Randomized controlled trial to reduce bacterial colonization of surgical drains after breast and axillary operations

Amy C. Degnim, Jeffrey S. Scow, Tanya L. Hoskin, Joyce P. Miller, Margie Loprinzi, Judy C. Boughey, James W. Jakub, Alyssa Throckmorton, Robin Patel, Larry M. Baddour

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

OBJECTIVE:: To determine whether bacterial colonization of drains can be reduced by local antiseptic interventions. BACKGROUND:: Drains are a potential source of bacterial entry into surgical wounds and may contribute to surgical site infection after breast surgery. METHODS:: After institutional review board 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 (DakinÊs) solution. Culture 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 1 week were positive (1+ or greater growth) in 66% (38/58) of control drains compared with 21% (14/67) of antisepsis drains (P = 0.0001). Drain tubing cultures demonstrated more than 50 colony-forming units in 19% (8/43) of control drains versus 0% (0/53) of treated drains (P = 0.004). Surgical site infection 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 surgical site infection rate is warranted (ClinicalTrials.gov Identifier: NCT01286168).

Original languageEnglish (US)
Pages (from-to)240-247
Number of pages8
JournalAnnals of surgery
Volume258
Issue number2
DOIs
StatePublished - Aug 1 2013

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Antisepsis
Breast
Randomized Controlled Trials
Surgical Wound Infection
Local Anti-Infective Agents
Chlorhexidine
Control Groups
Simple Mastectomy
Hypochlorous Acid
Sodium Hypochlorite
Research Ethics Committees
Lymph Node Excision
Stem Cells
Alcohols
Growth

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Degnim, Amy C. ; Scow, Jeffrey S. ; Hoskin, Tanya L. ; Miller, Joyce P. ; Loprinzi, Margie ; Boughey, Judy C. ; Jakub, James W. ; Throckmorton, Alyssa ; Patel, Robin ; Baddour, Larry M. / Randomized controlled trial to reduce bacterial colonization of surgical drains after breast and axillary operations. In: Annals of surgery. 2013 ; Vol. 258, No. 2. pp. 240-247.
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title = "Randomized controlled trial to reduce bacterial colonization of surgical drains after breast and axillary operations",
abstract = "OBJECTIVE:: To determine whether bacterial colonization of drains can be reduced by local antiseptic interventions. BACKGROUND:: Drains are a potential source of bacterial entry into surgical wounds and may contribute to surgical site infection after breast surgery. METHODS:: After institutional review board 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{\^E}s) solution. Culture 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 1 week were positive (1+ or greater growth) in 66{\%} (38/58) of control drains compared with 21{\%} (14/67) of antisepsis drains (P = 0.0001). Drain tubing cultures demonstrated more than 50 colony-forming units in 19{\%} (8/43) of control drains versus 0{\%} (0/53) of treated drains (P = 0.004). Surgical site infection 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 surgical site infection rate is warranted (ClinicalTrials.gov Identifier: NCT01286168).",
author = "Degnim, {Amy C.} and Scow, {Jeffrey S.} and Hoskin, {Tanya L.} and Miller, {Joyce P.} and Margie Loprinzi and Boughey, {Judy C.} and Jakub, {James W.} and Alyssa Throckmorton and Robin Patel and Baddour, {Larry M.}",
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Degnim, AC, Scow, JS, Hoskin, TL, Miller, JP, Loprinzi, M, Boughey, JC, Jakub, JW, Throckmorton, A, Patel, R & Baddour, LM 2013, 'Randomized controlled trial to reduce bacterial colonization of surgical drains after breast and axillary operations', Annals of surgery, vol. 258, no. 2, pp. 240-247. https://doi.org/10.1097/SLA.0b013e31828c0b85

Randomized controlled trial to reduce bacterial colonization of surgical drains after breast and axillary operations. / Degnim, Amy C.; Scow, Jeffrey S.; Hoskin, Tanya L.; Miller, Joyce P.; Loprinzi, Margie; Boughey, Judy C.; Jakub, James W.; Throckmorton, Alyssa; Patel, Robin; Baddour, Larry M.

In: Annals of surgery, Vol. 258, No. 2, 01.08.2013, p. 240-247.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Randomized controlled trial to reduce bacterial colonization of surgical drains after breast and axillary operations

AU - Degnim, Amy C.

AU - Scow, Jeffrey S.

AU - Hoskin, Tanya L.

AU - Miller, Joyce P.

AU - Loprinzi, Margie

AU - Boughey, Judy C.

AU - Jakub, James W.

AU - Throckmorton, Alyssa

AU - Patel, Robin

AU - Baddour, Larry M.

PY - 2013/8/1

Y1 - 2013/8/1

N2 - OBJECTIVE:: To determine whether bacterial colonization of drains can be reduced by local antiseptic interventions. BACKGROUND:: Drains are a potential source of bacterial entry into surgical wounds and may contribute to surgical site infection after breast surgery. METHODS:: After institutional review board 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 (DakinÊs) solution. Culture 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 1 week were positive (1+ or greater growth) in 66% (38/58) of control drains compared with 21% (14/67) of antisepsis drains (P = 0.0001). Drain tubing cultures demonstrated more than 50 colony-forming units in 19% (8/43) of control drains versus 0% (0/53) of treated drains (P = 0.004). Surgical site infection 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 surgical site infection rate is warranted (ClinicalTrials.gov Identifier: NCT01286168).

AB - OBJECTIVE:: To determine whether bacterial colonization of drains can be reduced by local antiseptic interventions. BACKGROUND:: Drains are a potential source of bacterial entry into surgical wounds and may contribute to surgical site infection after breast surgery. METHODS:: After institutional review board 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 (DakinÊs) solution. Culture 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 1 week were positive (1+ or greater growth) in 66% (38/58) of control drains compared with 21% (14/67) of antisepsis drains (P = 0.0001). Drain tubing cultures demonstrated more than 50 colony-forming units in 19% (8/43) of control drains versus 0% (0/53) of treated drains (P = 0.004). Surgical site infection 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 surgical site infection rate is warranted (ClinicalTrials.gov Identifier: NCT01286168).

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