Introduction: External ventricular drains (EVD) are a common neurosurgical procedure performed that provides critical benefit to the patient, but carries the risk of infection, reportedly between 0 and 20% (1). While studying the effect of improvements in EVD procedures is challenging, studies have demonstrated reductions in infection rates after bundles (2-4). Measuring compliance with new protocols can also be challenging, but electronic databases can aid in compliance and ease tracking. Additionally, these databases offer the ability to recruit multiple institutions and pool data to evaluate variation in technique on infection rate.
Methods: A literature search was used to find existing EVD protocols and related techniques to improve infections. The literature review was used to establish an evidenced-based protocol. A REDcap database was made to reflect essential steps within the protocol, along with easy access via a Quick Response code. An IRB was approved to track retrospective and prospective EVD infection rates. Multicenter implementation took place.
Results: Fourteen articles were reviewed and used to create a 21 step protocol. A REDcap database was created and accessible from any location for secure data entry. Comprehensive implementation was completed with presentations and through creation of junior resident education materials including point-of-view video of optimal EVD technique. An EVD committee was formed to track the infection rate and transition the database to be used as a template for outside institutions. A recruitment package was created to facilitate adoption by other institutions, which includes template IRB, REDcap database, workflow, and sustainability measures.
Conclusions: There is sufficient evidence in the literature to design a comprehensive EVD protocol. Through planning and available technology, it is possible to develop a novel method of pooling EVD data from multiple institutions in order to test the efficacy of single components of a protocol while creating new methodology for tracking EVD infection rates.
Patient Care: Decrease EVD infection rate, provide optimization of EVD protocol, outreach to other institutions for protocol implementation and tracking.
Learning Objectives: 1) Realize the importance of protocol implementation to improve infection rate in EVD procedures.
2) Acknowledge electronic databases provide up to date information and allow easy analysis of flaws within the protocol.
3) Multicenter approach provides increased data to support protocol implementation and can be easily transferred to various centers.
References: 1) Babu MA, Patel R, Marsh WR, Wijdicks EF. Strategies to decrease the risk of ventricular catheter infections: a review of the evidence. Neurocrit Care. 2012;16(1):194-202.
2) Dasic D, Hanna SJ, Bojanic S, Kerr RS. External ventricular drain infection: the effect of a strict protocol on infection rates and a review of the literature. Br J Neurosurg. 2006;20(5):296-300.
3)Kubilay Z, Amini S, Fauerbach LL, Archibald L, Friedman WA, Layon AJ. Decreasing ventricular infections through the use of a ventriculostomy placement bundle: experience at a single institution. J Neurosurg. 2013;118(3):514-20.
4) Flint AC, Rao VA, Renda NC, Faigeles BS, Lasman TE, Sheridan W. A simple protocol to prevent external ventricular drain infections. Neurosurgery. 2013;72(6):993-9.