QAPI 100 - Breast Tissue Expander Infections Associated with Post-surgical Manipulation: Implementing a New Process

Background: In 2021, Breast tissue expander (TE) infections were identified in patients who underwent TE access in plastic surgery clinic of a large academic public hospital system during National Health Safety Network (NHSN) surgical site infection (SSI)surveillance. We identified gaps in technique and corrected them with a new standardized procedure. The objective of this study is to assess the effectiveness of the new interventions in preventing TE infections.

Methods: Baseline period for the study was January – December 2021. Intervention period was January – June 2022. NHSN SSI criteria were used for the surveillance. A retrospective chart review and observations of TE access procedures were conducted for the study period. Our observations found gaps in sterile technique during the procedure: inadequate sterile field, skin preparation, opportunities with port disinfection of the saline bag, use of same tray for multiple patients, storing and cleaning the magnet locator between patients, five moments of hand hygiene during removal of old dressing and with instillation and aspiration. The new process included a switch to alcohol-based chlorhexidine gluconate skin preparation with increased surface area of the skin prepped, use of a sterile drape, expanding sterile field for the trays, disinfection of magnet locators between patients and 3-way stopcock tubing to fill the syringe from the saline bag.

Results: We found that seven per 100 patients (7%) who underwent TE access in the clinic in 2021 developed an infection after manipulation. The infection rate reduced to two percent during the intervention period (p value < 0.001).

Conclusions: It is important to examine the clinic process to prevent infections related to breast tissue expanders. Although they are not surgical procedures, they are invasive and carry significant infection risk. Therefore, sterile precautions need to be followed consistently. Our new standardized process proved to be effective in reducing breast TE infections.