Recommendations for hygiene management in small animal practices

Titelblatt, Inhalt, Abbildungs-, Tabellen- und Abkürzungsverzeichnis 1\. Einleitung und Zielsetzung 2\. Nosokomiale Infektionen 3\. Literaturauswertung zur Hygiene in Kleintierpraxen 3.1. Baulich-funktionelle Anforderungen 3.2. Reinigung und Desinfektion von Räumen und Oberflächen 3.3. Aufbereitung von Medizinprodukten 3.4. Händehygiene 3.5. Operationsvorbereitung des Patienten 3.6. Operationsvorbereitung des Personals 3.7. Hygienemassnahmen während der Operation 3.8. Perioperative Antibiotikaprophylaxe 3.9. Hygiene bei diagnostischen und therapeutischen Massnahmen 3.10. Abfallbeseitigung 4\. Empfehlungen für das Hygienemanagement in Kleintierpraxen 5\. Zusammenfassung 6\. Summary 7\. Literaturverzeichnis 8\. Anlage Hygienepläne Danksagung SelbständigkeitserklärungHygienemaßnahmen stellen einen wichtigen Bestandteil der Qualitätssicherung in der tierärztlichen Praxis dar. Durch die Beachtung hygienischer Vorschriften und Empfehlungen soll das Auftreten nosokomialer Infektionen verhindert, aber auch dem Arbeitsschutz der Mitarbeiter Rechnung getragen werden. Die in der Human- und in der Veterinärmedizin gegebenen Empfehlungen zum Hygienemanagement sind oft unterschiedlich und zum Teil sogar widersprüchlich. Des Weiteren gibt es in den bestehenden veterinärmedizinischen Kleintierpraxen große Unterschiede bezüglich der Ausstattungen, baulich-funktionellen Gegebenheiten und der angewendeten Hygienemaßnahmen. Eine Annäherung an die Hygienestandards humanmedizinischer Kliniken ist anzustreben. Ziel der Arbeit ist es, den Wissensstand in der Human- und Veterinärmedizin durch eine Literaturrecherche zusammenzutragen und Empfehlungen für das Hygienemanagement in Kleintierpraxen abzuleiten. Damit soll auch ein Beitrag zur Konkretisierung und Umsetzung des Kodex Gute Veterinärmedizinische Praxis geleistet werden. Um die zumeist auf dem Gebiet der Krankenhaushygiene gegebenen Empfehlungen mit den Gegebenheiten in Kleintierpraxen zu vergleichen, werden hygienisch relevante Bereiche definiert und die Prozesse einer Kleintierpraxis in einzelne Arbeitsschritte gegliedert. Unter Berücksichtigung der wichtigsten Übertragungswege von Krankheitserregern und der Tatsache, dass nosokomiale Infektionen vor allem chirurgische Patienten betreffen, stellt der operative Bereich mit den entsprechenden Vor- und Nachbereitungen einen Schwerpunkt dar. Für die hygienerelevanten Bereiche und Prozesse werden Empfehlungen und Forderungen im humanmedizinischen und veterinärmedizinischen Schrifttum gegenübergestellt und ausführlich unter dem Aspekt der Anwendung in Kleintierpraxen diskutiert. Dabei finden auch die geltenden gesetzlichen Vorschriften Berücksichtigung. Bei der Beschreibung der einzelnen Bereichen und Prozesse finden folgende Aspekte besondere Berücksichtigung: \- Bei den baulich-funktionellen Anforderungen werden Boden- und Wandbeläge im Warte-, Behandlungs- und Operationsraum betrachtet. Die Notwendigkeit von Wasch- vorrichtungen, Schleusen, raumlufttechnische Anlagen sowie von septischen und aseptischen Operationseinheiten wird diskutiert. \- Für die Reinigung und Desinfektion von Oberflächen und Räumen werden verschiedene Verfahren sowie deren Hilfsmittel beschrieben. Es wird dargestellt, in welchen Intervallen die verschiedenen Oberflächen und Räume einer Praxis zu reinigen bzw. zu desinfizieren sind. \- Für die Aufbereitung von Medizinprodukten wird der Weg kontaminierter Instrumente von der Entsorgung über die Reinigung und Desinfektion bis hin zur Verpackung und Sterilisation aufgezeigt. Dabei wird auf die unterschiedlichen, in der Praxis gängigen, Verfahren eingegangen. \- Bei der Händehygiene wird die Vorgehensweise beim Händewaschen sowie bei der hygienischen und chirurgischen Händedesinfektion betrachtet und auf die Indikationen für die einzelnen Maßnahmen hingewiesen. Auch die Nutzung von Schutzhand-schuhen wird diskutiert. \- Bei der Operationsvorbereitung des Patienten zur Bereitung eines aseptischen Operationsfeldes wird auf die Haarentfernung, die Hautreinigung und desinfektion sowie die Abdeckung des Operationsfeldes näher eingegangen. \- Bei der Operationsvorbereitung des Personals stehen das Anlegen von Bereichskleidung, Atemmaske, Kopfhaube, sterilem Kittel und sterilen Handschuhen im Mittelpunkt. \- Es werden auch hygienische Aspekte während der Operationsdurchführung, vor allem Verhaltensregeln für das Operationsteam und der Austausch kontaminierter Instrumente und Kleidung, erörtert. \- Für eine perioperative Antibiotikaprophylaxe werden Indikationen sowie die Auswahl, Applikationsart und -zeitpunkt des Antibiotikums diskutiert. \- Für die Durchführung diagnostischer und therapeutischer Maßnahmen werden hygienische Vorkehrungen bei Injektionen und Punktionen sowie beim Umgang mit Infusionssystemen, Venenkathetern, Blasenkathetern und Injektionsflüssigkeiten beschrieben. \- Abschließend wird auf die Abfallbeseitigung eingegangen. Abschließend werden Empfehlungen und Hygienepläne für die Mitarbeiter einer Kleintierpraxis erstellt.Hygiene measures represent an important part of quality management in a veterinary practice. Following obedience of hygiene regulations and recommendations shall prevent the incidence of nosocomial infections but also ensure safety and health of employees. The recommendations given in the human and veterinary medical literature often vary and sometimes are even contradictory. Furthermore there are great differences concerning the equipment, the structural and functional conditions and the used hygiene measures in existing small animal practices. An approach to the hygiene standards of human medical hospitals is desirable. The aim of this dissertation is to collect the knowledge in human and veterinary medical literature and to work out recommendations for the hygiene management in small animal practices. With this a contribution is supposed to be made to concrete and implement the codex Good Veterinary Practice (GVP) . To compare the recommendations especially given in literature on human sanitary in hospitals with the conditions in small animal practices, hygienic relevant areas are defined and the processes of a veterinary practice are structured into single work steps. According to the most important ways of communications and regarding the fact that nosocomial infections mostly concern surgical patients, the surgical field including its preparations and postprocessings constitute a main focus. Focussing the employment in small animal practices the recommendations and demands of the hygienic relevant areas and processes given in literature on human medical and veterinary medical are compared with each other and discussed in detail. Besides, attention is paid to actual legal regulations. The description of each single area and process takes account especially the following aspects: \- The chapter about structural and functional requirements treats floor and wall covering of waiting, treatment and operating room. The necessity of hand washing facilities, zoning and air condition systems as well as of septic and aseptic operation units is discussed. \- For cleaning and disinfection of rooms and surfaces different procedures with their used tools are described. The required intervals of cleaning and disinfection are presented. \- For preparation of medical products the way of contaminated instruments is followed from collection over cleaning and disinfection to wrapping and sterilisation. It is given attention to the different common methods used in practices. \- The chapter about cleaning and disinfection of hands points out the proceeding of hand washing, sanitary and surgical hand disinfection and the indications for each single procedure. Also the use of safety gloves is discussed. \- Preoperative hygiene measures of patients aim to prepare an aseptic operation area. So removal of hair, cleaning and disinfection of skin as well as draping of the operation area are presented in detail. \- The preparation of the surgical team focuses on surgical attire, masks, hair coverings, gowning and gloving. \- Further hygienic aspects during an operation are debated, above all rules of conduct for the surgical team and the exchange of contaminated instruments and attire. \- For perioperative prophylactic use of antibiotics indications and selection as well as form and time of application are discussed. \- For diagnostic and therapeutic treatments hygiene measures are described for injections and punctures as well as for handling of infusion systems, venous catheters, urinary catheters and injection fluids. \- At last attention is given to the waste disposal. In the end recommendations and hygiene plans for the employees of small animal practices are worked out

