Randomized Controlled Trial to Reduce Bacterial Colonization of Surgical Drains with the Use of Chlorhexidine-Coated Dressings After Breast Cancer Surgery
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.
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.
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).
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.
This study was partially supported with funds from the Breast Tumors Department of the Instituto Nacional de Cancerología, and from the Microbiology Laboratory of the Instituto Nacional de Rehabilitación. 3M donated the chlorhexidine gluconate-coated dressings, and Universidad Nacional Autónoma de México provided the materials for the molecular analysis. We acknowledge Drs. David Cantú and Lenny Gallardo for their valuable help in conducting the randomization of patients during the study, and Eduardo Rojas for his help during the post hoc development and recruitment of patients.
3M donated the Chlorhexidine-coated dressing (Tegaderm CHG; 3M) and was not involved in the writing of the research protocol, in the performance of the study, or in the analysis of the results. The authors declare no conflicts of interest related to this manuscript.
- 2.Instituto Nacional de Geografía y Estadística (2016). Estadísticas a propósito del día mundial de la lucha contra el cáncer de mama (19 de octubre). Retrieved 19 Oct 2018 www.inegi.org.mx/aproposito/mama0.
- 3.Arce C, Bargalló E, Villaseñor Y, Gamboa C, Lara F, Pérez Sánchez V, Villarreal P. Oncoguía: Cáncer de Mama. Cancerología. 2001;6:77–86.Google Scholar
- 8.Ruvalcaba-Limón E, Robles-Vidal C, Poitevin-Chacón A, Chávez-Macgregor M, Gamboa-Vignolle C, Vilar-Compte D. Complications after breast cancer surgery in patients treated with concomitant preoperative chemoradiation: a case-control analysis. Breast Cancer Res Treat. 2006;95:147–52.CrossRefGoogle Scholar
- 20.Roethlisberger M, Moffa G, Fisch U, Wiggli B, Schoen S, Kelly C, et al. Effectiveness of chlorhexidine dressing on silver-coated external ventricular drain-associated colonization and infection: a prospective single-blinded randomized controlled trial. Clin Infect Dis. 2018;67:1868–77.CrossRefGoogle Scholar
- 22.Barbadoro P, Marmorale C, Recanatini C, et al. May the drain be a way in for microbes in surgical infections? Am J Infect Control. 2015;1;44:283–8.Google Scholar