Introduction: Ventriculitis related to external ventricular drain (EVD) placement is a significant source of morbidity among neurological intensive care patients. Current rates of EVD-related infections generally range between 2 – 45% in the literature (1,2).

Methods: We tracked ventriculitis rates via cerebrospinal fluid cultures among 259 patients whose EVD sites were dressed with sterile bio-occlusive dressings and underwent routine sterile dressing exchanges every 48 hours; and we tracked an additional 113 patients whose EVD sites were dressed one time with a liquid polymer sealant (Dermabond).

Results: Patients with standard bio-occlusive dressings and wound care had a 15.1% ventriculitis rate, while patients with a onetime liquid polymer sealant dressing had a 3.54% ventriculitis rate (p = 0.002)(Figure 1). Staphylococcus epidermidis accounted for 79.5% of ventriculitises among patients with bio-occlusive dressings and routine wound care, while S. epidermidis represented 25.0% of ventriculitises among patients with a liquid polymer sealant dressing (p = 0.0455).

Conclusions: The one time application of Dermabond to EVD wounds and exit sites provides a superior protection against EVD-related ventriculitis than conventional EVD site wound care. Likely this superior prophylaxis results from the blockage of skin flora migration along the EVD exit tract.

Patient Care: This research provides good evidence that liquid polymer dressings may provide superior protection from skin flora-derived ventricular catheter infections. Prevention of these catheter-related ventriculitises would result in a significant reduction in neuro-intensive care unit morbidity.

Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the relevant risk factors for ventricular drain infections, 2) Identify methods of reducing ventricular drain infections, 3) Describe the effect of cyanoacrylate polymer dressings in ventriculitis rates.

References: 1) Camacho E, et al. “Infection rate and risk factors associated with infections related to external ventricular drain.” Infection 39:47-51, 2011 2) Park P, et al. “Risk of infection with prolonged ventricular catheterization.” Neurosurgery 55:594-599, 2004