title: Randomized trial of drain antisepsis after mastectomy and immediate prosthetic breast reconstruction.
abstract: BACKGROUND
  In this 2-site randomized trial, we investigated the effect of antiseptic drain care on bacterial colonization of surgical drains and infection after immediate prosthetic breast reconstruction.
  
  
  METHODS
  With IRB approval, we randomized patients undergoing bilateral mastectomy and reconstruction to drain antisepsis (treatment) for one side, with standard drain care (control) for the other. Antisepsis care included both: chlorhexidine disc dressing at drain exit site(s) and irrigation of drain bulbs twice daily with dilute sodium hypochlorite solution. Cultures were obtained from bulb fluid at 1 week and at drain removal, and from the subcutaneous drain tubing at removal. Positive cultures were defined as ≥1+ growth for fluid and >50 CFU for tubing.
  
  
  RESULTS
  Cultures of drain bulb fluid at 1 week (the primary endpoint) were positive in 9.9 % of treatment sides (10 of 101) versus 20.8 % (21 of 101) of control sides (p = 0.02). Drain tubing cultures were positive in 0 treated drains versus 6.2 % (6 of 97) of control drains (p = 0.03). Surgical site infection occurred within 30 days in 0 antisepsis sides versus 3.8 % (4 of 104) of control sides (p = 0.13), and within 1 year in three of 104 (2.9 %) of antisepsis sides versus 6 of 104 (5.8 %) of control sides (p = 0.45). Clinical infection occurred within 1 year in 9.7 % (6 of 62) of colonized sides (tubing or fluid) versus 1.5 % (2 of 136) of noncolonized sides (p = 0.03).
  
  
  CONCLUSIONS
  Simple and inexpensive local antiseptic interventions with a chlorhexidine disc and hypochlorite solution reduce bacterial colonization of drains, and reduced drain colonization was associated with fewer infections.
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN, USA, degnim.amy@mayo.edu.
authors.forename: Amy C
authors.initials: AC
authors.lastname: Degnim
authors.forename: Tanya L
authors.initials: TL
authors.lastname: Hoskin
authors.forename: Rushin D
authors.initials: RD
authors.lastname: Brahmbhatt
authors.forename: Anne
authors.initials: A
authors.lastname: Warren-Peled
authors.forename: Margie
authors.initials: M
authors.lastname: Loprinzi
authors.forename: Emily S
authors.initials: ES
authors.lastname: Pavey
authors.forename: Judy C
authors.initials: JC
authors.lastname: Boughey
authors.forename: Tina J
authors.initials: TJ
authors.lastname: Hieken
authors.forename: Steven
authors.initials: S
authors.lastname: Jacobson
authors.forename: Valerie
authors.initials: V
authors.lastname: Lemaine
authors.forename: James W
authors.initials: JW
authors.lastname: Jakub
authors.forename: Chetan
authors.initials: C
authors.lastname: Irwin
authors.forename: Robert D
authors.initials: RD
authors.lastname: Foster
authors.forename: Hani
authors.initials: H
authors.lastname: Sbitany
authors.forename: Michel
authors.initials: M
authors.lastname: Saint-Cyr
authors.forename: Erin
authors.initials: E
authors.lastname: Duralde
authors.forename: Sheri
authors.initials: S
authors.lastname: Ramaker
authors.forename: Robin
authors.initials: R
authors.lastname: Chin
authors.forename: Monica
authors.initials: M
authors.lastname: Sieg
authors.forename: Melissa
authors.initials: M
authors.lastname: Wildeman
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Scow
authors.forename: Robin
authors.initials: R
authors.lastname: Patel
authors.forename: Karla
authors.initials: K
authors.lastname: Ballman
authors.forename: Larry M
authors.initials: LM
authors.lastname: Baddour
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Esserman
mesh_terms: D000328:Adult; D000368:Aged; D000985:Antisepsis; D001943:Breast Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D057785:Catheters / Q000009:adverse effects / Q000382:microbiology*; D004322:Drainage / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty; D008408:Mastectomy; D008875:Middle Aged; D009367:Neoplasm Staging; D011182:Postoperative Care; D011379:Prognosis; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control*
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