Chlorhexidine dressings could reduce external ventricular drain infections: results from a systematic review and meta-analysis

Waqar, Mueez; Chari, Ajai; Islim, Abdurrahman I; Davies, Benjamin; Fountain, Daniel M; Larkin, Susan; Jenkinson, Michael D.; Patel, Hiren

doi:10.1016/j.jhin.2021.06.006

Cited by 8 publications

(4 citation statements)

References 25 publications

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“…Further, in terms of preventing EVD-related infections the use of Bactiseal EVD might be beneficial, however when the infection is already present, even the use of antibiotic-coated EVD show no advantage over regular EVD [ 34 ]. Further studies described that EVD-related infections could be prevented with chlorhexidine dressings [ 32 , 36 ]. Apart from these findings, a recent systematic review found, that there is a lot of controversies regarding the prevention and treatment of ventriculitis, which after all these years still leads to unclear practice when it comes to preventing EVD infections [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Management of external ventricular drain: to wean or not to wean?

Hallenberger,

Tharmagulasingam,

Licci

et al. 2024

Acta Neurochir

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Purpose External ventricular drain (EVD) is one of the most frequent procedures in neurosurgery and around 15 to 30% of these patients require a permanent cerebrospinal fluid (CSF) diversion. The optimal EVD weaning strategy is still unclear. Whether gradual weaning compared to rapid closure, reduces the rate of permanent CSF diversion remains controversial. The aim of this trial is to compare the rates of permanent CSF diversion between gradual weaning and rapid closure of an EVD. Methods This was a single-center, retrospective cohort study including patients between 2010 to 2020. Patients were divided into a weaning (WG) and non-weaning (NWG) group. The primary outcome was permanent CSF diversion rates, secondary outcomes included hospitalization time, EVD-related morbidity, and clinical outcome. Results Out of 412 patients, 123 (29.9%) patients were excluded due to early death or palliative treatment. We registered 178 (61.6%) patients in the WG and 111 (38.4%) in the NWG. Baseline characteristics were comparable between groups. The VPS rate was comparable in both groups (NWG 37.8%; WG 39.9%, p = 0.728). EVD related infection (13.5% vs 1.8%, p < 0.001), as well as non-EVD related infection rates (2.8% vs 0%, p < 0.001), were significantly higher in the WG. Hospitalization time was significantly shorter in the NWG (WG 24.93 ± 9.50 days; NWG 23.66 ± 14.51 days, p = 0.039). Conclusion Gradual EVD weaning does not seem to reduce the need for permanent CSF diversion, while infection rates and hospitalization time were significantly higher/longer. Therefore, direct closure should be considered in the clinical setting.

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Section: Discussionmentioning

confidence: 99%

Management of external ventricular drain: to wean or not to wean?

Hallenberger,

Tharmagulasingam,

Licci

et al. 2024

Acta Neurochir

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“…The introduction of an EVD care bundle that includes a standardized technique of hand washing for aseptic CSF sampling, the use of surgical theater‐standard scrubs and preparations, and cleaning the EVD access ports while wearing a mask and gloves significantly decreased the rate of infection from 21 to 9 cases per 1000 EVD‐days ( p = .003) 130,131 . In a meta‐analysis, the addition of a chlorhexidine‐impregnated dressing to the catheter exit site significantly reduced the incidence of EVD infections (7.9% vs. 1.7%; risk difference, 0.07; 95% CI, 0.0–0.13; p = .04) 130,132 . Similar bundled approaches for the prevention of Ommaya reservoir infections have been successful 129 .…”

Section: Specific Device‐related Recommendationsmentioning

confidence: 99%

“… 130 , 131 In a meta-analysis, the addition of a chlorhexidine-impregnated dressing to the catheter exit site significantly reduced the incidence of EVD infections (7.9% vs. 1.7%; risk difference, 0.07; 95% CI, 0.0–0.13; p = .04). 130 , 132 Similar bundled approaches for the prevention of Ommaya reservoir infections have been successful. 129 Hence, because of the difficulty in assessing the effectiveness of each individual component and based on the relatively low cost, to further reduce the rate of these infections, we recommend the continued use of these preventive bundles.…”

Section: Specific Device-related Recommendationsmentioning

confidence: 99%

Prevention of device‐related infections in patients with cancer: Current practice and future horizons

