title: Evidence-based protocol for infection control in immediate implant-based breast reconstruction.
abstract: Immediate breast implant reconstruction has among the highest incidence of infections in plastic surgery. A literature search returned key articles that showed a significant decrease in surgical-site infections by performing nasal swab evaluation to treat methicillin-sensitive and methicillin-resistant Staphylococcus aureus before surgery with mupirocin nasal ointment and 5 days of chlorhexidine scrub to the surgical area. Additional Level 1 data supported the use of chlorhexidine-alcohol over povidone-iodine solutions for skin preparation. Intraoperative data on breast pocket irrigation showed the benefits of povidone-iodine as well as a triple antibiotic solution. Nasal swabs from 120 patients showed no methicillin-resistant S. aureus but did identify 10 patients with methicillin-sensitive S. aureus, 1 with streptococcus, and 3 with gram-negative rods, which changed perioperative antibiotic management. On the basis of the previously mentioned data, an evidence-based protocol for infection control was developed to potentially decrease infection rates. Further cost and efficacy data are warranted.
authors.affiliation: Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. rcraft@partners.org
authors.forename: Randall O
authors.initials: RO
authors.lastname: Craft
authors.forename: Branimir
authors.initials: B
authors.lastname: Damjanovic
authors.forename: Amy S
authors.initials: AS
authors.lastname: Colwell
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D000985:Antisepsis / Q000379:methods; D019928:Breast Implantation; D002985:Clinical Protocols; D004203:Disinfection / Q000379:methods; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008408:Mastectomy; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D019990:Perioperative Care / Q000379:methods*; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000517:prevention & control*; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D013530:Surgical Wound Infection / Q000517:prevention & control*; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents