Veterinary Vertex
Veterinary Vertex is a weekly podcast that takes you behind the scenes of the clinical and research discoveries published in the Journal of the American Veterinary Medical Association (JAVMA) and the American Journal of Veterinary Research (AJVR). Tune in to learn about cutting-edge veterinary research and gain in-depth insights you won’t find anywhere else. Come away with knowledge you can put to use in your own practice – along with a healthy dose of inspiration to remind you what you love about veterinary medicine.
Veterinary Vertex
The Science of Decontaminating Subcutaneous Tissue: How Much Lavage is Enough?
Have you ever wondered exactly how much lavage solution is needed to effectively decontaminate a surgical wound? This question, so common in veterinary operating rooms, finally has an evidence-based answer.
Dr. Vanna Dickerson and veterinary student Cody Westmoreland from Texas A&M University join us to discuss their groundbreaking research on subcutaneous tissue lavage. Their study, published in the American Journal of Veterinary Research, reveals that using just 2.5 milliliters of sterile saline per centimeter of incision length can significantly reduce bacterial counts below infection-causing thresholds. This finding challenges previous assumptions and provides surgeons with a practical reference point for clinical decision-making.
The conversation explores the persistent challenge of surgical site infections, which affect 7-10% of patients following GI surgery despite our best preventive efforts. Dr. Dickerson shares her surprise at discovering that relatively modest lavage volumes produced significant bacterial reduction in their silicone model, though she suggests using approximately 10 mL per centimeter in clinical practice to account for the complexities of living tissue. Westmoreland, who brought his experience in surgical infection prevention to this veterinary student research project, discusses plans for future clinical validation studies and potential applications of artificial intelligence in wound management.
Beyond the science, we delve into the researchers' backgrounds, including Westmoreland's journey from operating room technician to veterinary student and Dr. Dickerson's collection of office dinosaurs that "make it impossible to have a bad day." Their work exemplifies how relatively simple interventions can significantly impact patient outcomes and client financial burden in veterinary practice.
Listen now to discover how this easy, inexpensive technique might improve your surgical outcomes, and don't forget to leave us a rating and review on your favorite podcast platform!
Open access article: https://doi.org/10.2460/ajvr.25.01.0030
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Speaker 2:You're listening to Veterinary Vertex, a podcast of the AVMA Journals. This episode we chat about how lavaging with at least 2.5 milliliters per centimeter of sterile saline reduces bacterial load in a subcutaneous tissue model, with our guests Vanna Dickerson and Cody Westmoreland.
Speaker 3:Welcome listeners. I'm Editor-in-Chief Lisa Fortier, and I'm joined by Associate Editor Sarah Wright. Today we have Cody and repeat guest Vanna, who I got the opportunity to meet when I was at Texas A&M a few weeks ago, joining us. Vanna and Cody, thank you so much for taking time out of your busy schedules to be here with us today. Yeah, thanks so much for having us.
Speaker 5:Thank you so much.
Speaker 2:All right, let's dive right in. So when I was rereading your article this morning, the first thing that came to mind was the solution to pollution is dilution, and I feel like that can maybe be the title for our episode today too. So your HABR article provides surgeons with a reference point for deciding what volume of lavage to use for the purposes of decontaminating a subcutaneous space. Please share with our listeners the background on this article.
Speaker 5:Yeah. So surgical site infections are a recurring challenge in postoperative management, with a relative incidence of about 7 to 10 percent following GI surgery. So while there's things we can do to reduce the risk, such as aseptic skin preparation, prophylactic antibiotics and peritoneal lavage, the subcutaneous tissue remains a potential location of contamination during GI surgery.
Speaker 2:Yeah, I think it's going to be really helpful info for our listeners. So definitely appreciate you both submitting this really important work to AJVR. So, that being said, what are some of the important take-home messages from this AJVR article?
