European Archives of Oto-Rhino-Laryngology

, Volume 275, Issue 5, pp 1249–1255 | Cite as

Does microbial colonisation of a neck drain predispose to surgical site infection: clean vs clean-contaminated procedures

  • Sheran Seneviratne
  • Gary Hoffman
  • Hemalatha Varadhan
  • Jane Kitcher
  • Daron Cope
Head and Neck



The study was designed to assess the difference in microbiological colonisation and growth that may occur in drains, in the setting of clean-contaminated compared to clean head and neck surgery.


A prospective observational cohort study was performed. Surgical drain tips upon removal were sent for bacterial culture and the culture results were compared between clean-contaminated and clean procedures using mixed effects logistic regression. In all statistical analyses, a priori, p < 0.05 (two-tailed) was calculated to indicate statistical significance.


One hundred and ten drains were examined in both clean-contaminated and clean procedures. Drains from clean-contaminated procedures had a significantly longer time in situ (11 vs 5 days, p < 0.001). Overall, significant evidence was seen for an association between procedure type and drain growth rates: 68% of clean-contaminated procedures; and 45% of clean procedures. Although not statistically significant, there was an increase in normal skin flora contaminated drains in clean-contaminated procedures (41 vs 25%). Rates of pathogenic skin organisms (15 vs 16%) and pathogenic oropharyngeal organisms (2.9 vs 0%) were similar for clean-contaminated vs clean procedure patients.


This preliminary study demonstrated a higher rate of microbial contamination of neck drains that were placed during procedures that involved continuity with the upper aero-digestive tract and neck. Retrograde migration of skin flora along the drain is common but of no clinical significance. Similar rates of pathogenic microbial growth have been demonstrated thus far. However, selection of nosocomial pathogens due to extended antibiotic prophylaxis may pose a risk for infection.

Level of evidence



Neck drain Surgical site infection Neck dissection Head and neck surgery 


Compliance with ethical standards

Conflict of interest

The authors have no funding, financial relationships or conflicts of interest to disclose.


  1. 1.
    Amir I, Morar P, Belloso A (2010) Postoperative drainage in head and neck surgery. Ann R Coll Surg Engl 92:651–654CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Memon MA, Memon MI, Donohue JH (2001) Abdominal drains: a brief historical review. Ir Med J 94:164–166PubMedGoogle Scholar
  3. 3.
    Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG (1992) CDC definitions of nosocomial surgical site infections: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 13:606–608CrossRefPubMedGoogle Scholar
  4. 4.
    Cruse PJ, Foord R (1973) A five-year prospective study of 23,649 surgical wounds. Arch Surg 107:206–210CrossRefPubMedGoogle Scholar
  5. 5.
    Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR (1999) Guideline for prevention of surgical site infection, Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 20:250–278CrossRefPubMedGoogle Scholar
  6. 6.
    Yates JL (1955) An experimental study of the local effects of peritoneal drainage. Am Surg 21:1048–1072PubMedGoogle Scholar
  7. 7.
    Dougherty SH, Simmons RL (1992) The biology and practice of surgical drains. Part 1. Curr Probl Surg 29:559–623CrossRefPubMedGoogle Scholar
  8. 8.
    Langerman A, Thisted R, Hohmann S, Howell M (2016) Antibiotic and duration of perioperative prophylaxis predicts surgical site infection in head and neck surgery. Otolaryngol Head Neck Surg 154:1054–1063CrossRefPubMedGoogle Scholar
  9. 9.
    Reiffel AJ, Barie PS, Spector JA (2013) A multi-disciplinary review of the potential association between closed-suction drains and surgical site infection. Surg Infect (Larchmt) 14:244–269CrossRefGoogle Scholar
  10. 10.
    Harris T, Doolarkhan Z, Fagan JJ (2011) Timing of removal of neck drains following head and neck surgery. Ear Nose Throat J 90:186–189PubMedGoogle Scholar
  11. 11.
    Becker GD, Parrell GJ (1979) Cefazolin prophylaxis in head and neck cancer surgery. Ann Otol Rhinol Laryngol 88:183, 1979CrossRefPubMedGoogle Scholar
  12. 12.
    Murphy J, Isaiab A, Dyalram D, Lubek J (2017) Surgical site infections in patients receiving osteomyocutaneous free flaps to the head and neck. Does choice of antibiotic prophylaxis matter? J Oral Maxillofac Surg 75:2223–2229CrossRefPubMedGoogle Scholar
  13. 13.
    Cohen ME, Salmasian H, Liu J, Zachariah P, Wright JD, Freedberg DE (2017) Surgical antibiotic prophylaxis and risk for postoperative antibiotic-resistant infections. J Am Coll Surg 225(5):631–638CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Head and Neck SurgeryJohn Hunter HospitalNewcastleAustralia
  2. 2.Department of Microbiology, NSW Health PathologyJohn Hunter HospitalNewcastleAustralia
  3. 3.Faculty of MedicineUniversity of NewcastleNewcastleAustralia

Personalised recommendations