Effect of Bundled Care on External VentricularDrain Infections: A Systematic Review and Meta-analysis

Area of Science:

• Neurosurgery
• Infectious Disease Epidemiology
• Evidence-Based Medicine

Background:

• External ventricular drains (EVDs) are essential for managing acute intracranial conditions.
• EVDs carry a significant risk of associated infections, posing a threat to patient outcomes.
• Standardized infection prevention strategies are needed to mitigate these risks.

Purpose of the Study:

• To systematically review and meta-analyze the effectiveness of infection prevention bundles in reducing EVD-associated infections.
• To identify key components of infection prevention bundles associated with lower infection rates.

Main Methods:

• Systematic literature search of PubMed, EMBASE, and Scopus databases.
• Meta-analysis using a random-effects model with Hartung-Knapp adjustment.
• Exploratory subgroup analysis of bundle element implementation in relation to infection rates.

Main Results:

• Twenty-two studies involving 6330 patients were analyzed.
• Bundle implementation significantly reduced EVD infection risk (pooled RR: 0.46, 95% CI: 0.33-0.65).
• Hand hygiene and preinsertion antibiotics were highly implemented; structured weaning protocols were not.

Conclusions:

• Implementing an infection prevention bundle is associated with a significant reduction in EVD infections.
• Antimicrobial-impregnated catheters, tunneled placement, and education programs were linked to lower infection rates (<5%).
• Optimizing EVD infection prevention requires core practices, technology, and education.