http://orcid.org/0000-0003-4591-6947
Introduction
Winning Poster Abstract at BVNA Congress
The Registered Veterinary Nurses’ perception of factors affecting quality of life in paraparetic and paraplegic dogs
Quality of life (QoL) assessment is well established in human medicine and is receiving increasing amounts of attention in veterinary medicine. QoL tools have been created for cats and dogs with specific chronic diseases but none relating to animals with paraplegia or paraparesis. Also, no research has been found on the Registered Veterinary Nurses’ (RVN) opinion or role of QoL assessment. This research project provides an insight into the continued homecare of paraplegic and paraparetic dogs as well as gathering the RVNs’ perception of the QoL factors associated with these conditions and their importance.
Hypotheses
1. Each of the patient and owner quality of life factors will be ranked as more important by those Registered Veterinary Nurses who work in referral practices compared to those who work in first opinion practices or other practices.
2. Each of the patient and owner quality of life factors will be ranked as more important by those Registered Veterinary Nurses that have been qualified longer.
Methods
This project used a cross-sectional study design where the data was collected using a self-administered online survey. The survey was emailed to Royal College of Veterinary Surgeons (RCVS) accredited practices in the United Kingdom, and was also advertised on social media platforms with the target population being RVNs. The questionnaire consisted of 4 sections containing both open and closed questions. The first section asked the participants to choose the type of practice they currently worked in, as well as how long they had been a qualified Veterinary Nurse. The next 2 sections contained 13 QoL factors specific to paraplegic and paraparetic dogs, where participants were asked to rate each factor by importance. These 13 factors were divided into owner factors (compliance with care, compliance with medication, ease of medication administration, time, affordability and assistance) and patient factors (pain, complications from the conditions, temperament, mobility, existing conditions, size of the patient and adverse effects of medication). The final section asked the participants whether they believed there were any further QoL factors that could be applicable to paraplegic or paraparetic dogs.
Chi Squared tests were used to test the association between the importance rating of the QoL factors and the type of practice worked in (first opinion, referral or other), whereas the Kruskal Wallis test was used to test the association between the number of years qualified as a RVN and the importance rating of the QoL factors. The p-value was set at p≤ 0.05.
Results
A total of 283 responses were included in the final data set. For the first hypothesis, 4 out of the 13 QoL factors were ranked as important by a larger number of RVNs working in referral practices compared to the first opinion and other practices.
However, the Chi squared indicated that the relationship between there factors was insignificant as the p-values were higher than 0.05; these factors were temperament (p=0.235), patient size (p=0.198), time (p=0.061), and assistance (p=0.729).
For the number of years qualified, the minimum number of years was 0.1 and the maximum was 38. Comparisons were made in the raw data collected a Kruskal Wallis test used to test the association between the number of years qualified and the importance score. The results revealed a significant relationship between 4 of the factors: assistance (p=0.025), ease of medication administration (p=0.000), size of the patient (p=0.012), and mobility (p=0.001).
The open comments provided support and justification to the importance ratings as well revealing further concerns associated with paraplegic and paraparetic dogs. Common suggestions for further factors to consider included access to transportation, the age of the patient and the owners’ accommodation.
Conclusion
All 13 QoL factors were considered important by the respondents in the survey. As there are many factors to consider regarding the homecare of paraplegic and paraparetic dogs, QoL discussions could provide the information needed for owners to make an informed decision about the future of their pet. As RVNs are actively involved in the care of these patients during hospitalisation, it is extremely beneficial for RVNs to be involved in this process. Following this study, further work could be completed in the form of a QoL tool specific to patients suffering with paraplegia or paraparesis.
Winner of the Presented Research Abstracts at BVNA Congress
The use of smart phones and tablets in a veterinary teaching hospital and the rate of contamination with nosocomial pathogens
Background
Personal Electronic Devices (PED) are increasing in ownership among medical and veterinary professionals. Although well documented in human medicine (Brady et al 2006, Manning et al 2013), the advantages of their role in the veterinary hospital are anecdotal. Questions also emerge regarding their potential to become nosocomial transmitters. The aim of this study was to identify PED uses in the hospital and determine the prevalence of nosocomial pathogens on their surfaces.
Methods
Fifty staff at Langford Veterinary Services, University of Bristol Teaching Hospital, were surveyed on their PED uses and device-cleaning routines. Forty-six PEDs were swabbed for bacteria. Cultured species were tested for antimicrobial resistance, phenotype and genotype by selective agar growth, disc diffusion tests and genetic sequencing.
Results
48/50 (96%) participants used their PED in the hospital and 41/48 (85%) used the device every day. There were multiple clinical and managerial PED uses reported including sending work e-mails, timing pulses, journal searching and taking photographs of cases. Staphylococci and/or Enterobacteria were found on 87% of PEDs. Vancomycin and oxacillin resistance were seen in 17/46 (37%) and 1/46 (2%) of samples respectively, including 13 vancomycin resistant, coagulase-positive staphylococci. The genotyped staphylococci appeared to be of human origin. Staff who disinfected their devices had significantly cleaner phones than those who did not (p=0.013) when data was analysed by a one-tail Fisher’s exact test.