Viola

Szvalb

Malek

et al. 2022

CA A Cancer J Clinicians

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Over the past several years, multifaceted advances in the management of cancer have led to a significant improvement in survival rates. Throughout patients’ oncological journeys, they will likely receive one or more implantable devices for the administration of fluids and medications as well as management of various comorbidities and complications related to cancer therapy. Infections associated with these devices are frequent and complex, often necessitating device removal, increasing health care costs, negatively affecting quality of life, and complicating oncological care, usually leading to delays in further life‐saving cancer therapy. Herein, the authors comprehensively review multiple evidence‐based recommendations along with best practices, expert opinions, and novel approaches for the prevention of diverse device‐related infections. The authors present many general principles for the prevention of these infections followed by specific device‐related recommendations in a systematic manner. The continuous involvement and meaningful cooperation between regulatory entities, industry, specialty medical societies, hospitals, and infection control‐targeted interventions, along with primary care and consulting health care providers, are all vital for the sustained reduction in the incidence of these preventable infections.

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“…[ 3 ] Complication rates vary but have been reported to be as high as 20–30% for hemorrhagic complications,[ 8 , 12 ] up to 45% for catheter misplacement,[ 12 ] and infection rates from 4% to 40%. [ 7 , 9 , 15 , 16 ] These complications are associated with an increase in hospital length of stay (LOS) and patient morbidity and mortality. [ 3 , 5 , 16 ] EVD misplacement may be associated with EVD failure, intracranial hemorrhage, higher reinsertion rates, and drain blockages.…”

Section: Introductionmentioning

confidence: 99%

Single institution series describing external ventricular drain (EVD) placement and short- and long-term complications related to placement accuracy

Sharma,

Head,

Mallela

et al. 2024

Surgical Neurology International

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Background: The placement of an external ventricular drain (EVD) for the treatment of acute hydrocephalus is one of the most common life-saving procedures that neurosurgeons perform worldwide. There are many well-known complications associated with EVD placement, including tract hemorrhages, intra-parenchymal and subdural hemorrhages, infection, and catheter misplacement. Given the variety of complications associated with EVD placement and the inconsistent findings on the relationship of accuracy to complications, the present study reviewed short- and long-term complications related to EVD placement at our institution. Methods: A retrospective review was conducted for all consecutive patients who underwent bedside EVD placement for any indication between December 2020 and December 2021. Collected variables included demographic information, etiology of disease state, pre-and post-operative head computed tomography measurements, and post-procedural metrics (immediate and delayed complications). Results: A total of 124 patients qualified for inclusion in our study. EVDs that were non-functioning/exchanged were not significantly related to age, accuracy, ventriculomegaly, sex, disposition, laterality, type of EVD used, intraventricular hemorrhage (IVH), etiology, or Kakarla Grade (KG) (all P > 0.17). The need for a second EVD was similarly not related to age, accuracy, ventriculomegaly, sex, disposition, location, laterality, type of EVD used, IVH, etiology, or KG (all P > 0.130). Patients who died, however, were significantly more likely to have a second contralateral EVD placed (18.2% vs. 4.9% P = 0.029). We also found that left-sided EVDs were significantly more likely to fail within seven days of placement (29.4% vs 13.3%, P = 0.037; relative risk (RR) 1.93, 95% confidence interval: 1.09-3.43), unrelated to age, sex, etiology, type of EVD, IVH, location of the procedure, or accuracy (all P > 0.07). This remained significant when using a binary logistic regression to control for ventriculomegaly, accuracy, mortality, age, sex, and etiology (P = 0.021, B = 3.43). Conclusion: In our cohort, although a clear relationship between inaccuracy and complication rates was not found, our data did demonstrate that left-sided EVDs were more likely to fail within the immediate postoperative time point, and patients who died were more likely to have a second, contralateral EVD placed.

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Chlorhexidine dressings could reduce external ventricular drain infections: results from a systematic review and meta-analysis

Cited by 8 publications

References 25 publications

Management of external ventricular drain: to wean or not to wean?

Management of external ventricular drain: to wean or not to wean?

Prevention of device‐related infections in patients with cancer: Current practice and future horizons

Single institution series describing external ventricular drain (EVD) placement and short- and long-term complications related to placement accuracy

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