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The American Society of Breast Surgeons.
Annals of Surgical Oncology

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Randomized Controlled Trial to Reduce Bacterial Colonization of Surgical Drains with the Use of Chlorhexidine-Coated Dressings After Breast Cancer Surgery

Frida Rivera-Buendía MD, Rafael Franco-Cendejas MD, MSc, Cristina Guadalupe Román-López MD, Claudia Adriana Colín-Castro MSc, Pharm, Noé Becerra-Lobato MSc, Biol, María de Lourdes García-Hernández BSc, Pharm, Patricia Cornejo-Juárez MD, MSc, Juan Enrique Bargalló-Rocha MD, Heriberto Medina-Franco MD, Diana Vilar-Compte MD, MSc
Breast Oncology
Volume 26, Issue 12 / November , 2019

Abstract

Background

Breast surgery is considered a clean surgery. However, surgical-site infection (SSI) rates are currently higher than predicted. Postoperative drains remain in situ for several days, with inevitable bacterial colonization and increased SSI risk.

Methods

This randomized controlled trial from October 2016 to January 2018 analyzed patients undergoing breast cancer surgery. The patients were randomized to either the standard drain care group or the antiseptic dressing group (3M® Tegaderm® CHG). Drain samples taken on postoperative days (PODs) 7 and 14 were cultured as standardized in the laboratory. Colonization rates and SSI were compared between the two groups.

Results

The study enrolled 104 patients with 167 surgical drains. The patients’ clinical characteristics were similar in the two groups, with no statistically significant differences. Bulb fluid cultures at postoperative week (POW) 1 were positive for 42.9% of the control group and 28.9% of the antiseptic group (p = 0.06). Cultures from the POW 2 assessment were positive for 79.7% of the control group versus 54.9% of the antiseptic group (p = 0.001). Cultures from drain tubes were positive for 79.8% of the control group and 50.7% of the antiseptic group (p = < 0.001). In 11 patients, an SSI developed, 3 (5.8%) from the intervention and 8 (15.4%) from the control procedure (p = 0.11).

Conclusion

The study findings demonstrated that the use of antiseptics at the drain exit site significantly reduced bacterial colonization of the closed drainage system in breast cancer surgery. Semi-permeable occlusive chlorhexidine-impregnated dressings provide an opportunity to test simple, safe, and low-cost interventions that may reduce drain bacterial colonization and SSI after breast surgery.

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