Conclusions
PEDs are very useful in the veterinary hospital, particularly for facilitating working practices. However, they can act as fomites for bacteria resistant to antibiotics including vancomycin: an antibiotic of last resort. Using disinfectant to clean PEDs reduces colony counts and this information should be implemented when forming protocols for these devices in the hospital.
Runner Up of the Presented Research Abstracts at BVNA Congress
Comparing the level of pathogenic micro-organism colonisation on a range of fomites, before and after the introduction of a new sanitising protocol
Previous research investigating pathogen colonisation has measured the colony counts of specific species, or persistence of isolates (Delarze and Sanglard, 2015; Hirsch, et al., 2014; Bass, et al., 2013) and established how intervention with sanitising wipes may have little impact on bioburden, or indeed may transfer pathogenic micro-organisms from one target to another (Ramm, et al., 2015; Lopez, et al., 2014).
The purpose of this study was to determine the speed of appearance of pathogens of interest (PI) Escherichia coli and Pseudomonas aeruginosa on clinical scissors and mobile phones used in a veterinary hospital environment. It was anticipated that the results would reveal the optimum timescale between sanitisation interventions (SI) to keep PI at an acceptably low level within the hospital environment. The study was sanctioned by Anglia Ruskin University and the University of Cambridge and was undertaken within the Queen’s Veterinary School Hospital, University of Cambridge.
Method
The study population comprised 100+ clinical staff with a starting sample size of twenty participants, which reduced to six across the study, though unavoidable attrition. Twelve fomites (six clinical scissors and six phones) from the six final participants were aseptically swabbed for 30 seconds each, sanitised with a Clinell Universal Wipe for one minute, as prescribed by the manufacturer (GAMA Healthcare) for these PI, and then returned to normal use. With increasing intervals of 48, 72 and 96 hours between sanitisation and the next swabbing, the fomites were re-gathered, swabbed and then re-sanitised before being returned. The swabs were cultured on Müeller Hinton agar [1] in O2, CO2, and microaerophilic environments, in the hospital’s on-site laboratories. Following this, the presence of Escherichia coli and Pseudomonas aeruginosa was sought through a process of elimination, undertaking assays, also on-site, to identify and reject all non-PI species.
The first four assays carried out on all species present included sub-culturing for Gram-positive species, aerobic/facultative anaerobic testing and microscopy. This was followed by six further assays on any Gram-negative bacilli discovered, including motility and oxidase testing, morphology/micromorphology (bacilli, cocci, spirillum) and arrangement (diplo, staphylo, strepto, tetrad), to eliminate further non-PI, leaving species hopefully identifiable as the pathogens of interest. These were then statistically analysed, using a two-way classification Chi-square to test for association between the SI intervals and the presence of the above pathogens, and a Kruskal Wallis H, to identify any difference observed in the presence or not of each species at each increased timepoint.
Results
The culturing of the bacteria revealed the presence of 44 different species, initially differentiated by characterisation. The first set of eliminative assays discounted 38 species, leaving six Gram-negative or Gram-neutral bacilli. These underwent the second string of assays described above, revealing that neither Escherichia coli nor Pseudomonas aeruginosa was present. In the absence of both PI, the Kruskal Wallis H analysis instead compared colony and species counts on the final six species, from the cultures produced after each intervention; no significant difference was found, irrespective of the duration of the sanitising interval. The Chi-squared test confirmed that there was no significant difference in bacterial and species loads between the time-points.
Conclusion
The results illustrated that it was not possible to identify an optimum interval for implementing regular SI in the hospital environment; bacterial species can recolonise at any time-point, irrespective of the intervals between one SI and the next. They demonstrated that, although it is possible to introduce SI observing the manufacturer’s prescribed duration for specific micro-organisms, identifying whether this has deactivated or removed them is a task almost impossible to verify in the working environment. In comparison with laboratory-based studies wherein the deliberate introduction of chosen pathogens in prescribed amounts was undertaken, this study has shown the transfer of pathogens to be much more dynamic within the busy clinical setting.
Pathogens cannot be eliminated in environments such as veterinary hospitals; the most that might be achieved is a high level of bio-management which minimises risk of infection to patients and staff. This may be best accomplished with a multimodal approach involving hand-hygiene compliance, education and routine SI on fomites, observing the manufacturer’s recommended guidance for the chosen product.
[1] Mueller, J.H. and Hinton, J., 1941. A protein-free medium for primary isolation of the gonococcus and meningococcus. Proceedings of the Society for Experimental Biology and Medicine, 48(1), pp.330-333.