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

Amy C. Degnim, Tanya L. Hoskin, Rushin D. Brahmbhatt, Anne Warren-Peled, Margie Loprinzi, Emily S. Pavey, Judy C. Boughey, Tina J. Hieken, Steven Jacobson, Valerie Lemaine, James W. Jakub, Chetan Irwin, Robert D. Foster, Hani Sbitany, Michel Saint-Cyr, Erin Duralde, Sheri Ramaker, Robin Chin, Monica Sieg, Melissa WildemanJeffrey S. Scow, Robin Patel, Karla Ballman, Larry M. Baddour, Laura J. Esserman

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: In this 2-site randomized trial, we investigated the effect of antiseptic drain care on bacterial colonization of surgical drains and infection after immediate prosthetic breast reconstruction. Methods: With IRB approval, we randomized patients undergoing bilateral mastectomy and reconstruction to drain antisepsis (treatment) for one side, with standard drain care (control) for the other. Antisepsis care included both: chlorhexidine disc dressing at drain exit site(s) and irrigation of drain bulbs twice daily with dilute sodium hypochlorite solution. Cultures were obtained from bulb fluid at 1 week and at drain removal, and from the subcutaneous drain tubing at removal. Positive cultures were defined as ≥1+ growth for fluid and >50 CFU for tubing. Results: Cultures of drain bulb fluid at 1 week (the primary endpoint) were positive in 9.9 % of treatment sides (10 of 101) versus 20.8 % (21 of 101) of control sides (p = 0.02). Drain tubing cultures were positive in 0 treated drains versus 6.2 % (6 of 97) of control drains (p = 0.03). Surgical site infection occurred within 30 days in 0 antisepsis sides versus 3.8 % (4 of 104) of control sides (p = 0.13), and within 1 year in three of 104 (2.9 %) of antisepsis sides versus 6 of 104 (5.8 %) of control sides (p = 0.45). Clinical infection occurred within 1 year in 9.7 % (6 of 62) of colonized sides (tubing or fluid) versus 1.5 % (2 of 136) of noncolonized sides (p = 0.03). Conclusions: Simple and inexpensive local antiseptic interventions with a chlorhexidine disc and hypochlorite solution reduce bacterial colonization of drains, and reduced drain colonization was associated with fewer infections.

Original languageEnglish (US)
Pages (from-to)3240-3248
Number of pages9
JournalAnnals of Surgical Oncology
Volume21
Issue number10
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

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Antisepsis
Mammaplasty
Mastectomy
Local Anti-Infective Agents
Chlorhexidine
Infection
Hypochlorous Acid
Surgical Wound Infection
Sodium Hypochlorite
Research Ethics Committees
Bandages
Therapeutics
Growth

ASJC Scopus subject areas

  • Surgery
  • Oncology
  • Medicine(all)

Cite this

Degnim, A. C., Hoskin, T. L., Brahmbhatt, R. D., Warren-Peled, A., Loprinzi, M., Pavey, E. S., ... Esserman, L. J. (2014). Randomized Trial of Drain Antisepsis After Mastectomy and Immediate Prosthetic Breast Reconstruction. Annals of Surgical Oncology, 21(10), 3240-3248. https://doi.org/10.1245/s10434-014-3918-9

Randomized Trial of Drain Antisepsis After Mastectomy and Immediate Prosthetic Breast Reconstruction. / Degnim, Amy C.; Hoskin, Tanya L.; Brahmbhatt, Rushin D.; Warren-Peled, Anne; Loprinzi, Margie; Pavey, Emily S.; Boughey, Judy C.; Hieken, Tina J.; Jacobson, Steven; Lemaine, Valerie; Jakub, James W.; Irwin, Chetan; Foster, Robert D.; Sbitany, Hani; Saint-Cyr, Michel; Duralde, Erin; Ramaker, Sheri; Chin, Robin; Sieg, Monica; Wildeman, Melissa; Scow, Jeffrey S.; Patel, Robin; Ballman, Karla; Baddour, Larry M.; Esserman, Laura J.

In: Annals of Surgical Oncology, Vol. 21, No. 10, 01.01.2014, p. 3240-3248.

