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.
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.
All patients who received EVD or LD from JanApril 2004 (period I), AugDec 2004 (period II), and JanMay 2005 (period III).
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: 0.031.7) and for the EVD with 0.7 (95%-CI: 0.22.2). 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.
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 name:||XXIst ISTH Congress|
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