External ventriculostomy-associated infection reduction after updating a care bundle

Area of Science:

• Neurosurgery
• Infectious Disease

Background:

• External ventricular drains (EVD) are crucial for managing neurological conditions but carry a risk of EVD-related infections (EVDRI).
• While gram-positive bacteria are common causes of EVDRI, gram-negative bacteria are the primary concern in this hospital.
• Standardized insertion techniques and guidelines are essential for infection prevention.

Purpose of the Study:

• To evaluate the effectiveness of a new bundle of measures in reducing EVDRI incidence.
• To compare EVDRI rates before and after the implementation of an updated protocol (UP) in 2017.

Main Methods:

• A cohort study included 198 patients requiring EVD insertion between January 1, 2015, and December 31, 2018.
• Patients were divided into two groups: before the updated protocol (87 patients) and after the updated protocol (111 patients).
• Key diagnoses included subarachnoid (42%) and intracerebral (24%) hemorrhage.

Main Results:

• The incidence of EVDRI decreased from 13.4 to 2.5 episodes per 1000 catheter days after implementing the UP.
• Gram-negative bacteria remained the most frequent cause of EVDRI.
• Previous craniotomy was the sole independent risk factor for EVDRI; affected patients required longer mechanical ventilation, hospital/ICU stays, and tracheostomies.

Conclusions:

• A care bundle emphasizing reduced catheter sampling and enhanced antiseptic measures significantly lowers EVDRI incidence.
• The updated management protocol led to reduced infections by both gram-negative and gram-positive bacteria.
• Observed benefits included decreased ICU and hospital lengths of stay.