INSPECTION OF VETERINARY CLINICAL FACILITIES
Checklist for Inspections
Registration of facilities and Guidelines: Exemption from Minimum requirements
Click here to go to Application for Exemption from the Minimum standards and Application: New Facility or Moving to New Premises
The criteria for appointment of inspectors:
Must be registered as a veterinarian or veterinary specialist with the South African Veterinary Council;
Have at least five (5) years experience in private practice, which includes sufficient current clinical exposure;
Must be conversant in at least two official languages;
Must be available during normal office hours
Preferably not be involved in private practice when appointed as inspector; and
May not have any transgressions recorded against his / her name.
Members of the profession are invited to submit their applications with curriculum vitaes to Council.
UPDATES ON PILOT PROJECT
The first evaluation process took place during October and November 2000 in Pretoria. 46 principals accepted the invitation to take part in the pilot project. 92 facilities in Pretoria were registered with Council at the time of the commencement of the pilot project.
37 Facilities were evaluated in December 2000 and 22 qualified for continued registration without major deficiencies, 14 facilities were regarded as outstanding facilities, having introduced further positive measures over and above the minimum standards. Serious deficiencies were identified at 8 facilities and immediate rectification thereof was recommended. 7 Facilities required minor rectification and a period of one year was recommended in which to rectify those deficiencies.
Mainly three areas presented where serious deficiencies were identified:
The most general deficiencies related to obtainable hygiene, asepsis and sterility. The application of basic principles of asepsis, sterility and the effective removal of dirt is not always understood correctly by principals and is unfortunately not present at some of the facilities.
A surgical theatre can only function " sterile" if it forms an enclosed unit. Unsterile - and routine procedures, storing capacity and passage is unacceptable in the theatre. Rectification in this case need not entail great expense and can be done through e.g. dry wall divisions and extractor fans.
The minimum theatre attire for routine procedure are caps, masks and gloves. Theatre gowns are essential for prolonged and complicated surgical procedures such as orthopedic invasive surgery. The professional appearance at facilities is remarkably created by the formal and appropriate dress of staff. The use of an overcoat befits the veterinarian.
Council subsequently circulated a guideline in the above regard with the Newsletter. Go to Policies and Guidelines on the home page and click on "Disinfectants and Antiseptics in Veterinary Practice".
43 Veterinary clinical facilities were finally evaluated in Pretoria and the inspections went well. The overall impression was one of a positive commitment from the participating practices to attend to deficiencies identified.
To enable practices in the rest of South Africa to pro-actively address some of the repetitive deficiencies identified during the evaluation process, they are listed and advice is given to address these deficiencies.
It is required that permanent identification in the film emulsion must be present. To comply with this rule, it is necessary to make use of a so-called ID printer. Inexpensive models are now available on the open market.
Monitoring equipment to ensure safe anaesthesia
Monitoring vital signs is an integral part of the protocol for treatment of every animal subjected to general anaesthesia. Unless a practice has a specialist surgeon in house or act as a referral centre for advanced procedures, purchasing expensive monitoring equipment is not requested. Simple and reliable indicators to monitor apnoea is now available and will be required (e.g. Apalert, Vet Alarm).
Active or passive anaesthetic gas scavenging equipment
There is a potential risk to the inhalation of volatile inhalation anaesthetics. A simple solution to the problem is to connect a pipe to the pop-off valve of the anaesthetic machine that drains exhaled air out of the room (passive) into the atmosphere.
Sterilized gowns, gloves, masks, caps and drapes
Pre-operative or (even worse) post-operative antibiotics are no replacement for correct theatre procedures.
Isolation facilities for patients with contagious diseases
A separate room is preferable but not mandatory. As long as it is possible to separate animals with contagious diseases from other hospital cases, the Council will accept it. It is even acceptable to have such a facility outside the main building, but it must be protected from extreme elements and monitored regularly.
UPDATE 3 AND 4
Council invited the principals of veterinary clinical facilities to take part in the evaluation of facilities in the Johannesburg and Vaal Triangle areas. 176 Principals were invited to take part and 83 principals accepted the invitation. The inspectors is in this area are Prof. A M Lübbe and Prof. S S van den Berg. Approximately 40 facilities have been inspected. The remainder of facilities will be inspected during March 2002. Principals have been requested to comment on the inspection reports. The Pre-Advice committee will finalise the process in this area once all reports and comments are received.
Successful preparatory inspections were held in the Western Cape Province on 17 and 18 July 2002. Three of these inspections were held by Prof S S van den Berg and three held under his direction and were attended by the inspectors appointed in the Western Cape Metropolitan area Drs C P Harte, D T Longland and G C N Trace and attended on invitation by the representative of the Directorate Veterinary Services of Western Cape Province, Dr P Koen.
Inspectors commenced with the inspection of 69 veterinary clinical facilities in the Western Cape Metropolitan area in August 2002. Although a number of rural practitioners accepted the invitation to take part in the pilot project it was resolved to only inspect the rural facilities when inspections are formalised by regulation.
Principals of facilities are provided with an inspection form for self-evaluation of their facilities prior to the inspections taking place, which proved to expedite the inspection process.
UPDATE- APRIL 2003
Inspections held in the Western Cape Province
50 Inspections were held in the Western Cape Province and mainly in the Cape Town Metropolitan area; of all these facilities inspected, 13 complied with all the minimum requirements for facilities. 37 Facilities did not comply with all the minimum requirements and depending on the deficiencies, principals were given one month, three months or twelve months in which to rectify deficiencies.
