External ventricular drain infection: the effect of a strict protocol on infection rates and a review of the literature

• Published in: British journal of neurosurgery Vol. 20; no. 5; pp. 296 - 300
• Main Authors: Dasic, D., Hanna, S. J., Bojanic, S., Kerr, R. S. C
• Format: Journal Article
• Language: English
• Published: England Informa UK Ltd 01-10-2006; Taylor & Francis; Taylor & Francis Ltd
• Subjects: Audit; Catheters, Indwelling - adverse effects; Central Nervous System Bacterial Infections - etiology; Central Nervous System Bacterial Infections - prevention & control; Cerebral Ventricles - surgery; Cerebrospinal Fluid Shunts - adverse effects; Clinical Protocols - standards; CNS infection; Drainage - adverse effects; Drainage - standards; Encephalitis - etiology; Encephalitis - prevention & control; Evidence-Based Medicine - standards; external ventricular drain; Female; Humans; infection; Infections; Intracranial Pressure; Male; Middle Aged; Monitoring, Physiologic - adverse effects; Neurosurgery; Prospective Studies; Retrospective Studies; Transplants & implants; ventriculostomy
• ISSN: 0268-8697; 1360-046X
• DOI: 10.1080/02688690600999901

External ventricular drains (EVDs), like any surgically-implanted foreign body, are at risk of infection. We present the results of a completed audit loop following introduction of an evidence-based protocol for their insertion and management. There were two phases over a 2-year period. Phase 1 was a retrospective audit of our EVD infection rate. Phase 2 was a prospective audit of the infection rate subsequent to the introduction of a protocol for the insertion and management of EVDs. In phase 1, the infection rate was 27%. In phase 2, the infection rate was 12%. This was a statistically significant reduction (p < 0.05, Chi-squared test). EVD infection is unfortunately a common clinical problem and associated with potential morbidity and mortality. This study demonstrates that adherence to an evidence-based protocol for their insertion and management is associated with a significant reduction in the infection rate.