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Annals of Surgical Oncology

, Volume 26, Issue 12, pp 3883–3891 | Cite as

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

  • Frida Rivera-Buendía
  • Rafael Franco-Cendejas
  • Cristina Guadalupe Román-López
  • Claudia Adriana Colín-Castro
  • Noé Becerra-Lobato
  • María de Lourdes García-Hernández
  • Patricia Cornejo-Juárez
  • Juan Enrique Bargalló-Rocha
  • Heriberto Medina-Franco
  • Diana Vilar-CompteEmail author
Breast Oncology

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.

Notes

Acknowledgment

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.

Disclosure

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.

Supplementary material

10434_2019_7631_MOESM1_ESM.docx (98 kb)
Supplementary material 1 (DOCX 97 kb)
10434_2019_7631_MOESM2_ESM.docx (18 kb)
Supplementary material 2 (DOCX 18 kb)

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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Frida Rivera-Buendía
    • 1
    • 5
  • Rafael Franco-Cendejas
    • 2
  • Cristina Guadalupe Román-López
    • 1
  • Claudia Adriana Colín-Castro
    • 2
  • Noé Becerra-Lobato
    • 2
  • María de Lourdes García-Hernández
    • 2
  • Patricia Cornejo-Juárez
    • 1
  • Juan Enrique Bargalló-Rocha
    • 3
  • Heriberto Medina-Franco
    • 4
  • Diana Vilar-Compte
    • 1
    Email author
  1. 1.Department of Infectious DiseasesInstituto Nacional de CancerologiaMexico CityMexico
  2. 2.Infectious Diseases DivisionInstituto Nacional de Rehabilitación Luis Guillermo Ibarra IbarraMexico CityMexico
  3. 3.Breast Tumor DepartmentInstituto Nacional de CancerologiaMexico CityMexico
  4. 4.Division of SurgeryInstituto Nacional de Ciencias Médicas y NutriciónMexico CityMexico
  5. 5.MD/PhD (PECEM) Program, Facultad de MedicinaUniversidad Nacional Autónoma de MéxicoMexico CityMexico

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