Antiseptic interventions reduce bacterial colonization of surgical drains

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1. Surgical drains not treated with antisepsis had significantly more positive 1-week drain fluid cultures.

2. Though not significant, there was a trend towards lower infection rates in patients receiving antiseptic drain care.

Study Rundown: The findings in this study provide strong evidence that local, inexpensive antiseptic regimens for surgical drains decrease bacterial colonization.  The data also suggest, with caution, that the decrease in bacterial colonization decreases the risk of surgical site infection.  The decrease in the rate of surgical site infections did not reach statistical significance because the study was not powered for that endpoint, but with a p=0.06, it is certainly suggestive.  The authors included the patient from the treatment group with an infection, despite developing it outside of the usual 30-day surgical site infection consideration period.  All other infections happened before 20 days post-operatively, and had the treatment group infection been left out, this infection rate decrease would have been significant.  Strengths of this study include the randomization of treatment and the blinding of the surgeons evaluating for infection.  Nonetheless, some patients with an infection had negative drain cultures, and vice versa.  Therefore, without the power to detect significance in the decrease of infection rate, the significant decrease in bacterial colonization cannot be definitively proven to decrease infection in this situation.  Further study is necessary.

Click to read the study in Annals of Surgery

In Depth [randomized, controlled study]: The present study divided 100 patients undergoing mastectomy and/or axillary lymph node dissection to antisepsis and control groups.  Overall, 125 surgical drains were placed, 58 drains in the control group and 67 in the antisepsis group.  The control group underwent alcohol swab cleaning of the drain exit sites twice a day, whereas the antisepsis group was treated using a chlorhexidine disc at the exit site and bulb irrigation with dilute sodium hypochlorite solution twice daily.  Surgeons were blinded to the patient’s drain regimen by having study coordinators remove all dressing materials before surgeon evaluations.  Drain tubing cultures taken at 1 week post-operatively showed 66% infection rate in control group and 21% in the antisepsis group (p=0.0001).  6 surgical site infections occurred, 5 in the control group and 1 in the antisepsis (p=0.06).  

By David Mattos and Allen Ho

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