Multimodal assessment of the prevention of surgical site infections in breast surgery in a French university hospital.

Abstract

Introduction: Monitoring surgical site infections (SSIs) incidence through surveillance systems enables tailored infection prevention interventions. In our facility, annual surveillance of SSIs in breast surgeries revealed a significant increase of SSI incidence rates six times higher than the national average in France in 2024. This study aimed to investigate the factors contributing to the increase in SSIs following breast surgery at the South Hospital Group of the Hospices Civils de Lyon (HCL), Pierre-Bénite, France.

Methods: The study was divided into three parts, all including breast surgeries: (1) an observational audit of professional practices assessing the compliance of operator attire in the operating room, conducted from May 30 to July 5, 2024), (2) an observational audit assessing the compliance of patient preoperative skin preparation, (May 30-July 5, 2024), (3) a retrospective case-control study nested within a prospective cohort of adult women who underwent breast surgery between January 1, 2019, and June 1, 2024.

Results: Overall, out of 220 observations, 207 (94%) professionals wore a mask upon entering the operating room, and 192 (87%) wore a mask that covered both the chin and nose. Of the 25 skin preparation observations, six (24%) antiseptic applications did not dry naturally, and 10 (40%) did not dry for at least 30 s. The case-control study revealed that coagulase-negative staphylococci and Staphylococcus aureus were the most prevalent pathogens. A BMI > 30 kg/m² was a risk factor for SSIs in breast surgery (OR = 3.21, 95% CI [1.57-6.56), as well as diabetes (OR = 3.09, 95% CI [1.16-8.31]) and the administration of antibiotic prophylaxis other than cefazolin (OR = 6.49, 95% CI [1.12-37.44]). Traceability of disinfection in the patient record with an alcohol-based antiseptic agent was a protective factor against the occurrence of SSIs (OR = 0.48, 95% CI [0.24-0.97]).

Conclusion: This multimodal study identified significant non-compliance regarding the wearing of caps, masks, and jewellery, as well as patient skin preparation. Obese and diabetic patients, as well as those receiving prophylactic antibiotics other than cefazolin, are particularly at risk for SSIs. Delving deeply into the reasons why professionals disregard recommendations related to operating room attire and antisepsis could be highly beneficial for the prevention of SSIs.