Speaker 4:Yeah. So I think for me, I think when we have a traumatic injury and there's pus or necrotic debris kind of staring at you in the face, I think that's a helpful guide for, okay, I need to lavage and debride until everything sort of looks clean to my eye. But this kind of study came about for me just because I think when it's an incision you created, I had been asked before, well, if I'm going to lavage it, how much should I use? And I said, well, I don't really know. We have guidelines, you know something like 200 to 300 mils per keg if it's an abdomen septic or something like that, but not so much for wound or sub-Q spaces.
Speaker 4:And so for me the take-home message was really just kind of a starting point. We did find that two and a half mils per centimeter lavage decreased it at least below that 10 to the fifth per mil CFU count. That kind of historically we've said is what we worry about being at risk for infection. But we did find even more reduction in bacterial counts the higher we went, which makes sense of course. But I think for me, clinically what I'll probably use is something like 10 mils per centimeter, since probably our real patient has a lot more nuances than our little silicone model did.
Speaker 3:Really cool that you can model that too, vanna, well done. What sparked your interest in SSIs?
Speaker 5:Yeah, so for me. I'm currently a vet student, but prior to starting my veterinary education, I worked in the operating room here at Texas A&M and my entire role there was helping the surgeons to help minimize the surgical site infection risk to the best of our abilities. And having developed that relationship with surgical site infection prevention and with my current aspirations of pursuing surgery, it only felt right that my project for the veterinary medical scientist research training program that occurs during the summer months here at A&M just had to involve surgical site infections.
Speaker 3:Glad you mentioned that, Cody. I forgot you're a vet student. That's super cool, Well done. You talked earlier about what the maybe some of the most important findings of the article, but always when we do these things, we're surprised, which then leads to more articles and more hypotheses. What were some of the most surprising findings from this article?
Speaker 4:Yeah, I was surprised that the two and a half mil per centimeter took our bacterial counts below 10 to the fifth. I really thought that was going to be kind of a baby volume that didn't really quite get it and that we would need higher. So that was surprising to me. I think we talk about a lot in the article and kind of already mentioned it. I think bacterial adherence to these silicone models is not the same as a live animal sub-Q, so that's probably part of it. Same as a live animal subqueue, so that's probably part of it. And certainly there are probably more crevices than you know we had in our model. So I think still again, probably I would be reaching for a little bit more, but that did surprise me.
Speaker 2:So what are the next steps for research in this topic?
Speaker 5:The next immediate step to this project would be validating our model to actual clinical cases. While we believe the trend in reduction with the lavage volumes used in our model can be used to guide clinical decisions on lavage, further investigation is definitely needed to evaluate for these differences. We started with the model because, given the relatively low incidence of surgical site infections after GI surgery at our institution, over 300 clinical cases will have to be required to adequately power such a study.
Speaker 3:Sounds like a multicenter study to me. Cody, I've seen your project in your future.
Speaker 4:Residency project Right there you go.
Speaker 3:Cody, I don't know if you have this experience in your experience as a technician as well, but we have a manuscript in JAVMA that also shows that the vast majority of people, whoever is doing the scrubbing, don't scrub for the recommended amount of time. It's pretty fascinating. An observer they didn't know they were being observed actually timed it. You thought you were scrubbing for the 10 minutes, but it was five or four or seven or eight or whatever it is. So that would be an interesting factor in your next step of research in this area.
Speaker 5:Yeah, that's a very interesting thought how to definitely consider that going forward.
Speaker 2:Yeah, I can send you the article, Cody, after this. It's definitely really interesting. Got a lot of attention on social media as well, so happy to pass that along. So before we start, I was just chatting with Savannah. Actually, how is volunteering at the AI Headshot Lounge at AVMED convention this year? So AI is definitely at the forefront of my mind, driven immersing it for the weekend. So do you see a?
Speaker 4:role for AI in this area of research at all in the future.
Speaker 4:Yeah, I think I thought a lot about this.
Speaker 4:I've been always letting my student or house officer pick which questions they want to answer and they always give me this one. I don't know why, but I think two areas. I mean I'm actually working with our biomedical engineering group here at A&M right now on what they're ultimately hoping will be a machine learning system where you can image, for example, a wound and use data from that to have this machine tell you I think this wound is going to heal in two weeks, or I think X is wrong with the phase of wound healing. So I think that's one area that we potentially could see this. And I think the other thing that could be useful is, especially for a particular practice. It probably would be relatively simple to set up a system where you, you know, kind of say, okay, I had a surgical site infection in these 10 cases this year and use sort of an AI system to look at all of the kind of different variables, to look for patterns. I think those are kind of two areas that I could see it becoming useful for infections.
