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Determinants of Clean Surgical Wound Infections for Breast Procedures at an Oncology Center

Published online by Cambridge University Press:  21 June 2016

Coleman Rotstein ,
Richard Ferguson ,
K. Michael Cummings ,
Marion R. Piedmonte ,
Joyce Lucey  and
Anne Banish
Coleman Rotstein*
Affiliation:
Department of Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
Richard Ferguson
Affiliation:
Department of Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
K. Michael Cummings
Affiliation:
Cancer Control and Epidemiology, Cleveland Clinic Foundation, Cleveland, Ohio
Marion R. Piedmonte
Affiliation:
Roswell Park Cancer Institute, Buffalo, New York, Biostatistics and Epidemiology, Cleveland Clinic Foundation, Cleveland, Ohio
Joyce Lucey
Affiliation:
Laboratory Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
Anne Banish
Affiliation:
Laboratory Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
*
McMaster Medical Unit, Henderson General Hospital, 711 Concession St., Hamilton, Ontario L8V 1C3, Canada
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Abstract

Objective:

To determine the clean surgical wound infection rate for breast procedures and the risk factors predisposing patients to these infections.

Design:

A survey study.

Setting:

Oncology center.

Patients:

A consecutive sample of adult female patients who underwent surgical breast procedures for suspected carcinoma of the breast. Patients undergoing excisional biopsy, lumpectomy, or mastectomy from January 1985 to January 1987 were included in the study.

Intervention:

Clean surgical wound infection rates were derived overall and for each procedure type. The medical records of all patients were then reviewed to extract data on patient characteristics and operative information in order to assess the risk factors for infection.

Results:

Among the breast procedures performed on 448 patients, the overall clean surgical wound infection rate was 8.7% (39/448). The clean surgical wound infection rate for each procedure type was as follows: biopsy 2.3%, lumpectomy 6.6%, and mastectomy 19%. In addition to the type of procedure, factors significantly (p< .05) associated with the development of clean surgical wound infection in the univariate analysis included: presence of surgical drains (p<.01); closed suction drainage (odds ratio [OR] = 16.5, 95% confidence interval [CI95] = 5.0-54.7); location of the drain (OR = 3.3, CI95= 1.7-6.6); prolonged preoperative stay (OR= 1.2, CI,, = 1.0-1.5); length of surgery (OR=2.2, CI95= 1.7-3.0); and greater mean age (OR= 1.6, CI,, = 1.2-2.1).

Conclusion:

Clean surgical wound infections are not uncommon in patients undergoing breast procedures. Factors relating to both the patient and operative techniques contribute to the clean surgical wound infection rate. Further consideration should be given to perioperative antibiotic prophylaxis for selected breast procedures, and the role of surgical drains should be reassessed.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 13 , Issue 4 , April 1992 , pp. 207 - 214
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1992

