title: Prospective Evaluation of Ventriculostomy Infections.
abstract: BACKGROUND
  Hospital-acquired infections associated with external drainage of ventricular cerebrospinal fluid (CSF) are a significant source of concern for the patients and the provider team alike. Traditional rates of ventriculostomy infection range from 10-17% in a time-dependent fashion. Changing physician and nursing practices fueled this concern over infections.
  
  
  OBJECTIVE
  We sought to prospectively identify the risk factors associated with ventriculostomy infections as part of a quality assurance project.
  
  
  METHODS
  One hundred consecutive patients were evaluated and data were collected on 91. The primary indications for ventriculostomy were subarachnoid hemorrhage (46%), intracerebral hemorrhage (24%), and trauma (22%). Variables prospectively evaluated included pre-incision antibiotics, sterile technique bundling, setting of placement (operating room versus intensive care unit), experience of operator (attending, resident, or physician assistant), catheter type (antibiotic impregnated or not), use of a post-insertion dressing, and in-dwell time of the catheter.
  
  
  RESULTS
  There was only one infection in 91 patients (1.1%). This infection occurred in a patient without an antibiotic-impregnated catheter that was inserted by a resident physician. Compliance with pre-insertion antibiotics was very high, but most other variables had modest deviations in compliance.
  
  
  CONCLUSIONS
  Infection rate related to external ventricular drainage is very low. Our data suggest that non-antibiotic impregnated catheters may be associated with infection, but that other variables thought to be critical may be of less value.
authors.affiliation: Department of Emergency Medicine, New York Presbyterian Hospital, University Hospital of Columbia and Cornell.
authors.forename: Emmagene
authors.initials: E
authors.lastname: Worley
authors.affiliation: Department of Nursing, Inova Fairfax Hospital.
authors.forename: Sonia
authors.initials: S
authors.lastname: Astle
authors.affiliation: Department of Neurosurgery, Virginia Commonwealth University.
authors.forename: Joe C
authors.initials: JC
authors.lastname: Watson
keywords: critical care; external ventricular drain; meningitis; ventriculitis