Speaker 2:For those of you just joining us, we're discussing decontaminating subcutaneous tissues and linear surgical wounds with our guests Vanna and Cody.
Speaker 3:Hey, cody, even though you're a veterinary student, you have a lot of training, and how did that help you to prepare to write this article?
Speaker 5:Yeah, so my undergraduate degree was in biomedical sciences, but also, like I mentioned, for this project, I participated in the Veterinary Medical Scientist Research Training Program, which is a 13-week-long program during the summer here at A&M, and this program held weekly seminars and topics like scientific writing and statistics, which really aided me when I was first writing this article, and, of course, I couldn't have done it without my mentor, dr Dickerson.
Speaker 4:Yeah, I'll add. I think most of the vet schools run a VMS RTT, so if there's anybody listening that you know maybe is a vet student and potentially interested in research, it's a great opportunity, very cool.
Speaker 2:We love to see veterinary students' names in our journals. And, Cody, have you heard of our journal awards? I know I think Vanna has.
Speaker 5:I have yes.
Speaker 2:Awesome, very cool, very cool, great. See, the word is spreading. So for those of you listeners that maybe don't know, we do give awards to students and house officers as well for articles that are published in our journals. So we take rolling nominations they close in March every year and then our judging panel looks at the articles and then we select winners. So very cool. So now we got to move on to the fun part, I think, of this episode.
Speaker 4:As you know, van, I get this question a lot. This is a very important question for our listeners. What for things like packing off the GI before you cut into it, changing gloves, changing instruments for closure? But at least for me it makes me feel a lot better that it's kind of one more step that we can do to hopefully prevent surgical site infections that's not giving systemic antibiotics. So I think that's my takeaway from this. That I think is important is this is an easy thing that you can do. It's cheap, quick, so something you can add to a repertoire to hopefully decrease your surgical site incidents.
Speaker 2:And on the other side of the relationship, what's one thing clients should know about this topic.
Speaker 5:Yeah. So while we cannot cannot predict or prevent the risk of surgical site infections entirely, our hope is that utilizing lavage on the subcutaneous tissues will help mitigate this risk further. Not only can this improve outcomes for our post-operative patients, but it should also ease the financial burden these complications can have on our clients.
Speaker 3:Hey, cody, while we have you and this will date you, maybe we're always surprised. What was the first concert you attended?
Speaker 5:In 2008,. I went to the Houston Life's Lock Show and Rodeo and I was forced to go to this concert with my sister, but it was the Hannah Montana concert.
Speaker 3:I don't think we've gotten that answer?
Speaker 2:Have we Sarah? No, we haven't. But, cody, mine was Justin Bieber, like baby JD, like just starting out, like middle school, yeah, so that's a fun one.
Speaker 3:That's awesome. And Vanna, for you. What's the oldest or the most interesting item on your desk or in your desk drawer?
Speaker 4:Yeah, so I have a lot of random things in my office and on my desk, but I think probably the most interesting are my bajillion dinosaurs, because you just like can't have a bad day if you look up and see a dinosaur, you've got to smile. So I have probably like five or six or more in my office.
Speaker 3:That's awesome. We haven't gotten that answer either.
Speaker 2:See, these are fun. So you know we can do the video and we can actually see, like, what's on your desk. I think that's really cool for our listeners and viewers. Well, just thank you both so much for being here today and for also contributing your work to AJBR.
Speaker 4:Yeah, thanks for having us again.
Speaker 5:Yeah, thank you so much.
Speaker 2:And to our listeners. You can read Vanette Cody's article on AJBR. I'm Sarah Wright at Lisa Fortier. Be on the lookout for next week's episode and don't forget to leave us a rating and review on Apple Podcasts or whatever platform you listen to.