Rural Large Animal Practices
Prof S S van den Berg inspected four practices during January 2003 in an attempt to ascertain whether the minimum standards were relevant and applicable for large animal practices. A full report will follow.
Inspections in the Durban Metropolitan area
Invitations were sent out to members in the Durban Metropolitan area to take part in the inspections as part of the inspection pilot project. The inspections will commence on 7 April 2003.
Protocol for Inspections
The principal is invited to participate and performs a self- evaluation;
The inspector inspects the facility and reports thereon;
The principal comments on the inspection report;
The report and comments are referred to Council as follows:
Continued registration, downgraded or de-registered;
Continued registration on condition that the shortcomings are attended to within stated time limits;
Application for exemption of certain requirements or application for extension to comply, need to be submitted. (For details visit the web page under registration forms )
The Durban inspections were held from April 2003 to September 2003.
" The inspections in the Durban Metropolitan area once again took place in amenable circumstances. I am impressed that even those principals who have been aware of the deficiencies in their facilities, volunteered for inspection of their facilities. It is under these circumstances that inspections can be justified and serve a purpose. Principals should take cognisance thereof that when they are invited to take part on voluntary inspections in future. I wish to thank all those principals for the kind and professional manner in which I was received and guided through their practices." Prof S S van den Berg
"Reaction to inspections in Durban and surrounding areas has been positive and constructive, practical cost effective solutions to deficiencies are generally welcomed. The most common deficiencies are lack of radiographic viewers in theatre, absent or inadequate scavenging of anaesthetic gases, absent or inadequate facilities for isolation and incomplete equipment for aseptic surgery (e.g. caps etc.) Proper isolation would require expensive alterations in many facilities, but the profession may be informed that the SAVC is at present satisfied with a minimum standard of isolation in one area of the ward with separate drainage to the rest of the ward."
Dr P C Ardington
RURAL FACILITIES: MAIN DEFICIENCIES IDENTIFIED June 2003
The minimum standards for rural hospitals are under review as farmers seldom take their animals to practices and there are therefore no real need for theatres for production animals. The main deficiencies identified during inspections were:
Vehicles not equipped in particular for cool storage;
Syringes not adequately sterilised and if sterilised transported in dust;
Insufficient record keeping;
Inadequate security arrangements for the practice and staff;
Animals can easily escape from the practices.
INSPECTIONS: Durban and Metropolitan area
Prof S S van den Berg
Fellow colleagues, an invitation is extended to you to contact an inspector in your area to give advice prior to the commencement of changes to your facility and/ or purchasing or building a new facility. This may assist you in saving costs and/ or avoiding pitfalls.
I wish to thank my colleagues for the warm reception that I received.
During my visit to Natal, I was pleasantly surprised with the sound and good collegial relationship amongst members of the profession, with the exception of one or two it appeared as though members worked well together. There are also active attempts to create opportunities for CPD.
Daar is aan my genoem dat van die praktyke huiwerig was om aan die loodsprojek van Durban en omgewing, deel te neem. Dit is vreemd in aggenome die positiewe ervarings in ander metropole.
The following general deficiencies were noted:
Direction boards, I am of the opinion that more direction boards can be erected to effectively indicate to the public where practices are situated. Some of the practices that were inspected were difficult to locate.
Business centres, I am not positive about practices in business centres-with exception of one practice. These are my objections:
the principal of the facility has no control over the complex;
the space is usually limited and must be subdivided with temporary materials which are not advisable for maintaining hygienic circumstances;
noise factors, whether from within the practice or from adjacent/nearby businesses (a motor vehicle workshop was adjacent to one such facility);
there are no facilities to house animals outside (everything is paved). To take animals on a leash is not ideal in an environment where there are food stores as well; and
there is usually also only one communal rest room.
I am of the opinion that facilities in business centres should be limited to consulting rooms -the pre-advice inspections committee will discuss this matter.
Crime, although only three practices visited by myself, were affected by crime, there is still not enough awareness/ alertness and practices are not well prepared to deal with criminals.
Asepsis, a lack of knowledge is still prevalent despite the guidelines issued by Council. Only a few practices could present a protocol positively. Click on policies and guidelines on the home page.
Consulting rooms, only non-invasive operations may be performed at consulting rooms provided that provision is made for a separate theatre -and that animals are not kept overnight "all in all out". A number of practices conduct advanced surgery without the required facilities. The pre-advice inspections committee will discuss this matter.
Scheduled drugs, M99 is used in three practices for small animal procedures. I have asked Dr Kenneth Joubert to comment and give advice on the use of M99 for small animal procedures.
A positive development in practices is the appointment of practice managers which result in the smooth running of practices and high standards maintained- the way to go. One principal requested review of the Act to allow partnerships with non veterinarians for example trained managers.
UPDATE NOVEMBER 2003
44 Inspections were held in the Durban Metropolitan area; of these facilities inspected, 6 complied with all the minimum requirements for facilities. 33 Facilities did not comply with all the minimum requirements and depending on the deficiencies, principals were given one month, three months or twelve months in which to rectify deficiencies. 5 Facilities were down graded to consulting rooms as they did not comply with the requirements for hospitals.
Following a request that principals be allowed to form partnerships with non veterinarians for example trained practice managers the SAVA informed Council that the status quo should remain;
Facilities that comply with the minimum standards for facilities were issued with certificates stating that the facility was inspected and complied with the minimum standards for facilities and principals are entitled to quote the remarks made by the inspectors in their inspection reports relating to their respective facilities.