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References

1. Horan, TC, White, JW, Jarvis, WR, et al. 1984: nosocomial infection surveillance. MMWR. 1986;35 (1SS):17SS—29SS.Google ScholarPubMed
2. Olson, M, O'Connor, M, Schwartz, ML. Surgical wound infections: a 5-year prospective study of 20,193 wounds at the Minneapolis VA Medical Center. Ann Surg. 1984;199:253–259.CrossRefGoogle Scholar
3. Cruse, PJE. Foord, R. The epidemiology of wound infection: a 10-year prospective study of 62,939 wounds. Surg Clin North Am. 1980;60:27–40.CrossRefGoogle Scholar
4. Rotstein, C, Cummings, KM, Nicolaou, AL, Lucey, J, Fitzpatrick, J. Nosocomial infection rates at an oncology center. Infect Control Hosp Epidemiol. 1988;9:13–19.CrossRefGoogle ScholarPubMed
5. Woolf, B. On estimating the relationship between blood group and disease. Ann Hum Genet. 1955;19:251–253.CrossRefGoogle Scholar
6. Say, CC, Donegan, W. A biostatistical evaluation of complications from mastectomy. Surg Gynecol Obstet. 1974;138:370–376.Google ScholarPubMed
7. Budd, DC, Cochran, RC, Sturtz, DL, Fouty, WJ Jr. Surgical morbidity after mastectomy operations. Am J Surg. 1978;135:218–220.CrossRefGoogle ScholarPubMed
8. Ehrenkranz, NJ. Surgical wound infection occurence in clean operations: stratification for interhospital comparisons. Am J Med. 1981;70:909–914.CrossRefGoogle Scholar
9. Beatty, JD, Robinson, GV, Zaia, JA, et al. A prospective analysis of nosocomial wound infection after mastectomy. Arch Suyg. 1983;118:1421–1424.Google ScholarPubMed
10. Hayes, JA, Bryan, RM. Wound healing following mastectomy. Aust NZ J Surg. 1984;54:25–27.CrossRefGoogle ScholarPubMed
11. Tejler, G, Aspegren, K. Complications and hospital stay after surgery for breast cancer: a prospective study of 385 patients. Br J Surg. 1985;72:542–544.10.1002/bjs.1800720714CrossRefGoogle ScholarPubMed
12. Badr, El, Din, A, Guenier, C, Nogaret, JM, et al. Local postoperative morbidity following preoperative irradiation in locally advanced breast cancer. Eur J Surg Oncol. 1989;15:486–489.Google Scholar
13. Vinton, AL, Traverso, W, Zehring, RD. Immediate breast reconstruction following mastectomy is as safe as mastectomy alone. Arch Surg. 1990;125:1303–1308.CrossRefGoogle ScholarPubMed
14. Wagman, LD, Tegtmeier, B, Beatty, JD, et al. A prospective, randomized double-blind study of the use of antibiotics at the time of mastectomy. Surg Gynec Obstet. 1990;170:12–16.Google ScholarPubMed
15. Hoefer, RA Jr., DuBois, JJ, Ostrow, LB, Silver, LE. Wound complications following modified radical mastectomy: an analysis of perioperative factors. Journal of the American Osteopathic Association. 1990;90:47–53.CrossRefGoogle ScholarPubMed
16. Platt, R, Zaleznik, DE, Hopkins, CC, et al. Perioperative antibiotic prophylaxis for herniorrhaphy and breast surgery. N Engl J Med. 1990;322:153–160.CrossRefGoogle ScholarPubMed
17. Keidan, RD, Hoffman, JP, Weese, JL, et al. Delayed breast abscesses after lumpectomy and radiation therapy. Am Surg. 1990;56:440–444.Google ScholarPubMed
18. Chen, J, Gutkin, Z, Bawnik, J. Postoperative infections in breast surgery. J Hosp Infect. 1991;17:61–65.10.1016/0195-6701(91)90078-MCrossRefGoogle ScholarPubMed
19. Culver, DH, Horan, TC, Gaynes, RP, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. Am J Med. 1991;91(suppl 3B):152S—157S CrossRefGoogle ScholarPubMed
20. Cruse, PJ, Foord, R. A five-year prospective study of 23,649 surgical wounds. Arch Surg. 1973;107:206–209.CrossRefGoogle Scholar
21. Gil-Egea, MJ, Pi-Sunyer, MT, Verdaguer, A, Sanz, F, Sitges-Serra, A, Eleizegui, LT. Surgical wound infections: prospective of 4,468 clean wounds, Infect Control. 1987;8:277–279.CrossRefGoogle Scholar
22. Haley, RW, Culver, DH, Morgan, WM, White, JW, Emori, TG, Hooton, TM. Identifying patients at high risk of surgical wound infection: a simple multivariate index of patient susceptibility and wound contamination. Am J Epidemiol. 1985;121:206–215.CrossRefGoogle ScholarPubMed
23. Nagachinta, T, Stephens, M, Reitz, B, Polk, BE. Risk factors for surgical wound infection following cardiac surgery. J Infect Dis. 1987;156:967–973.CrossRefGoogle ScholarPubMed
24. Houck, JP, Rypins, EB, Sarfeh, JJ, Tuler, GL, Shimoda, KJ. Repair of incisional hernia. Surg Gynecol Obstet. 1989;169:397–399.Google ScholarPubMed
25. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections. Am J Infect Control. 1988; 16:128–140 CrossRefGoogle ScholarPubMed
26. Morris, AM. A controlled trial of closed wound suction drainage in radical mastectomy. Br J Surg. 1973;60:357–359.CrossRefGoogle Scholar
27. Moss, JP. Historical and current perspectives on surgical drainage. Surg Gynec Obstet. 1981;152:517–527.Google ScholarPubMed