Research output: Contribution to journalArticle

Degnim, AC, Hoskin, TL, Brahmbhatt, RD, Warren-Peled, A, Loprinzi, M, Pavey, ES, Boughey, JC, Hieken, TJ, Jacobson, S, Lemaine, V, Jakub, JW, Irwin, C, Foster, RD, Sbitany, H, Saint-Cyr, M, Duralde, E, Ramaker, S, Chin, R, Sieg, M, Wildeman, M, Scow, JS, Patel, R, Ballman, K, Baddour, LM & Esserman, LJ 2014, 'Randomized Trial of Drain Antisepsis After Mastectomy and Immediate Prosthetic Breast Reconstruction', Annals of Surgical Oncology, vol. 21, no. 10, pp. 3240-3248. https://doi.org/10.1245/s10434-014-3918-9
Degnim AC, Hoskin TL, Brahmbhatt RD, Warren-Peled A, Loprinzi M, Pavey ES et al. Randomized Trial of Drain Antisepsis After Mastectomy and Immediate Prosthetic Breast Reconstruction. Annals of Surgical Oncology. 2014 Jan 1;21(10):3240-3248. https://doi.org/10.1245/s10434-014-3918-9
Degnim, Amy C. ; Hoskin, Tanya L. ; Brahmbhatt, Rushin D. ; Warren-Peled, Anne ; Loprinzi, Margie ; Pavey, Emily S. ; Boughey, Judy C. ; Hieken, Tina J. ; Jacobson, Steven ; Lemaine, Valerie ; Jakub, James W. ; Irwin, Chetan ; Foster, Robert D. ; Sbitany, Hani ; Saint-Cyr, Michel ; Duralde, Erin ; Ramaker, Sheri ; Chin, Robin ; Sieg, Monica ; Wildeman, Melissa ; Scow, Jeffrey S. ; Patel, Robin ; Ballman, Karla ; Baddour, Larry M. ; Esserman, Laura J. / Randomized Trial of Drain Antisepsis After Mastectomy and Immediate Prosthetic Breast Reconstruction. In: Annals of Surgical Oncology. 2014 ; Vol. 21, No. 10. pp. 3240-3248.
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title = "Randomized Trial of Drain Antisepsis After Mastectomy and Immediate Prosthetic Breast Reconstruction",
abstract = "Background: In this 2-site randomized trial, we investigated the effect of antiseptic drain care on bacterial colonization of surgical drains and infection after immediate prosthetic breast reconstruction. Methods: With IRB approval, we randomized patients undergoing bilateral mastectomy and reconstruction to drain antisepsis (treatment) for one side, with standard drain care (control) for the other. Antisepsis care included both: chlorhexidine disc dressing at drain exit site(s) and irrigation of drain bulbs twice daily with dilute sodium hypochlorite solution. Cultures were obtained from bulb fluid at 1 week and at drain removal, and from the subcutaneous drain tubing at removal. Positive cultures were defined as ≥1+ growth for fluid and >50 CFU for tubing. Results: Cultures of drain bulb fluid at 1 week (the primary endpoint) were positive in 9.9 {\%} of treatment sides (10 of 101) versus 20.8 {\%} (21 of 101) of control sides (p = 0.02). Drain tubing cultures were positive in 0 treated drains versus 6.2 {\%} (6 of 97) of control drains (p = 0.03). Surgical site infection occurred within 30 days in 0 antisepsis sides versus 3.8 {\%} (4 of 104) of control sides (p = 0.13), and within 1 year in three of 104 (2.9 {\%}) of antisepsis sides versus 6 of 104 (5.8 {\%}) of control sides (p = 0.45). Clinical infection occurred within 1 year in 9.7 {\%} (6 of 62) of colonized sides (tubing or fluid) versus 1.5 {\%} (2 of 136) of noncolonized sides (p = 0.03). Conclusions: Simple and inexpensive local antiseptic interventions with a chlorhexidine disc and hypochlorite solution reduce bacterial colonization of drains, and reduced drain colonization was associated with fewer infections.",
author = "Degnim, {Amy C.} and Hoskin, {Tanya L.} and Brahmbhatt, {Rushin D.} and Anne Warren-Peled and Margie Loprinzi and Pavey, {Emily S.} and Boughey, {Judy C.} and Hieken, {Tina J.} and Steven Jacobson and Valerie Lemaine and Jakub, {James W.} and Chetan Irwin and Foster, {Robert D.} and Hani Sbitany and Michel Saint-Cyr and Erin Duralde and Sheri Ramaker and Robin Chin and Monica Sieg and Melissa Wildeman and Scow, {Jeffrey S.} and Robin Patel and Karla Ballman and Baddour, {Larry M.} and Esserman, {Laura J.}",
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T1 - Randomized Trial of Drain Antisepsis After Mastectomy and Immediate Prosthetic Breast Reconstruction

AU - Degnim, Amy C.

