Surveillance, control, and prevention of surgical site infections in breast cancer surgery: a 5-year experience.
BACKGROUND
We analyzed variations in surgical site infections (SSIs) during 5 years of a prospective surveillance program and investigated possible contributors to SSIs in a cohort of patients who underwent surgery for breast cancer.


METHODS
All breast surgeries performed between January 2001 and December 2005 were registered. Patients were followed-up by direct observation for at least 30 days under standardized conditions. The main outcome studied was SSI. A case-control analysis was conducted to identify SSI-associated risk factors and to evaluate SSI variations by means of a control chart.


RESULTS
During the study period, a total of 2338 breast cancer surgeries were recorded, and 441 SSIs (18.9%) were diagnosed. SSI frequency varied across the 5-year period, with a sharp decline seen after the introduction of preventive policies. After 2002, 3 out-of-confidence limits of SSIs were observed, 2 related to the use of evacuation systems and 1 associated with a group of rotating residents. Concomitant preoperative chemoradiation (odds ratio [OR]=3.47; 95% confidence interval [CI]=2.51 to 4.80), hematoma (OR=3.05; 95% CI=1.70 to 5.52), age > or = 58 years (OR=1.83; 95% CI=1.27 to 2.65), body mass index > or = 30.8 (OR=1.58; 95% CI=1.14 to 2.18), and duration of surgery > or = 160 minutes (OR=1.73; 95% CI=1.20 to 2.50) were found to be SSI-associated risk factors.


CONCLUSIONS
After 5 years of a continuous prospective surveillance program, we were able to decrease the rate of SSIs in patients undergoing breast cancer surgery (from 33.3% in 2000 to 18.9% in 2005), identify SSI-associated risk factors, and improve the quality of care delivered to these patients.
Vilar-Compte
Diana
D
Department of Infectious Diseases, National Cancer Institute, Tlalpan, Mexico. diana_vilar@yahoo.com.mx
Rosales
Samuel
S
Hernandez-Mello
Norma
N
Maafs
Eduardo
E
Volkow
Patricia
P
D000367:Age Factors; D001943:Breast Neoplasms / Q000601:surgery*; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006406:Hematoma / Q000150:complications; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000592:standards; D007396:Internship and Residency / Q000706:statistics & numerical data; D008408:Mastectomy / Q000009:adverse effects*; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D011159:Population Surveillance; D011300:Preoperative Care; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control*; D013997:Time Factors