title: Randomized controlled trial to reduce bacterial colonization of surgical drains after breast and axillary operations.
abstract: OBJECTIVE
  To determine whether bacterial colonization of drains can be reduced by local antiseptic interventions.
  
  
  BACKGROUND
  Drains are a potential source of bacterial entry into surgical wounds and may contribute to surgical site infection after breast surgery.
  
  
  METHODS
  After institutional review board approval, patients undergoing total mastectomy and/or axillary lymph node dissection were randomized to standard drain care (control) or drain antisepsis (treated). Standard drain care comprised twice daily cleansing with alcohol swabs. Antisepsis drain care included (1) a chlorhexidine disc at the drain exit site and (2) irrigation of the drain bulb twice daily with dilute sodium hypochlorite (Dakin's) solution. Culture results of drain fluid and tubing were compared between control and antisepsis groups.
  
  
  RESULTS
  Overall, 100 patients with 125 drains completed the study with 48 patients (58 drains) in the control group and 52 patients (67 drains) in the antisepsis group. Cultures of drain bulb fluid at 1 week were positive (1+ or greater growth) in 66% (38/58) of control drains compared with 21% (14/67) of antisepsis drains (P = 0.0001). Drain tubing cultures demonstrated more than 50 colony-forming units in 19% (8/43) of control drains versus 0% (0/53) of treated drains (P = 0.004). Surgical site infection was diagnosed in 6 patients (6%)--5 patients in the control group and 1 patient in the antisepsis group (P = 0.06).
  
  
  CONCLUSIONS
  Simple and inexpensive local antiseptic interventions with a chlorhexidine disc and hypochlorite solution reduce bacterial colonization of drains. Based on these data, further study of drain antisepsis and its potential impact on surgical site infection rate is warranted (ClinicalTrials.gov Identifier: NCT01286168).
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA. degnim.amy@mayo.edu
authors.forename: Amy C
authors.initials: AC
authors.lastname: Degnim
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Scow
authors.forename: Tanya L
authors.initials: TL
authors.lastname: Hoskin
authors.forename: Joyce P
authors.initials: JP
authors.lastname: Miller
authors.forename: Margie
authors.initials: M
authors.lastname: Loprinzi
authors.forename: Judy C
authors.initials: JC
authors.lastname: Boughey
authors.forename: James W
authors.initials: JW
authors.lastname: Jakub
authors.forename: Alyssa
authors.initials: A
authors.lastname: Throckmorton
authors.forename: Robin
authors.initials: R
authors.lastname: Patel
authors.forename: Larry M
authors.initials: LM
authors.lastname: Baddour
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D058491:Bacterial Load; D057785:Catheters / Q000009:adverse effects / Q000382:microbiology*; D002710:Chlorhexidine / Q000627:therapeutic use*; D004202:Disinfectants / Q000627:therapeutic use*; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008197:Lymph Node Excision; D008408:Mastectomy; D008875:Middle Aged; D009779:Occlusive Dressings; D011182:Postoperative Care / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D011446:Prospective Studies; D016037:Single-Blind Method; D012973:Sodium Hypochlorite / Q000627:therapeutic use*; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D004202:Disinfectants; D012973:Sodium Hypochlorite; D002710:Chlorhexidine