title: Use of a cyanoacrylate skin adhesive to reduce external ventricular drain infection rates.
abstract: OBJECT.: Ventriculitis related to external ventricular drain (EVD) placement is a significant source of morbidity in neurological intensive care patients. Current rates of EVD-related infections range from 2% to 45% in the literature. The authors sought to determine if a 2-octyl cyanoacrylate adhesive would result in lower infection rate than standard semiocclusive dressings.
  
  
  METHODS
  The authors tracked ventriculitis rates via CSF cultures among 259 patients whose EVD sites were dressed with sterile semiocclusive dressings and underwent routine sterile dressing exchanges every 48 hours. They analyzed data obtained in an additional 113 patients whose EVD sites were dressed one time with a surgical adhesive, 2-octyl cyanoacrylate.
  
  
  RESULTS
  Ventriculitis rate in patients with standard bioocclusive dressings and wound care was 15.1%, whereas that in patients with a 2-octyl cyanoacrylate dressing was 3.54% (p = 0.002). Staphylococcus genus accounted for 79.5% of instances of ventriculitis among patients with bioocclusive dressings and routine wound care, whereas it accounted for 25.0% of the instances of ventriculitis among patients with a liquid polymer sealant dressing. A 90% reduction in Staphylococcus infection completely accounts for the observed effect (p = 0.04).
  
  
  CONCLUSIONS
  The one-time application of 2-octyl cyanoacrylate to EVD wounds and exit sites provided superior protection against EVD-related ventriculitis compared to conventional EVD-site wound care. Likely this protection results from a barrier to the entry of gram-positive skin flora along the EVD exit tract. The results should be validated in a randomized trial.
authors: Children's Healthcare of Atlanta, Georgia;
authors: Markus J
authors: MJ
authors: Bookland
authors: Vishad
authors: V
authors: Sukul
authors: Patrick J
authors: PJ
authors: Connolly
mesh_terms: D000368:Aged; D002408:Catheters, Indwelling / Q000382:microbiology*; D002552:Cerebral Ventricles / Q000382:microbiology / Q000601:surgery*; D058565:Cerebral Ventriculitis / Q000517:prevention & control*; D003487:Cyanoacrylates / Q000627:therapeutic use*; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies
chemical_list: D003487:Cyanoacrylates
keywords: AUC = area under the curve; CDC = Centers for Disease Control and Prevention; EVD = external ventricular drain; GCS = Glasgow Coma Scale; RBC = red blood cell; ROC = receiver operating characteristic; WBC = white blood cell; cyanoacrylate skin adhesive; external ventricular drainage; iatrogenic infection; ventriculitis