AU - Hoskin, Tanya L.

AU - Brahmbhatt, Rushin D.

AU - Warren-Peled, Anne

AU - Loprinzi, Margie

AU - Pavey, Emily S.

AU - Boughey, Judy C.

AU - Hieken, Tina J.

AU - Jacobson, Steven

AU - Lemaine, Valerie

AU - Jakub, James W.

AU - Irwin, Chetan

AU - Foster, Robert D.

AU - Sbitany, Hani

AU - Saint-Cyr, Michel

AU - Duralde, Erin

AU - Ramaker, Sheri

AU - Chin, Robin

AU - Sieg, Monica

AU - Wildeman, Melissa

AU - Scow, Jeffrey S.

AU - Patel, Robin

AU - Ballman, Karla

AU - Baddour, Larry M.

AU - Esserman, Laura J.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Background: In this 2-site randomized trial, we investigated the effect of antiseptic drain care on bacterial colonization of surgical drains and infection after immediate prosthetic breast reconstruction. Methods: With IRB approval, we randomized patients undergoing bilateral mastectomy and reconstruction to drain antisepsis (treatment) for one side, with standard drain care (control) for the other. Antisepsis care included both: chlorhexidine disc dressing at drain exit site(s) and irrigation of drain bulbs twice daily with dilute sodium hypochlorite solution. Cultures were obtained from bulb fluid at 1 week and at drain removal, and from the subcutaneous drain tubing at removal. Positive cultures were defined as ≥1+ growth for fluid and >50 CFU for tubing. Results: Cultures of drain bulb fluid at 1 week (the primary endpoint) were positive in 9.9 % of treatment sides (10 of 101) versus 20.8 % (21 of 101) of control sides (p = 0.02). Drain tubing cultures were positive in 0 treated drains versus 6.2 % (6 of 97) of control drains (p = 0.03). Surgical site infection occurred within 30 days in 0 antisepsis sides versus 3.8 % (4 of 104) of control sides (p = 0.13), and within 1 year in three of 104 (2.9 %) of antisepsis sides versus 6 of 104 (5.8 %) of control sides (p = 0.45). Clinical infection occurred within 1 year in 9.7 % (6 of 62) of colonized sides (tubing or fluid) versus 1.5 % (2 of 136) of noncolonized sides (p = 0.03). Conclusions: Simple and inexpensive local antiseptic interventions with a chlorhexidine disc and hypochlorite solution reduce bacterial colonization of drains, and reduced drain colonization was associated with fewer infections.

AB - Background: In this 2-site randomized trial, we investigated the effect of antiseptic drain care on bacterial colonization of surgical drains and infection after immediate prosthetic breast reconstruction. Methods: With IRB approval, we randomized patients undergoing bilateral mastectomy and reconstruction to drain antisepsis (treatment) for one side, with standard drain care (control) for the other. Antisepsis care included both: chlorhexidine disc dressing at drain exit site(s) and irrigation of drain bulbs twice daily with dilute sodium hypochlorite solution. Cultures were obtained from bulb fluid at 1 week and at drain removal, and from the subcutaneous drain tubing at removal. Positive cultures were defined as ≥1+ growth for fluid and >50 CFU for tubing. Results: Cultures of drain bulb fluid at 1 week (the primary endpoint) were positive in 9.9 % of treatment sides (10 of 101) versus 20.8 % (21 of 101) of control sides (p = 0.02). Drain tubing cultures were positive in 0 treated drains versus 6.2 % (6 of 97) of control drains (p = 0.03). Surgical site infection occurred within 30 days in 0 antisepsis sides versus 3.8 % (4 of 104) of control sides (p = 0.13), and within 1 year in three of 104 (2.9 %) of antisepsis sides versus 6 of 104 (5.8 %) of control sides (p = 0.45). Clinical infection occurred within 1 year in 9.7 % (6 of 62) of colonized sides (tubing or fluid) versus 1.5 % (2 of 136) of noncolonized sides (p = 0.03). Conclusions: Simple and inexpensive local antiseptic interventions with a chlorhexidine disc and hypochlorite solution reduce bacterial colonization of drains, and reduced drain colonization was associated with fewer infections.

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