Evaluation Methodology | Intraoperative Lavage Strategies
Evaluation Methodology

How intraoperative lavage strategies are assessed

Activity-based microbiologic endpoints at surgical closure

This page outlines the scientific evaluation framework used to assess intraoperative lavage strategies in veterinary surgery — including how bacterial reduction at surgical closure is measured and why this endpoint is used in place of infection rates.1–3

At a glance

  • Endpoint: Residual bacterial burden at surgical closure
  • Methods: Quantitative microbiologic recovery (CFU / log reduction)
  • Models: In vitro and in vivo surgical models
  • Context: Evaluates intraoperative activity under surgical control

Why bacterial reduction is measured at closure

Surgical site infection outcomes reflect a complex interaction of perioperative, host-related, and environmental variables, including immune status, antibiotic exposure, postoperative wound care, and implant handling.4

Because these variables occur beyond the point of intraoperative intervention, infection rates alone do not isolate the activity of a lavage strategy applied during surgery.4,5

Activity-based evaluation in infection control

Standardized, activity-based assays are widely used to evaluate infection-control technologies, including surgical hand antisepsis, wound irrigation solutions, implant decontamination strategies, and sterilization systems.6–9

In these contexts, quantitative microbial reduction serves as the primary endpoint, enabling controlled, head-to-head comparison of interventions under identical conditions.6,7

The purpose of such testing is to determine relative antimicrobial activity and performance at the point of use, rather than to predict long-term clinical outcomes directly.7–9

Standardized evaluation methods

Evaluation of intraoperative lavage strategies typically incorporates defined bacterial inoculation, standardized lavage protocols, quantitative microbiologic recovery, and direct comparison under identical conditions.1,10

These methods are designed to isolate the effect of the lavage solution itself and enable meaningful comparison between strategies.1,10

Evaluation flow

[ Bacterial Inoculation ] → [ Standardized Lavage ] → [ Quantitative Recovery (CFU) ] → [ Head-to-Head Comparison ]

In vivo surgical models

Controlled in vivo surgical models are used to evaluate lavage performance under conditions that more closely reflect intraoperative use while preserving experimental control.11,12

Relationship to infection-rate trials

Important context: These studies evaluate bacterial reduction at closure using standardized microbiologic endpoints that isolate intraoperative activity under surgical control. This approach addresses a different question than infection-rate trials, which reflect multiple postoperative, environmental, and host-related variables.4,5

Application to Simini Protect Lavage

Simini Protect Lavage has been evaluated using the standardized, activity-based methodologies described above, demonstrating bacterial reduction at closure across laboratory, in vivo surgical, and clinical observational settings relevant to veterinary orthopedic surgery.10–16

Next steps

SIMINI

Evaluated using standardized microbiologic methods consistent with accepted infection-control assessment practices.

References

  1. ASTM ("American Society for Testing and Materials") International. ASTM E2799 and E3435: Standard test methods for antimicrobial activity evaluation.
  2. Donlan RM. Biofilms and device-associated infections. Emerg Infect Dis. 2001.
  3. Owens CD, Stoessel K. Surgical site infections: epidemiology, microbiology and prevention. J Hosp Infect. 2008.
  4. Mangram AJ, et al. Guideline for prevention of surgical site infection. Infect Control Hosp Epidemiol. 1999.
  5. van Walraven C, et al. Influence of postoperative variables on surgical site infection outcomes. Ann Surg. 2002.
  6. FDA. Surgical hand antiseptic drug products guidance.
  7. Rutala WA, Weber DJ. Disinfection, sterilization, and antisepsis: principles and practices. Clin Infect Dis. 2016.
  8. AAMI ST79. Comprehensive guide to steam sterilization.
  9. ASTM. Sterilization and disinfection validation standards.
  10. O’Donnell J, Wu M, Cochrane N, et al. Efficacy of common antiseptic solutions against clinically relevant planktonic microorganisms. Orthopedics. 2022.
  11. Texas Tech University. Murine surgical wound model evaluating intraoperative lavage at closure.
  12. Powell A, et al. Effect of commercially available wound irrigation solutions on uninfected host tissue in a murine model. Arthroplasty Today. 2024.
  13. Hamad C, Sheppard W, Chun R, et al. Comparing the in vitro efficacy of commonly used surgical irrigants for the treatment of implant-associated infections. J Bone Joint Surg Am. 2025.
  14. Kia C, Cusano A, Messina J, et al. Effectiveness of topical adjuvants in reducing biofilm formation on orthopedic implants. J Shoulder Elbow Surg. 2021.
  15. Seta J, et al. Efficacy of irrigation solutions on removal of Staphylococcus aureus from porous titanium implants. J Arthroplasty. 2024.
  16. Forzisi I, Vezzoni L, Bozzerla M, Vezzoni A. Use of Simini Protect Lavage as an adjuvant in revision orthopedic surgery. Vet Comp Orthop Traumatol Open. 2025.