Reducing Postbreast Reconstruction Infection Rates: Our Journey to Achieving Low Postoperative Infection Outcomes

Breast surgeries are classified as clean procedures associated with a lower risk of post-operative infections; however, the reported infection rates post-breast surgeries are still significantly high. Surgical site infections (SSIs) are indeed one of the most common and serious complications following breast surgery.

A retrospective study assessed the rate of SSIs post-breast reconstructive surgery after the implementation of the infection control protocol at James Cook University Hospital and Friarage Hospital from December 2022 to June 2024. Initial post-operative breast reconstruction cases at James Cook University Hospital and Friarage Hospital showed a high SSI rate of 23%, with Theatre 22 in James Cook University Hospital reporting 25%, despite adherence to infection control protocols.  Subsequent investigations identified Pseudomonas contamination in scrub water taps and inadequate airflow in Theatre 22 as potential sources. Corrective actions were implemented, including relocating surgeries to facilities with superior air filtration and forming a Protocol Reinforcement Team to ensure strict adherence to infection control measures and the Protocol of Breast Reconstruction Surgery (PBRS).  Data was collected from the information department of James Cook University Hospital retrospectively, looking at all patients who underwent breast reconstruction procedures from December 2022 to June 2024. Patients who developed SSIs at the breast reconstruction implant site were identified by reviewing the patients' notes. The confirmed diagnosis as well as the classification and potential risk factors were identified retrospectively from the patients' notes as well. All patients included in the study were strictly adherent to the PBRS. IBM SPSS Statistics for Windows, Version 21 (Released 2012; IBM Corp., Armonk, New York, United States) was used for both descriptive and inferential analyses of the data, and no adjustments were made for multiple comparisons.

Among 31 patients (48 procedures), complications included delayed infection (n=1 procedure), drain exit site infection (n=1 procedure), skin necrosis (n=2 procedures), wound dehiscence (n=1 procedure), and seroma (n=1 procedure). We reported low infection rates to post-breast reconstruction with strict adherence to the PBRS (02.08%) in comparison to the current guidelines and published literature (up to 25%).

Despite improvements, SSIs remain a significant concern in implant-based breast reconstruction procedures. Adopting and adhering to a standardized PBRS are strongly recommended to further reduce complications and enhance patient outcomes.