Signal and response properties indicate an optoacoustic effect underlying the intra-cochlear laser-optical stimulation

Optical cochlea stimulation is under investigation as a potential alternative to conventional electric cochlea implants in treatment of sensorineural hearing loss. If direct optical stimulation of spiral ganglion neurons (SGNs) would be feasible, a smaller stimulation volume and, therefore, an improved frequency resolution could be achieved. However, it is unclear whether the mechanism of optical stimulation is based on direct neuronal stimulation or on optoacoustics. Animal studies on hearing vs. deafened guinea pigs already identified the optoacoustic effect as potential mechanism for intra-cochlear optical stimulation. In order to characterize the optoacoustic stimulus more thoroughly the acoustic signal along the beam path of a pulsed laser in water was quantified and compared to the neuronal response properties of hearing guinea pigs stimulated with the same laser parameters. Two pulsed laser systems were used for analyzing the influence of variable pulse duration, pulse energy, pulse peak power and absorption coefficient. Preliminary results of the experiments in water and in vivo suggesta similar dependency of response signals on the applied laser parameters: Both datasets show an onset and offset signal at the beginning and the end of the laser pulse. Further, the resulting signal amplitude depends on the pulse peak power as well as the temporal development of the applied laser pulse. The data indicates the maximum of the first derivative of power as the decisive factor. In conclusion our findings strengthen the hypothesis of optoacoustics as the underlying mechanism for optical stimulation of the cochlea. © SPIE 201

