Covert surveillance of infection prophylaxis measures applied during
implant surgery.
Julia R Henderson, Sandhir Kandola, Susan Hignett, Rebecca Teasdale, Ashley
Topps, Cliona C Kirwan on behalf of the North West Breast Trainees Research
Collaborative.
Introduction
Infective complications following breast-implant surgery are difficult to treat
and can lead to explantation. We aimed to establish current use of all infectionprophylaxis measures, specifically adherence to ABS Oncoplastic guidelines for
MRSA, MSSA screening and prophylactic antibiotics and to assess application of
other infection-control precautions.
Methods
From May-December 2014, prospective infection-prophylaxis data was collected
in real time during breast-implant surgery, across six UK breast units.
Results
63 patients under 19 Consultants had 81 implant procedures (36 bilateral): 46
immediate reconstructions (31 ADMs), 21 implant exchanges, 10 augmentations
and 4 delayed reconstructions. All patients (100%) were MRSA screened and
given perioperative antibiotics. Two of six units used disposable gowns and
drapes. Three units used laminar-flow and for 32/47 (68%) of their cases. 56/63
(89%) received postoperative antibiotics, median 5 days (range 0-14). Among
the 14 consultants performing more than one procedure (range 2-16), only one
used exactly the same precautions when siting an implant, commonest
inconsistencies being cavity washing, re-draping and method of glove change.
Precautions
MSSA screening
Closed-glove technique
Warning signs on theatre door
All staff masked when implant opened
Re-prepping of skin
Cavity washing
Implant washing
Gloves changed prior to implant handling
No. Patients (%)
10(16)
43(68)
45(71)
No. Procedures (%)
68(84)
63(78)
71(88)
41(51)
80(99)
Conclusions
ABS guidance for MRSA (but not MSSA) screening and IV antibiotics were met in
all cases. Considerable inter-surgeon, and more surprisingly, intra-surgeon
variability of infection-prophylaxis measures exists amongst surgeons. This may
be due to lack of evidence to support interventions.