title: Surgical site infection (SSI) rates among patients who underwent mastectomy after the introduction of SSI prevention policies.
abstract: OBJECTIVE
  To describe the results of an intervention program to reduce the rate of surgical site infection (SSI) in the breast tumor department of a referral teaching hospital for patients with cancer.
  
  
  METHODS
  Preventive measures introduced in the Breast Tumor Department of the study hospital included the following: starting in July 2000, use of sterile technique for wound care; starting in 2001, use of closed antireflux silicone evacuation systems, use of perioperative antimicrobial prophylaxis, provision of feedback to surgeons, and remodeling of the ambulatory wound care clinic. We conducted surveillance of all patients who underwent mastectomy between February 1 and December 31, 2001, and the SSI rate was calculated. A case-control analysis was performed for risk factors known to be associated with SSI. Results were compared with the data from 2000.
  
  
  RESULTS
  The study included data on 385 surgeries. SSIs were registered in 52 (13.7%) of these 385, which was a rate 58.6% less than the 2000 infection rate (33.1%). Risk factors associated with SSI included concomitant chemotherapy and radiation therapy (OR, 3.6 [95% confidence interval {CI}, 1.9-7.1]), surgery performed during an evening shift (OR, 1.9 [95% CI, 1.1-3.6]), and insertion of a second drainage tube during the late postoperative period (OR, 2.8 [95% CI, 1.4-5.7]). The mean number (+/- SD) of postoperative visits to the outpatient wound care clinic was reduced from 11.6+/-7.1 in 2000 to 9.2+/-4.4 in 2001 (P<.001, Student's t test). The mean number of days that the evacuation systems were used was reduced from 19.0 to 16.0 days (P=.001, Student's t test).
  
  
  CONCLUSIONS
  Continuous wound surveillance, along with feedback to surgeons, use of closed antireflux evacuation systems, and standardized practices in wound and drainage-tube care, decreased by 58.6% the rate of SSI in a breast surgical department with high rates of infection.
authors.affiliation: Department of Infectious Diseases, Instituto Nacional de Cancerologia, Mexico City, Mexico. diana_vilar@yahoo.com.mx
authors.forename: Diana
authors.initials: D
authors.lastname: Vilar-Compte
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Roldán-Marín
authors.forename: Carlos
authors.initials: C
authors.lastname: Robles-Vidal
authors.forename: Patricia
authors.initials: P
authors.lastname: Volkow
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000592:standards*; D008408:Mastectomy / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D011159:Population Surveillance; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*