The multimodal Munich Clinical Deep Phenotyping study to bridge the translational gap in severe mental illness treatment research

Introduction: Treatment of severe mental illness (SMI) symptoms, especially negative symptoms and cognitive dysfunction in schizophrenia, remains a major unmet need. There is good evidence that SMIs have a strong genetic background and are characterized by multiple biological alterations, including disturbed brain circuits and connectivity, dysregulated neuronal excitation-inhibition, disturbed dopaminergic and glutamatergic pathways, and partially dysregulated inflammatory processes. The ways in which the dysregulated signaling pathways are interconnected remains largely unknown, in part because well-characterized clinical studies on comprehensive biomaterial are lacking. Furthermore, the development of drugs to treat SMIs such as schizophrenia is limited by the use of operationalized symptom-based clusters for diagnosis. Methods: In line with the Research Domain Criteria initiative, the Clinical Deep Phenotyping (CDP) study is using a multimodal approach to reveal the neurobiological underpinnings of clinically relevant schizophrenia subgroups by performing broad transdiagnostic clinical characterization with standardized neurocognitive assessments, multimodal neuroimaging, electrophysiological assessments, retinal investigations, and omics-based analyzes of blood and cerebrospinal fluid. Moreover, to bridge the translational gap in biological psychiatry the study includes in vitro investigations on human-induced pluripotent stem cells, which are available from a subset of participants. Results: Here, we report on the feasibility of this multimodal approach, which has been successfully initiated in the first participants in the CDP cohort; to date, the cohort comprises over 194 individuals with SMI and 187 age and gender matched healthy controls. In addition, we describe the applied research modalities and study objectives. Discussion: The identification of cross-diagnostic and diagnosis-specific biotype-informed subgroups of patients and the translational dissection of those subgroups may help to pave the way toward precision medicine with artificial intelligence-supported tailored interventions and treatment. This aim is particularly important in psychiatry, a field where innovation is urgently needed because specific symptom domains, such as negative symptoms and cognitive dysfunction, and treatment-resistant symptoms in general are still difficult to treat

Intracochlear near infrared stimulation: Feasibility of optoacoustic stimulation in vivo

Intracochlear optical stimulation has been suggested as an alternative approach to hearing prosthetics in recent years. This study investigated the properties of a near infrared laser (NIR) induced optoacoustic effect. Pressure recordings were performed at the external meatus of anaesthetized guinea pigs during intracochlear NIR stimulation. The sound pressure and power spectra were determined. The results were compared to multi unit responses in the inferior colliculus (IC). Additionally, the responses to NIR stimulation were compared to IC responses induced by intracochlear electric stimulation at the same cochlear position to investigate a potentially confounding contribution of direct neural NIR stimulation. The power spectra of the sound recorded at the external meatus (n = 7) had most power at frequencies below 10 kHz and showed little variation for different stimulation sites. The mean spike rates of IC units responding to intracochlear NIR stimulation (n = 222) of 17 animals were significantly correlated with the power of the externally recorded signal at frequencies corresponding to the best frequencies of the IC units. The response strength as well as the sound pressure at the external meatus depended on the pulse peak power of the optical stimulus. The sound pressure recorded at the external meatus reached levels above 70 dB SPL peak equivalent. In hearing animals a cochlear activation apical to the location of the fiber was found. The absence of any NIR responses after pharmacologically deafening and the comparison to electric stimulation at the NIR stimulation site revealed no indication of a confounding direct neural NIR stimulation. Intracochlear optoacoustic stimulation might become useful in combined electro-acoustic stimulation devices in the future

Effects of cavitation bubble interaction with temporally separated fs-laser pulses

We present a time-resolved photographic analysis of the pulse-to-pulse interaction. In particular, we studied the influence of the cavitation bubble induced by a fs-pulse on the optical focusing of the consecutive pulse and its cavitation bubble dynamics in dependence on temporal pulse separation in water. As a first result, by decreasing the temporal separation of laser pulses, there is a diminishment of the laser-induced optical breakdown (LIOB) efficiency in terms of energy conversion, caused by disturbed focusing into persisting gas bubbles at the focal volume. A LIOB at the focal spot is finally suppressed by impinging the expanding or collapsing cavitation bubble of the preceding pulse. These results could be additionally confirmed in porcine gelatin solution with various concentrations. Hence, the interaction between the laser and transparent ophthalmic tissue may be accompanied by a raised central laser energy transmission, which could be observed in case of a temporal pulse overlap. In conclusion, our experimental results are of particular importance for the optimization of the prospective ophthalmic surgical process with future generation fs-lasers