Surveillance, control, and prevention of surgical site infections in breast cancer surgery: A 5-year experience

Background: We analyzed variations in surgical site infections (SSIs) during 5 years of a prospective surveillance program and investigated possible contributors to SSIs in a cohort of patients who underwent surgery for breast cancer. Methods: All breast surgeries performed between January 2001 and December 2005 were registered. Patients were followed-up by direct observation for at least 30 days under standardized conditions. The main outcome studied was SSI. A case-control analysis was conducted to identify SSI-associated risk factors and to evaluate SSI variations by means of a control chart. Results: During the study period, a total of 2338 breast cancer surgeries were recorded, and 441 SSIs (18.9%) were diagnosed. SSI frequency varied across the 5-year period, with a sharp decline seen after the introduction of preventive policies. After 2002, 3 out-of-confidence limits of SSIs were observed, 2 related to the use of evacuation systems and I associated with a group of rotating residents. Concomitant preoperative chemoradiation (odds ratio [OR] = 3.47: 95% confidence interval [CI] = 2.51 to 4.80), hematoma (OR = 3.05: 95% CI = 1.70 to 5.52), age >= 58 years (OR = 1.83 95% Cl = 1.27 to 2.65), body mass index >= 30.8 (OR = 1.58; 95% Cl = 1.14 to 2.18). and duration of surgery >= 160 minutes(OR = 1.73; 95% CI = 1.20 to 2.50)were found to be SSI-associated risk factors. Conclusions: After 5 years of a continuous prospective surveillance program, we were able to decrease the rate of SSIs in patients undergoing breast cancer surgery (from 33.3% in 2000 to 18.9% in 2005), identify SSI-associated risk factors, and improve the quality of care delivered to these patients.