Investigation into various risk factors associated with surgical site infection in large animals.

This research comprised four studies aiming to contribute to our knowledge regarding factors associated with an increased risk of developing surgical site infection (SSI) in the large animal clinical setting. \n The first study of this thesis reported the prevalence of MRSA in hospitalized horses in a referral hospital in Atlantic Canada and describes the use of surveillance and whole genome sequencing to follow an outbreak of MRSA in this veterinary teaching hospital. This was the first report of MRSA ST398 t011 in horses in North America and intercontinental spread from Europe to North America via veterinary personnel was likely the cause of the reported MRSA outbreak. This highlights that aside from animal movement, movement of veterinary personnel can pose a risk for transmission of MRSA to horses from one geographical region to another. \n The second study determined the incidence of glove perforation in large animal surgery based on water leak test (WLT) and electroconductivity testing (ECT) and identified risk factors for glove perforation. Glove perforation rates in large animal surgery appear to be comparable to those in human and in small animal studies, and ECT was more sensitive than WLT in detecting glove perforations. Factors that increase the odds of glove perforation included the duration a glove was worn, invasiveness of the procedure, and role of the wearer in the surgical procedure. \n The third study compared the ability of four surgical hand preparation techniques to reduce total aerobic bacterial counts on equine surgeon’s hands. While all four hand preparation techniques evaluated in this study were effective based on the Food and Drug Administration’s (FDA’s) Tentative Final Monograph (ASTM E-1115), use of a sole alcohol based agent was less effective than chlorhexidine (CHx) containing products providing evidence that use of CHx still has value for preparation of equine surgeon’s hands. However, the use of a brush scrub technique with CHx showed no benefit compared to rub techniques in reducing bacterial counts. \n The last study’s objective was to describe the change of microbiota on human hands during the process of hand antisepsis and surgery, and similarly, the change in microbiota of the horses’ skin over the course of surgical antisepsis and surgery. Preliminary results of this study did not identify significant changes in microbiota composition from before to after antiseptic preparation of both human and equine skin samples. Further sample processing and analysis needs to be carried out before conclusions from this study can be drawn but quantification of bacterial numbers and assessment of viability remain major challenges with next generation sequencing approaches and may warrant combined approaches of culture-dependent and independent methodologies for a more complete assessment of the effect of antiseptic methods and their efficacy. \n These studies demonstrated that investigation of factors that influence SSI in large animal surgery require a comprehensive approach and are partly limited by low surgical case load and the multifactorial nature of the etiology of SSI. This work did fill gaps in knowledge about factors that had been previously described in other species to influence the rate of SSI.

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