The implementation of an external ventricular drain care bundle to reduce infection rates

Talibi, Sayed Samed; Silva, Adikarige Hd; Afshari, Fardad T.; Hodson, James; Roberts, Stuart; Oppenheim, Beryl; Flint, Graham; Chelvarajah, Ramesh

doi:10.1080/02688697.2020.1725436

Cited by 18 publications

(11 citation statements)

References 19 publications

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“…Over the last couple of decades surgical sciences have moved progressive with advancing methods to reduce the complications associated with surgical site infections (SSI) [ 1 ]. Complications in neurosurgery can be catastrophic with significant associated morbidity and mortality [ [14] , [15] , [16] ].…”

Section: Discussionmentioning

confidence: 99%

Adverse financial and clinical burden of the use of prophylactic antibiotics in neurosurgical patients

Khan¹,

Shamshad²,

Batchelor-Parry³

et al. 2023

Surgery Open Science

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Section: Discussionmentioning

confidence: 99%

Adverse financial and clinical burden of the use of prophylactic antibiotics in neurosurgical patients

Khan¹,

Shamshad²,

Batchelor-Parry³

et al. 2023

Surgery Open Science

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“…Since the introduction of antimicrobial-coated catheters, infection rates of less than 2% have been reported at many centers [ 24 – 29 ]. The single most important risk factor for CSF infection in patients with EVD/LD is the duration of external CSF diversion [ 21 , 23 , 30 – 32 ]. This factor is not influenced by the HeMoVal study, since the indications for insertion and removal of CSF diversion devices are made independent of the study exclusively based on clinical criteria assessed by the independent treating physician (e.g., increased intracranial pressure, need for pressure monitoring).…”

Section: Discussionmentioning

confidence: 99%

“…The HeMoVal study increases the number of manipulations of the EVD/LD system compared to clinical routine due to the daily sampling regimen. Evidence regarding the existence, strength, and causality of an association between such manipulations and the incidence of CSF infections is sparse and inconclusive [ 21 , 23 , 30 – 39 ], but theoretically an increased risk of infection with each manipulation must be assumed. However, strict adherence to aseptic techniques limits this risk to an absolute minimum [ 40 – 42 ].…”

Section: Discussionmentioning

confidence: 99%

The HeMoVal study protocol: a prospective international multicenter cohort study to validate cerebrospinal fluid hemoglobin as a monitoring biomarker for aneurysmal subarachnoid hemorrhage related secondary brain injury

et al. 2022

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Introduction Preclinical studies provided a strong rationale for a pathophysiological link between cell-free hemoglobin in the cerebrospinal fluid (CSF-Hb) and secondary brain injury after subarachnoid hemorrhage (SAH-SBI). In a single-center prospective observational clinical study, external ventricular drain (EVD) based CSF-Hb proved to be a promising biomarker to monitor for SAH-SBI. The primary objective of the HeMoVal study is to prospectively validate the association between EVD based CSF-Hb and SAH-SBI during the first 14 days post-SAH. Secondary objectives include the assessment of the discrimination ability of EVD based CSF-Hb for SAH-SBI and the definition of a clinically relevant range of EVD based CSF-Hb toxicity. In addition, lumbar drain (LD) based CSF-Hb will be assessed for its association with and discrimination ability for SAH-SBI. Methods HeMoVal is a prospective international multicenter observational cohort study. Adult patients admitted with aneurysmal subarachnoid hemorrhage (aSAH) are eligible. While all patients with aSAH are included, we target a sample size of 250 patients with EVD within the first 14 day after aSAH. Epidemiologic and disease-specific baseline measures are assessed at the time of study inclusion. In patients with EVD or LD, each day during the first 14 days post-SAH, 2 ml of CSF will be sampled in the morning, followed by assessment of the patients for SAH-SBI, co-interventions, and complications in the afternoon. After 3 months, a clinical follow-up will be performed. For statistical analysis, the cohort will be stratified into an EVD, LD and full cohort. The primary analysis will quantify the strength of association between EVD based CSF-Hb and SAH-SBI in the EVD cohort based on a generalized additive model. Secondary analyses include the strength of association between LD based CSF-Hb and SAH-SBI in the LD cohort based on a generalized additive model, as well as the discrimination ability of CSF-Hb for SAH-SBI based on receiver operating characteristic (ROC) analyses. Discussion We hypothesize that this study will validate the value of CSF-Hb as a biomarker to monitor for SAH-SBI. In addition, the results of this study will provide the potential base to define an intervention threshold for future studies targeting CSF-Hb toxicity after aSAH. Study registration ClinicalTrials.gov Identifier NCT04998370. Date of registration: August 10, 2021.

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“…Numerous bundles that target the prevention of ventriculitis in patients with EVD have been defined [70][71][72][73]. They typically feature protocolization of various aspects of care, including choice of EVD (e.g., antibiotic-impregnated), prophylactic and periprocedural antibiotics, skin preparation, aseptic and operative techniques, EVD tunneling distance, maintenance cares (e.g., sampling frequency, monitoring, disconnections), and infection surveillance.…”

Section: Prevention Bundlesmentioning

confidence: 99%

“…They typically feature protocolization of various aspects of care, including choice of EVD (e.g., antibiotic-impregnated), prophylactic and periprocedural antibiotics, skin preparation, aseptic and operative techniques, EVD tunneling distance, maintenance cares (e.g., sampling frequency, monitoring, disconnections), and infection surveillance. Benefits ranging from reduced rates of ventriculitis to shorter duration and fewer doses of antibiotics without an increase in ventriculitis and reduced rates of multiresistant organism infections have been reported from the use of bundles [70][71][72][73]. With the absence of harm and possibility of benefit, institutions that manage patients with EVDs should strongly consider the adoption of a protocolized bundle aimed at preventing ventriculitis.…”

Section: Prevention Bundlesmentioning

confidence: 99%

Ventriculitis: Infection or Inflammation

2021

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Ventriculitis, or infection of the cerebrospinal fluid, in the presence of external ventricular drains (EVD), is an important complication and associated with substantial mortality, morbidity, and healthcare costs. Further, the conditions that require the insertion of an EVD, such as neurotrauma and subarachnoid hemorrhage, are themselves associated with inflammation of the cerebrospinal fluid. Phenotypically, patients with inflammation of the cerebrospinal fluid can present with very similar symptoms, signs, and laboratory findings to those with infection. This review examines various controversies relating to the definitions, diagnosis, challenges of differentiating infection from inflammation, prevention, and treatment of ventriculitis in patients with EVDs.

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The implementation of an external ventricular drain care bundle to reduce infection rates

Cited by 18 publications

References 19 publications

Adverse financial and clinical burden of the use of prophylactic antibiotics in neurosurgical patients

Adverse financial and clinical burden of the use of prophylactic antibiotics in neurosurgical patients

The HeMoVal study protocol: a prospective international multicenter cohort study to validate cerebrospinal fluid hemoglobin as a monitoring biomarker for aneurysmal subarachnoid hemorrhage related secondary brain injury

Ventriculitis: Infection or Inflammation

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