TY - JOUR
T1 - Effectiveness of a multimodal strategy to reduce external ventricular drain–associated infection
T2 - A quasi-experimental study
AU - Pongkaew, Chaiwat
AU - Noiphithak, Raywat
AU - Rukskul, Pataravit
AU - Yodwisithsak, Pornchai
AU - Tantongtip, Dilok
AU - Nimmannitya, Pree
AU - Punyarat, Prachya
AU - Duangprasert, Gahn
AU - Kaewwichai, Wadrawee
AU - Songphul, Sirada
AU - Chancharoenrat, Watcharee
AU - Jantarathaneewat, Kittiya
AU - Chokaouychai, Chattrabongkot
AU - Sukhor, Sasikan
AU - Apisarnthanarak, Piyaporn
AU - Camins, Bernard C.
AU - Weber, David J.
AU - Apisarnthanarak, Anucha
N1 - Publisher Copyright:
© 2024 Association for Professionals in Infection Control and Epidemiology, Inc.
PY - 2024/11
Y1 - 2024/11
N2 - 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.
AB - 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.
KW - Bundle
KW - Healthcare-associated infections
KW - Infection prevention
KW - Neurosurgery
KW - Resource-limited settings
UR - http://www.scopus.com/inward/record.url?scp=85198549375&partnerID=8YFLogxK
U2 - 10.1016/j.ajic.2024.06.026
DO - 10.1016/j.ajic.2024.06.026
M3 - Article
C2 - 38969072
AN - SCOPUS:85198549375
SN - 0196-6553
VL - 52
SP - 1307
EP - 1313
JO - American Journal of Infection Control
JF - American Journal of Infection Control
IS - 11
ER -