Effectiveness of a multimodal strategy to reduce external ventricular drain–associated infection: A quasi-experimental study

• Published in: American journal of infection control Vol. 52; no. 11; pp. 1307 - 1313
• Main Authors: Pongkaew, Chaiwat, Noiphithak, Raywat, Rukskul, Pataravit, Yodwisithsak, Pornchai, Tantongtip, Dilok, Nimmannitya, Pree, Punyarat, Prachya, Duangprasert, Gahn, Kaewwichai, Wadrawee, Songphul, Sirada, Chancharoenrat, Watcharee, Jantarathaneewat, Kittiya, Chokaouychai, Chattrabongkot, Sukhor, Sasikan, Apisarnthanarak, Piyaporn, Camins, Bernard C., Weber, David J., Apisarnthanarak, Anucha
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2024
• Subjects: Bundle; Healthcare-associated infections; Infection prevention; Neurosurgery; Resource-limited settings; Resource-limited settings; Infection prevention; Neurosurgery; Bundle; Healthcare-associated infections
• ISSN: 0196-6553; 1527-3296; 1527-3296
• DOI: 10.1016/j.ajic.2024.06.026

Infection is a serious complication in neurosurgical patients who undergo external ventricular drain (EVD) insertion.
We conducted a quasi-experimental study in patients who underwent EVD insertion to evaluate the impact of a multi-modal strategy to reduce the incidence of external ventricular drain associated infections (EVDAIs). The study was divided into 2 periods; (1) the pre-intervention period when techniques for EVD insertion and maintenance were up to the discretion of the neurosurgeons and (2) the post-intervention after implementation of a multi-modal strategy (cefazolin antibiotic prophylaxis, preoperative chlorhexidine showers, application of postoperative chlorhexidine-impregnated dressing, limited manipulation of the EVD, and meticulous EVD management). The primary outcome was the incidence rate of EVDAIs; secondary outcomes included in-hospital mortality rate, the hospital length of stay.
In total, 135 patients were included. The incidence rate of EVDAIs was significantly reduced in the post-intervention period (5.6 cases/1,000 EVD-days) compared with the pre-intervention period (18.2 cases/1,000 EVD-days; P=0.026). There were no differences in all secondary outcomes analyzed. This multi-modal strategy was associated with high satisfaction among health care personnel.
Implementation of a multi-modal strategy was associated with a reduction in the incidence of EVDAIs. This was in line with our goal of promoting a new culture of safety despite being in a resource-limited setting.
•Multi-modal strategy reduced EVDAI rates.•Multi-modal strategy did not reduce the hospital length of stay and the mortality.•Multi-modal strategy can be implemented without barriers by neurosurgical staff.