“For several years we have gathered data that shows that it is not always necessary,” says Hugo Schmökel.
Hugo Schmökel, Chief Veterinary Officer at Evidensia Specialistdjursjukhuset (Specialist Animal Hospital) Strömsholm. It contradicts the recommendation in the rest of the world and was something that Hugo Schmökel, diplomat ECVS and PhD, expressed doubts about when he started at the Specialist Animal Hospital.
Now that he sees it, he is as great a proponent as is Lennart Sjöström, former Chief Veterinarian at Strömsholm, and medically responsible for surgery and orthopedics, in reducing antibiotics in surgical procedures.
Hugo Schmökel, Chief Veterinary Officer at Evidensia Specialistdjursjukhuset Strömsholm.
To eliminate antibiotic prophylaxis in surgical procedures – what instead? While antibiotics are a life-saving drug, antibiotic-resistant bacteria are one of the biggest threats in the world currently: many previously good bacteria are no longer as effective in treatment, and more people die today with multiresistant bacteria than in road accidents. Reduced antibiotic use is essential if we are to reverse the development. This is the way you go at Specialistdjursjukhuset Strömsholm.
Hugo tells us that there is no evidence that antibiotics after surgery work. On the contrary, it means that the bacteria are given time to adapt the resistance due to a low dose administered orally.
However, giving antibiotics perioperatively (preoperatively and intraoperatively) intravenously while operating means that a high dose is given in a short period of time, which means that the bacteria do not develop resistance.
So a first step toward reducing antibiotic use during surgery was to eliminate postoperative prophylaxis. But at the Specialist Animal Hospital Strömsholm, one goes further:
“We try not to use antibiotics post-operatively at all. And while the worldwide recommendation is to provide perioperative antibiotics, we have collected data for several years to prove that it is not always necessary. Now we know it works without – with one exception. Instead, we focus on hygiene,” says Hugo.
The exception is hip prostheses with bone cement and TPLO / CBLO. The infection risk is greater, and if there is an infection, it can easily become a dire situation (amputation or worst case – death).
Lennart Sjöström, former chief veterinary surgeon at Evidensia Specialistdjursjukhuset Strömsholm.
Hygiene work that makes a difference
That Sweden is a precursor in terms of increasing hygiene and reducing antibiotic use, we have to thank Lennart Sjöström for. Lennart has been working at Evidensia Specialistdjursjukhuset Strömsholm for many years, and has developed the guidelines for hygiene work there. He is still working there in a consultant role.
Lennart tells us that 25 years ago he began to reflect on antibiotic-resistant bacteria and how the spread of infection between patients, staff and premises was connected:
– We took 20,000 – 30,000 bacterial samples on all surfaces – floors, door handles, computers, personnel – to identify possible contagious sites. We have never found a resistant bacterium in the environment – on the other hand, samples taken from the patients showed that they carry the infection!
– In order to prevent patient bacteria from spreading to other patients or entering their own operating wounds, we focused hard on a hygiene program that included all stages of the operation, from the first arrival for the operation through to returning home. We enforced strict rules for hand disinfection before and after every stage, and careful instructions for cleaning and disinfection. It has worked very well.
At Specialistdjursjukhuset Strömsholm, the facilities have been built to provide more space and improve hygiene. There are separate surgery rooms for different types of surgery, a completely separate part of surgery for patients with infections, and separate IVA, all working to isolate the animals as much as possible.
Furthermore, a patient never lies directly on the floor, table surface or the like, but always on the disposable materials. All personnel who handle the surgery patient have disposable gloves that are constantly changed, all keyboards are disinfected (throughly wiped with alcohol solutions every day) and much more, Hugo explains and adds:
“We have commendable staff who follow our hygiene routines – it’s important! – and they are very proud of what they do. We are privileged!”
It’s a groundbreaking job done, and Lennart says:
“I’m a little proud of this. We have done pioneering work and demonstrated that it really works. We have reduced the prophylactic use of antibiotics to near zero.”
Follow these links to the research data and results mentioned in the text: