Reducing external drainage-related cerebrospinal fluid infections through implementation of a multidisciplinary protocol: experience in a paediatric hospital.
OBJECTIVE
To assess the frequency of external cerebrospinal fluid (CSF) drain-related CNS infections before and after implementation of a protocol for their prevention.


METHODS
Quasi-experimental study, with comparison of incidence before and after the implementation of the intervention.


METHODS
Bambino Gesù Children's Hospital in Rome, Italy. Children receiving an external cerebrospinal fluid drain from 1 January 2013 to 31 March 2015.


METHODS
Drain-related infections.


RESULTS
Fifty-two patients were included in the study. Before protocol implementation, cumulative incidence was 14 per 100 drains. Incidence rate was 8/1,000 catheter-days. After protocol implementation, cumulative incidence and incidence rate were 6.7 per 100 drains and 4.6 per 1,000 catheter-days (p=0.61 and p=0.2 versus the pre-intervention period, respectively). Infected patients were significantly younger (median age: 16.5 days vs 13.4 months; p=0.026), had a significantly higher number of procedures (5 vs 1 procedure per patient; p <0.0001) and were most frequently affected by post-haemorrhagic hydrocephalus of premature newborns (50% vs 16.7%; p=0.039), compared to non-infected patients.


CONCLUSIONS
After protocol implementation, we observed a reduction of incidence of CSF drain-related infections, though the short post-intervention period limited the power of the study to detect a significant difference. Patients <1 year of age, with multiple interventions and post-haemorrhagic hydrocephalus had higher risk of CSF drain-related infections.
Direzione sanitaria, Ospedale Pediatrico Bambino Gesù, Roma, Italy.|Unità Sanità pubblica, Dip. Scienze biomediche, biotecnologiche e traslazionali, Università di Parma, Italy.
Veronica
V
Ciorba
Direzione sanitaria, Ospedale Pediatrico Bambino Gesù, Roma, Italy.
Gaetano
G
Ciliento
U.O. Epidemiologia clinica, Direzione sanitaria, Ospedale Pediatrico Bambino Gesù, Roma, Italy. marta.ciofidegliatti@opbg.net.
Marta Luisa
ML
Ciofi Degli Atti
D019072:Antibiotic Prophylaxis; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000517:prevention & control*; D058565:Cerebral Ventriculitis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects* / Q000295:instrumentation; D002985:Clinical Protocols; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006470:Hemorrhage / Q000150:complications; D006776:Hospitals, Pediatric; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000601:surgery; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control / Q000601:surgery; D033183:Interdisciplinary Communication; D008581:Meningitis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D015397:Program Evaluation; D012189:Retrospective Studies; D012384:Rome