title: A Simple Infection Control Protocol Durably Reduces External Ventricular Drain Infections to Near-Zero Levels.
abstract: OBJECTIVE
  External ventricular drains (EVDs) historically have a high rate of infection, and EVD infections are a cause of significant morbidity and mortality. We have shown previously that a simple infection control protocol reduced the rate of EVD infections during a 3-year period, and the present study examines whether infection rates were durably reduced over an additional 4 years.
  
  
  METHODS
  Retrospective analysis of EVDs placed in the intensive care unit of a tertiary neurosurgical center over an additional 4 year follow-up period.
  
  
  RESULTS
  In the 4-year follow-up period, 189 EVDs were placed in 173 patients. The previously observed decrease in cerebrospinal fluid culture positivity from 9.8% in the baseline period to 0.8% in the first 3 years of the protocol period continued in the 4-year follow-up period (0%, 0 of 189 EVD placements, 0 per 1000 catheter-days; P < 0.001 compared with baseline). The previously observed decrease in the rate of ventriculitis from 6.3% to 0.8% also continued in the follow-up period (0%, 0 of 189 EVD placements, 0 per 1000 catheter-days; P < 0.001 compared with baseline). Over the total 7 years of protocol use, the rate of culture positivity was 0.3% (1 of 308 EVD placements, 0.29 per 1000 catheter-days) and the rate of ventriculitis was 0.3% (1 of 308 EVD placements, 0.29 per 1000 catheter-days). The only observed infection over 7 years occurred in a patient who removed their own EVD.
  
  
  CONCLUSIONS
  A straightforward EVD infection control protocol substantially and durably reduces EVD infections to a near-zero rate.
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California, USA; Department of Neuroscience, Kaiser Permanente, Redwood City, California, USA. Electronic address: alexander.c.flint@kp.org.
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Flint
authors.affiliation: Department of Neurology, University of California, San Francisco, San Francisco, California, USA.
authors.forename: Shahed
authors.initials: S
authors.lastname: Toossi
authors.affiliation: Department of Neuroscience, Kaiser Permanente, Redwood City, California, USA.
authors.forename: Sheila L
authors.initials: SL
authors.lastname: Chan
authors.affiliation: Department of Neuroscience, Kaiser Permanente, Redwood City, California, USA.
authors.forename: Vivek A
authors.initials: VA
authors.lastname: Rao
authors.affiliation: Department of Neuroscience, Kaiser Permanente, Redwood City, California, USA.
authors.forename: William
authors.initials: W
authors.lastname: Sheridan
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D001458:Bandages; D055499:Catheter-Related Infections / Q000517:prevention & control*; D058565:Cerebral Ventriculitis / Q000517:prevention & control*; D002710:Chlorhexidine / Q000627:therapeutic use; D002985:Clinical Protocols; D005260:Female; D006204:Hair Removal; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D017792:Surgical Stapling; D014696:Ventriculostomy / Q000295:instrumentation / Q000379:methods*
chemical_list: D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine
keywords: External ventricular drain; Infection control; Intensive care unit; Patient safety