if this affects it, but they were both from Germany and studied there.

In the second practice it was a chain with almost 30 vets of varying ages, so it felt more like a business with enforced rules like health and safety etc, although some weren't enforced- signs saying about PPE for dentals were right next to the vets and nurses who didn't bother with it! However the site with the hospital was a lot stricter and did actually follow the 'rules' about gowning etc, presumably because that's where they did the more complicated and longer ops.

Is it possible there's also a money factor? Practice 1 is a small independent and could it be possible they chose not to as a business decision - perhaps (and I am completely hypothesising at this point) because you can charge separately for antibiotics whereas to charge for extra items like gowns being sterilised it would have to be taken into account for the overall op cost, so 'skipping' that step could save money?

I imagine that line of thought is a very dangerous one actually, because there's a fine line between operating a viable business and being only profit minded. While I don't think that's the case from the practice I saw, I imagine vets are not immune?

There's no such thing as a stupid question.

Any form of surgery provides risk of contamination. The one thing as a surgeon you don't want is bacteria/contamination within a body cavity or a wound - it impedes healing and can cause further issues. There will never be a 100% sterile environment for surgery and there will always be risk of contamination, however there are lengths vets can go to in order to reduce the risk of contamination of a wound and prevent infection post op.

There are older vets who simply just 'scrub up' and perform surgery without gloves - and the newer more recent graduates will either scrub up and glove up, or scrub up, gown up and glove up. The more of a barrier between the surgeon and the surgery the less risk of contamination.

It also depends on the type of surgery - surgeries such as spinal/ortho surgeries need to be as sterile as possible, hence the gloving, gowning, hats and face masks to prevent possible infection.

A lot of vets will have rules regarding theatre, changing scrubs to clean/sterile ish scrubs, sterile gowns, change of shoes which are sterile in the environment and no member of staff can step foot in the theatre without wearing the correct attire. All theatres are fully disinfected after a day of operations, and again no-one steps foot in there until the following operation, and even then a theatre is often 'damp dusted' using disinfection to remove any contamination that might have settled overnight.

Cost is a big thing when it comes to having a sterile environnement however most of the sterile gowns/gloves etc are pretty cheap to obtain these days, and there are re-usable gowns and drapes for example but they can harbour more contamination than the disposable ones.


If you look at it this way before you enter a body cavity everything is sterile as the skin acts as a barrier for the internal organs against microbes, the moment you take a scalpel to skin, you're breaking that barrier, so you need to make sure you're not dropping things in there from the environment that shouldn't be there. You also have different wound types such as clean, clean contaminated, contaminated and dirty, depending on the age of the wound, and the area of the body you're going into (something you'll be taught as a vet student).

Depending on the area of surgery some sites are virtually impossible to keep sterile - operations on anal glands/ around the bottom are never going to be sterile no matter how hard you try.

You'll see different procedures every practice you go in to, each practice has its own way of doing things, if you've ever watched the Yorkshire vet, hes an older vet who doesn't glove up for surgery, however I would never perform surgery myself without having gloves on, but you'll go on a farm visit and castrate bulls with no scrubbing up, no gloves due to the environment in which the procedure is being performed - with bulls the wound is left open to allow any rubbish to drain out, however you still sometimes end up with abscesses in those situations, but without knocking out a bull and having a theatre it isn't possible, so farm vets work with what they've got on farms - farm practice is a whole different ball game.

I think the dates of qualifying - 1980/90s are significant. I don't think the country of qualifying is. Certainly in the 80s it was normal not to wear gloves and sterile gowns in a typical practice.

Corporates do tend to have more "rules" and the enforcement probably varies depending on who is in charge of that site.

I doubt that charging for antibiotics comes into it at all. You can also charge for using sterile gloves and gowns. Small independent practices often have less focus on profit when compared with the corporates.

Employed vets are often not bothered about if the practice makes a profit. However the vets that own it and have to be able to pay their staff and keep a roof over their own heads do tend to care. If a business isn't viable it closes and that isn't good for anybody. Profit means money may be available to re-invest into the practice on more equipment or staff for example. Profit is not a dirty word, it is necessary unless you are a charity with enough donations to sustain you.

Thank you for the reply! I've found this entire topic fascinating as it's something I never even thought about until a few weeks ago.

The whole farm vets thing- that does beg the question of how many animals get infections which would have been prevented had it been feasible to have a higher level of sterilisation? I imagine it's just not financially viable or practical to try though. Another thing for me to mull over!

It’s just not physically possible. Any abscesses are drained and left open to drain and antibiotics given. You couldn’t bring in 10 bull cows and knock them out and perform the surgery in a sterile environment, it would take hours and would be incredibly expensive, not worth it. As long as basic measures are put in place to avoid contaminating wounds most wounds don’t get infected, and blue spray is a magic thing in farm animal practice 😂

Yes I can see how that's not possible, but I now have an image in my head of someone walking a bull into a vets consult room...

Haha if you ever come across that experience take photographic evidence!

Is this purely to avoid contaminating inside the animal & causing an infection?

Are there any other reasons?

What are the risks of not doing this?

Is it controversial if vets don't do some of the above? Or accepted as you do it your way I'll do it mine?
Is it ever 'mandatory' to do it eg major ops definitely, advisory for minor, or should it always be done?

That's something I really liked seeing at the first practice actually, because they were partners both vets would just cut prices for certain clients because they knew the family for the past x decades and they were going through hard times recently etc, whereas they wouldn't for others. In the second practice as it was more commercial, individual vets didn't have the autonomy for that sort of judgement.

Have a think about it...

What if you as a full paying customer found out others similar to yourself were getting substantial discounts?

What if you were going through similar issues?

What if that person or persons was not as hard up as they claimed?

What if you were queuing in Tesco and the women in front was awarded a substantial discount on her weekly shop and you weren't?

It sounds lovely awarding discounts to people but it can also cause substantial discontent among other clients who aren't getting this discount and can seriously affect the finances of the company.

Offering a consistent and fair service to all customers should be the goal, regardless of race, gender, age or personal circumstances.

From personal experience offering a consistent service is far less likely to generate complaints, often from those who has benefited from your generosity! You are also far less likely to find yourself in compromising situations where people are trying to take advantage of your good nature. It's amazing how quickly word of these "secret" acts of kindness spread