May the drain be a way in for microbes in surgical infections?

• Published in: American journal of infection control Vol. 44; no. 3; pp. 283 - 288
• Main Authors: Barbadoro, Pamela, MD, Marmorale, Cristina, MD, Recanatini, Claudia, MD, Mazzarini, Giorgia, MD, Pellegrini, Ilaria, MD, D'Errico, Marcello M., MD, Prospero, Emilia, MD, MPH
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2016; Mosby-Year Book, Inc
• Subjects: Adult; Aged; Aged, 80 and over; Data collection; Drainage - adverse effects; Drainage - methods; Female; Hospitals, Teaching; Humans; Infection Control; Infectious Disease; Italy; Male; Microorganisms; Middle Aged; Nosocomial infections; Regression analysis; Risk factor; Risk Factors; Surgery; Surgical site infection; Surgical Wound Infection - etiology; Wound classification; Italy; Surgical site infection; Risk factor; Wound classification
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2015.10.012

Background Surgical site infection (SSI) is among the most frequent hospital-acquired infections occurring in surgical patients and leads to increased morbidity, mortality, and costs. We aimed to identify risk factors for SSI in patients undergoing surgical procedures, with a particular attention to the use of drains. Methods This study includes all patients undergoing abdominal surgical procedures in 2 surgical wards in a teaching hospital in central Italy. Collected data included patient's demographic and clinical characteristics, procedure characteristics, administration of perioperative antibiotic prophylaxis, and microorganism isolated. The outcome of interest was SSI. Findings A total of 872 abdominal surgery procedures were surveyed during the study period. Drains were placed in 37.0% of cases. SSI rate was 6.4% globally and 13.6% among the patients with drains, versus 2.4% in those without a drain ( P  < .001). In 72.1% of cases antibiotic prophylaxis was administered. The logistic regression analysis ( P  < .001) shown insertion of a drain (odds ratio [OR], 5.14; 95% confidence interval [CI], 2.63-10.08), prolonged surgery (OR, 1.98; 95% CI, 1.09-3.59), and American Society of Anesthesiologists score equal to 3 (OR, 6.13; 95% CI, 2.33-16.11) as independent risk factors for SSI, whereas antibiotic prophylaxis was protective (OR, 0.53; 95% CI, 0.29-0.99). Conclusion This study revealed surgical drains as a risk factor for SSI, pointing out the need of a clearer understanding of drain role in the dynamics of SSI occurrence, with the purpose of decreasing infection risk through targeted preventive interventions.