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Reducing external drainage-related cerebrospinal fluid infections through implementation of a multidisciplinary
Veronica Ciorba1,2, Gaetano Ciliento1, Marta Luisa Ciofi Degli Atti3
1Direzione sanitaria, Ospedale Pediatrico Bambino Gesù, Roma, Italy.
Insights
A new protocol reduced cerebrospinal fluid (CSF) drain infections in children, although the study period was too short to confirm statistical significance. Younger patients with post-hemorrhagic hydrocephalus faced higher infection risks.
Area of Science:
- Neuroscience
- Infectious Diseases
- Pediatric Critical Care
Background:
- External cerebrospinal fluid (CSF) drains are crucial for managing hydrocephalus in pediatric patients.
- CSF drain-related central nervous system (CNS) infections pose a significant risk, impacting patient outcomes.
- Standardized protocols are essential for preventing healthcare-associated infections in neurocritical care settings.
Purpose of the Study:
- To evaluate the effectiveness of a newly implemented prevention protocol on the incidence of external CSF drain-related CNS infections.
- To compare infection rates before and after the protocol's introduction in a pediatric hospital setting.
Main Methods:
- A quasi-experimental study design was employed, comparing infection incidence before and after protocol implementation.
- Data were collected from pediatric patients who received external CSF drains between January 2013 and March 2015.
- The primary outcome measure was the incidence of drain-related infections, analyzed by cumulative incidence and rate per catheter-day.
Main Results:
- The study included 52 pediatric patients.
- Post-protocol implementation, the cumulative incidence of infections decreased from 14 to 6.7 per 100 drains, and the rate fell from 8 to 4.6 per 1,000 catheter-days.
- Infected patients were significantly younger (median 16.5 days vs. 13.4 months), had more procedures (median 5 vs. 1), and were more likely to have post-hemorrhagic hydrocephalus (50% vs. 16.7%).
Conclusions:
- Implementation of the prevention protocol was associated with a reduction in CSF drain-related infections.
- The study's short post-intervention period limited statistical power to confirm a significant difference.
- Risk factors for CSF drain-related infections include young age (<1 year), multiple interventions, and post-hemorrhagic hydrocephalus.
Objective:
To assess the frequency of external cerebrospinal fluid (CSF) drain-related CNS infections before and after implementation of a protocol for their prevention.
Design:
Quasi-experimental study, with comparison of incidence before and after the implementation of the intervention.
Setting And Participants:
Bambino Gesù Children's Hospital in Rome, Italy. Children receiving an external cerebrospinal fluid drain from 1 January 2013 to 31 March 2015.
Main Outcome Measures:
Drain-related infections.
Results:
Fifty-two patients were included in the study. Before protocol implementation, cumulative incidence was 14 per 100 drains. Incidence rate was 8/1,000 catheter-days. After protocol implementation, cumulative incidence and incidence rate were 6.7 per 100 drains and 4.6 per 1,000 catheter-days (p=0.61 and p=0.2 versus the pre-intervention period, respectively). Infected patients were significantly younger (median age: 16.5 days vs 13.4 months; p=0.026), had a significantly higher number of procedures (5 vs 1 procedure per patient; p <0.0001) and were most frequently affected by post-haemorrhagic hydrocephalus of premature newborns (50% vs 16.7%; p=0.039), compared to non-infected patients.
Conclusions:
After protocol implementation, we observed a reduction of incidence of CSF drain-related infections, though the short post-intervention period limited the power of the study to detect a significant difference. Patients <1 year of age, with multiple interventions and post-haemorrhagic hydrocephalus had higher risk of CSF drain-related infections.
