Effectiveness of a multimodal strategy to reduce external ventricular drain–associated infection: A quasi-experimental study

Chaiwat Pongkaew, Raywat Noiphithak, Pataravit Rukskul, Pornchai Yodwisithsak, Dilok Tantongtip, Pree Nimmannitya, Prachya Punyarat, Gahn Duangprasert, Wadrawee Kaewwichai, Sirada Songphul, Watcharee Chancharoenrat, Kittiya Jantarathaneewat, Chattrabongkot Chokaouychai, Sasikan Sukhor, Piyaporn Apisarnthanarak, Bernard C. Camins, David J. Weber, Anucha Apisarnthanarak

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Infection is a serious complication in neurosurgical patients who undergo external ventricular drain (EVD) insertion. Methods: We conducted a quasi-experimental study in patients who underwent EVD insertion to evaluate the impact of a multi-modal strategy to reduce the incidence of external ventricular drain associated infections (EVDAIs). The study was divided into 2 periods; (1) the pre-intervention period when techniques for EVD insertion and maintenance were up to the discretion of the neurosurgeons and (2) the post-intervention after implementation of a multi-modal strategy (cefazolin antibiotic prophylaxis, preoperative chlorhexidine showers, application of postoperative chlorhexidine-impregnated dressing, limited manipulation of the EVD, and meticulous EVD management). The primary outcome was the incidence rate of EVDAIs; secondary outcomes included in-hospital mortality rate, the hospital length of stay. Results: In total, 135 patients were included. The incidence rate of EVDAIs was significantly reduced in the post-intervention period (5.6 cases/1,000 EVD-days) compared with the pre-intervention period (18.2 cases/1,000 EVD-days; P=0.026). There were no differences in all secondary outcomes analyzed. This multi-modal strategy was associated with high satisfaction among health care personnel. Conclusions: Implementation of a multi-modal strategy was associated with a reduction in the incidence of EVDAIs. This was in line with our goal of promoting a new culture of safety despite being in a resource-limited setting.

Original languageEnglish
Pages (from-to)1307-1313
Number of pages7
JournalAmerican Journal of Infection Control
Volume52
Issue number11
DOIs
StatePublished - Nov 2024

Keywords

  • Bundle
  • Healthcare-associated infections
  • Infection prevention
  • Neurosurgery
  • Resource-limited settings

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