A bundle approach to reduce the incidence of external ventricular and lumbar drain-related infections

Clinical article

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Object

An important complication of external CSF drainage is bacterial meningitis or ventriculitis, resulting in increased morbidity, mortality, and health care costs. In 2003, a high rate (37%) of probable drain-related infections was identified at the authors' hospital. A multidisciplinary working group was installed to reduce this incidence to < 10% within 1.5 years.

Methods

An intervention strategy based on 5 pillars (increased awareness, focused standard operating procedures, a diagnostic and therapeutic algorithm, timely administration of prophylaxis, and improvement of the drainage system) was designed and implemented from 2004 to 2006. During this period all patients with external CSF drainage were prospectively monitored.

Results

Between 2004 and 2006, there were 467 patients in whom 579 drains (external ventricular and external lumbar) had been placed. The overall incidence of drain-related infections was 16.2% in 2004, 8.9% in 2005, and 11.3% in 2006. For external lumbar drains the number of infections per 100 drain days was 2.4 in 2004, 0.6 in 2005, and 0.8 in 2006. For external ventricular drains these rates were 1.7, 1.0, and 1.2, respectively. Meanwhile, the causative noncutaneous microorganisms, indicative for systemic-contamination during manipulation, decreased. By retrospective analysis, the proportion of patients with a probable drain-related infection decreased from 37% in 2003 to 9% in 2005 and 2006.

Conclusions

The authors' multidisciplinary approach in which different preventive measures were combined was associated with a significant reduction in the incidence of drain-related secondary meningitis, and thus provides an important improvement of patient safety.

Abbreviations used in this paper: CNS = coagulase-negative staphylococci; ELD = external lumbar drain; EVD = external ventricular drain; ICU = intensive care unit; SOP = standard operating procedure.
Article Information

Contributor Notes

Address correspondence to: Maurine A. Leverstein-van Hall, M.D., Ph.D., Department of Microbiology, Infectious Diseases and Inflammation, University Medical Center Utrecht, HP G04.614, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. email: M.LeversteinvHall@umcutrecht.nl.Please include this information when citing this paper: published online July 31, 2009; DOI: 10.3171/2009.6.JNS09223.
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