title: Reduction in external ventricular drain infection rate. Impact of a minimal handling protocol and antibiotic-impregnated catheters.
abstract: BACKGROUND
  Many strategies have been developed with the aim of reducing external ventricular drain-related infections. Antibiotic-impregnated catheters are one of them.
  
  
  METHODS
  We report 648 cases of external ventricular drain from a total of 534 patients treated at the Virgen del Rocío Hospital between 1995 and 2006. Three subgroups were considered: group 1 included patients treated between 1995 and 2000, as well as a total of 190 external ventricular drains and 59 cases of infection (31.05%); group 2, with patients treated between 2000 and 2004 and managed with a minimal handling protocol, included 210 external ventricular drains and nine cases of infection (4.29%); and group 3, treated between 2004 and 2006, with 248 external ventricular drains and six cases of infection (2.41%). This latter subgroup included patients managed with a minimal handling protocol and antibiotic-impregnated catheters.
  
  
  RESULTS
  Infection rate was 17% when non-antibiotic-impregnated catheters were employed and 2.41% when antibiotic-impregnated catheters were inserted (p < 0.001). This difference was statistically significant before and after the introduction of a minimal handling protocol, with percentages of 5.31% and 3.27%, respectively (p < 0.001; odds ratio 0.08; absolute risk reduction 27.26%). However, no statistically significant difference was observed in infection rate when the impact of a minimal handling protocol was considered: 4.29% when only the protocol was introduced and 2.41% when both the protocol and antibiotic-impregnated catheters were used (p > 0.05).
  
  
  CONCLUSIONS
  Minimal handling protocols constitute an essential strategy in the reduction of external ventricular drain-related infections. Besides that, the use of antibiotic-impregnated catheters may reduce infection-related hospital costs.
authors.affiliation: Department of Neurosurgery, Hospital Virgen del Rocío, C/Manuel Siurot s/n, 41013, Seville, Spain. monicargarvia@msn.com
authors.forename: Mónica
authors.initials: M
authors.lastname: Rivero-Garvía
authors.forename: Javier
authors.initials: J
authors.lastname: Márquez-Rivas
authors.forename: Manuel Enrique
authors.initials: ME
authors.lastname: Jiménez-Mejías
authors.forename: Olaf
authors.initials: O
authors.lastname: Neth
authors.forename: Ana Belén
authors.initials: AB
authors.lastname: Rueda-Torres
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D002408:Catheters, Indwelling / Q000382:microbiology*; D002555:Cerebrospinal Fluid / Q000382:microbiology; D002557:Cerebrospinal Fluid Shunts / Q000295:instrumentation*; D002981:Clindamycin / Q000008:administration & dosage*; D020099:Coated Materials, Biocompatible; D003428:Cross Infection / Q000517:prevention & control*; D004866:Equipment Contamination / Q000517:prevention & control*; D006801:Humans; D012293:Rifampin / Q000008:administration & dosage*; D013203:Staphylococcal Infections / Q000517:prevention & control*; D013211:Staphylococcus aureus; D013212:Staphylococcus epidermidis; D013530:Surgical Wound Infection / Q000517:prevention & control*; D014640:Vancomycin / Q000008:administration & dosage*
chemical_list: D000900:Anti-Bacterial Agents; D020099:Coated Materials, Biocompatible; D002981:Clindamycin; D014640:Vancomycin; D012293:Rifampin