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Decrease of external ventricular or lumbar drain related infections by a multidisciplinary approach

Abstract number: o273

Leverstein-van Hall  M.A., Hopmans  T.E.M., Blok  H.E.M., Berkelbach van der Sprenkel  J.W., Bonten  M.J.M.

Introduction: 

Extraventricular (EVD) and lumbar drains (LD) are important temporary measures for patients requiring continuous cerebrospinal fluid (CSF) drainage. Reported incidences of drain related meningitis have varied from 2.4 to 15%. In the UMCU, microbiologically confirmed CSF infections in patients with EVD/LD increased from 28% in 2001 to 47% in 2003. The aim of this prospective study was to reduce the incidence of drain-related meningitis to less than 10% in 2005.

Patients: 

All patients who received EVD or LD from Jan–April 2004 (period I), Aug–Dec 2004 (period II), and Jan–May 2005 (period III).

Interventions: 

A multidisciplinary team (neurosurgery, clinical microbiology, and hospital hygiene) designed a strategy based on 4 pillars: (1) implementation of drain management protocols for medical and nursing staff based on the "no-touch" concept, optimal hygiene and strict criteria for placement and removal of drains, (2) implementation of an algorithm on diagnostic and therapeutic management of patients suspect of drain-related meningitis, (3) implementation of a new protocol on pre-operative prophylaxis, (4) introduction of a closed drain system. Results are depicted in the table. The decrease of the infection rate in period III versus I was more pronounced for ELD than for EVD. The RR to acquire an infection per 100 days at risk decreased for the ELD with 0.2 (95%-CI: 0.03–1.7) and for the EVD with 0.7 (95%-CI: 0.2–2.2). From period I to III a sharp shift was observed in the kind of micro-organisms isolated from the CSF; in period III the typical nosocomial pathogens had disappeared.

Conclusions: 

The incidence of drain-related meningitis has decreased from 39% in 2003 to less than 10% in 2005. Awareness of the problem and the interventions performed in 2004 were probably important causative factors in this reduction. Adequate prophylaxis remains a point of concern and new strategy seems needed for improvement.

Session Details

Date: 01/08/2007
Time: 00:00-00:00
Session name: XXIst ISTH Congress
Subject:
Location: Oxford, UK
Presentation type:
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