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Reducing surgical site infections (SSI) in breast surgeries, including a newly identified risk for sentinel node biopsies


In 2012, 19 infections out of 561 breast surgeries (Standardized infection Ratio (SIR) 3.372, 95% CI 2.09-5.168) led to the discovery that non-sterile radiation probes pierced their sterile sheaths. After disinfecting the probes, the SSI was 0%, then subsequently increased.


The objective of this study was to identify risk factors for continued infections in 2013 and 2014.


Rates of SSI were calculated for each surgeon. Case control analyses identified risk factors using R version 3.1.2. Cases were observed and results shared with surgical teams.


Of 26 surgeons, Surgeon X had 33% (386) of the 1169 procedures in 2012-2013 and 52% (13/25) of the infections: the SSI rate was 3.38% (13/384), which was significantly greater than expected 0.32 from the U.S. National Health Safety Network risk adjusted control cases (SIR 3.117 ( 95% CI1.73-5.20)).

Surgeon X’s sentinel node biopsies in 2014 had a 9-fold increased SSI risk (OR 9.0, Fisher Exact, p=.051); several practice variations were observed.


The rate of SSI was reduced to zero in the 4th QTR of 2014, after communicating surgeon-specific rates, possible risk factors, and peer coaching. Practice changes included high-level disinfection (HLD) of radiation probes used in surgical fields, use of disposable hair bonnets, anchoring drains, and revised prepping.

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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Catlin, M., Blue, C., Thompson, R. et al. Reducing surgical site infections (SSI) in breast surgeries, including a newly identified risk for sentinel node biopsies. Antimicrob Resist Infect Control 4 (Suppl 1), O31 (2015).

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