Improving Ventriculostomy Management: Risk and Cost Reduction Through a Multidisciplinary Approach

Area of Science:

• Neurosurgery
• Infectious Disease Prevention
• Healthcare Quality Improvement

Background:

• Ventriculostomy is a critical procedure, but it carries a high risk of life-threatening infections.
• Ventriculostomy-associated infections (VAI) pose a significant threat to patient safety and increase healthcare costs.

Purpose of the Study:

• To develop and evaluate a cost-effective, evidence-based intervention to decrease ventriculostomy-associated infection (VAI) rates.
• To assess the impact of antibiotic-coated ventriculostomy catheters and optimized cerebrospinal fluid (CSF) sampling on VAI rates and costs.

Main Methods:

• A retrospective study analyzed VAI rates and costs across three phases (June 2008–December 2016).
• Phase 1 involved standard catheters and daily CSF sampling.
• Phase 2 introduced antibiotic-coated ventriculostomy catheters (AC-Vs), while Phase 3 reduced CSF sampling to twice weekly.

Main Results:

• VAI rates decreased from 3.3 infections per 1000 device-days in phase 1 to 1.6 in phase 2 and 0.8 in phase 3.
• The combined intervention of AC-Vs and reduced CSF sampling led to a 75.8% reduction in VAI rates (P = 0.01).
• The intervention generated substantial cost savings, estimated at $1.02 million during phase 3, with an average projected saving of $175 per patient per day (72% cost reduction).

Conclusions:

• Combining antibiotic-coated ventriculostomy catheters with decreased frequency of cerebrospinal fluid sampling is a highly effective strategy.
• This evidence-based approach significantly reduces ventriculostomy-associated infections.
• The intervention offers significant cost savings, making it a valuable quality improvement initiative.