Randomized Controlled Trial to Reduce Bacterial Colonization of Surgical Drains After Breast and Axillary Operations

Abstract

Objective To determine if bacterial colonization of drains can be reduced by local antiseptic interventions. Summary Background Drains are a potential source of bacterial entry into surgical wounds and may contribute to surgical site infection (SSI) after breast surgery. Methods Following IRB approval, patients undergoing total mastectomy and/or axillary lymph node dissection were randomized to standard drain care (control) or drain antisepsis (treated). Standard drain care comprised twice daily cleansing with alcohol swabs. Antisepsis drain care included 1) a chlorhexidine disc at the drain exit site and 2) irrigation of the drain bulb twice daily with dilute sodium hypochlorite (Dakin’s) solution. Cultures results of drain fluid and tubing were compared between control and antisepsis groups. Results Overall, 100 patients with 125 drains completed the study with 48 patients (58 drains) in the control group and 52 patients (67 drains) in the antisepsis group. Cultures of drain bulb fluid at one week were positive (1+ or greater growth) in 66% (38/58) of control drains compared to 21% of antisepsis drains (14/67), (p=0.0001). Drain tubing cultures demonstrated >50 CFU in 19% (8/43) of control drains versus 0% (0/53) of treated drains (p=0.004). SSI was diagnosed in 6 patients (6%) - 5 patients in the control group and 1 patient in the antisepsis group (p=0.06). Conclusions Simple and inexpensive local antiseptic interventions with a chlorhexidine disc and hypochlorite solution reduce bacterial colonization of drains. Based on these data, further study of drain antisepsis and its potential impact on SSI rate is warranted.

Randomized Trial of Drain Antisepsis After Mastectomy and Immediate Prosthetic Breast Reconstruction

“…Drain care instructions are previously described, with antisepsis measures including a chlorhexidine disc- Biopatch® (Ethicon, Inc., Somerville, NJ) application to drain sites every three days and twice daily irrigation of the drainage bulb with dilute Dakin's solution. 8 Dakin's concentration was 0.0125% buffered sodium hypochlorite for the first 44 subjects and commercially available 0.125% for the remaining 60 subjects due to ease in procurement. All drains on a surgical side were treated per assigned study arm.…”

“…On the day of drain removal, both subcutaneous drain tubing and bulb fluid were obtained aseptically for cultures, as previously described. 8 Clinical infections were treated per routine clinical care. Information on late infections was captured with medical record review and telephone follow-up at one year.…”

“…8 Growth in bulb fluid was reported as: negative, broth only, or plate growth of 1+, 2+, 3+, 4+. Drain tubing isolates were reported semiquantitatively in colony forming units (CFU) as: <10, 10–19, 20–50, 51–100 or >100.…”

“…8 In that study, women undergoing immediate breast reconstruction were excluded due to common utilization of prolonged postoperative antibiotics, which might impact bacterial colonization in drains. Considering the risk of implant loss associated with SSI, we performed a prospective, surgeon-blinded, randomized controlled trial to assess effects of simple local antisepsis measures on bacterial colonization of drains and SSI after mastectomy with immediate prosthetic breast reconstruction.…”

Evidence-Based Strategies to Reduce Postoperative Complications in Plastic Surgery

“…Those patches have been shown to be effective at reducing infections related to vascular and epidural catheters, 115 and at minimizing contamination of closed-suction drains in breast surgery. 116 There is little clinical evidence, however, that they reduce the risk of surgical-site infections in plastic surgery, specifically when prosthetic implants are used. 117…”