Drain Antisepsis

To evaluate the effects of antiseptic drain care on drain colonization and infection after immediate breast reconstruction

Patients undergoing bilateral mastectomy and immediate breast reconstruction had right and left breast area randomly assigned to usual drain care or the experimental protocol. All subjects received IV antibiotics within 30 minutes of surgical incision and oral antibiotics until drains were removed. All participants and family members were instructed in drain care. The experimental procedure involved application of a chlorhexidine disc to drain sites every three days and irrigation of the drainage bulb with dilute Dakins solution (0.0125% sodium hypochlorite) twice daily. Patients were followed at post-op day (POD) 6–10 for culture of drain fluid. Drains were removed as individually appropriate, and tubing and fluid were cultured at that time. Surgical site infections were identified within 365 days of surgery.

• N = 104 patients, 208 individual surgical sites  
• MEDIAN AGE = 46 years
• AGE RANGE = 25–87
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: Patients had either breast cancer or bilateral mastectomy for cancer prevention. Over 50% had a mastectomy for risk reduction.

• SITE: Single site  
• SETTING TYPE: Multiple settings
• LOCATION: Rochester, NY

• PHASE OF CARE: Active antitumor treatment

• Single blind randomized, controlled parallel group trial

• Drain and tubing colonization defined as ≥ 50 colony-forming units
• Surgical site infection (SSI) defined as purulent drainage, positive culture from the wound, inflammation with incision opening without positive culture, or physician diagnosis of infection. SSI was determined by team consensus, who were blinded to the study group.

Drain bulb fluid colonization POD 6–10 was 9.9% with antisepsis and 20.8% with control management (p = 0.02). Drain tubing and bulb fluid colonization at removal was significantly higher in the control condition (p ≤ 0.03). At POD 30, SSI rate was 3.8% among controls and 0% with the antisepsis protocol, and at one year, SSI rate was also lower in the antisepsis group. SSI rates were not significantly different.

Drain antisepsis with chlorhexidine patch and irrigation with dilute Dakin’s solution was associated with reduced drain and drain fluid colonization, but did not produce significant differences in surgical-site infections.

• Questionable protocol fidelity
• Care was done by patients in the home, and adherence to protocol was unclear. Usual care was not described.

The procedure tested here for drain antisepsis produced less drain colonization but did not demonstrate longer term significant results to reduce surgical site infection, though infection rates were lower with the antisepsis. Further research is warranted to confirm any significant difference. Though SSI rates tend to be rather small, SSI post bilateral mastectomy and breast reconstruction can be devastating. Drain antisepsis approaches may provide an opportunity to reduce risk of postoperative surgical-site infections in which drains are used.