V. 3 N. 3 (2024): simul-action for elevation
Articles

Safe external ventricular drain management for infection prevention and control: a narrative review

PDF (English)
  • Giulia Caroti,
  • Eustachio Parente,
  • Beatrice Meucci
Giulia Caroti
Neurosurgical Intensive Care Unit, Careggi University Hospital, Florence, Italy
Eustachio Parente
Department of Health Professions, Meyer Children’s Hospital IRCCS, Florence, Italy
Beatrice Meucci
Neurosurgical Intensive Care Unit, Careggi University Hospital, Florence, Italy
DOI: https://doi.org/10.36253/if-2788

Pubblicato 2024-09-30

Parole chiave

  • Drain EVD,
  • External ventricular,
  • External Ventricular Catheter,
  • EVD Infection,
  • EVD Cover Dressing

Copyright (c) 2024 Giulia Caroti, Eustachio Parente, Beatrice Meucci

Creative Commons License

TQuesto lavoro è fornito con la licenza Creative Commons Attribuzione 4.0 Internazionale.

Abstract

Introduction: External ventricular drain (EVD) placement is a common neurosurgical procedure. Nurses play a crucial role in care, troubleshooting, and monitoring of EVD-related complications, making their education and training in this area of paramount importance. A well-trained nurse possesses the necessary knowledge and skills to recognize and respond promptly to EVD-related complications, such as infections, bleeding, and blockages. External ventricular drainage is associated with a high rate of nosocomial meningitis. The introduction of a well- implemented EVD care bundle can significantly decrease EVD infection rates. The support of the multi-item bundle for EVD is considered very important to reduce EVD-related infections.
Aim: To summarize the most recent available evidence for the prevention and control of EVD infections.
Methods: Comprehensive literature search had been done using the PubMed (Medline), Embase, CINAHL, and Cochrane databases. The narrative review was performed according to the PRISMA Extension for Scoping Review checklist (PRISMA-ScR).
Results: The query identified 4266 studies; after duplicate removal and exclusion of papers due to non-pertinent criteria, 26 studies were included. Only three papers were related to pediatric patients and all were about EVD anchoring. Regarding the risk of infection, bundles and protocols are important for the reduction of the occurrence rate; however, staff adherence to these is fundamental.
Conclusion: Multidisciplinary staff and training are fundamental to improve EVD management. Avoiding routine or daily sampling reduces the EVD infection rate. When the procedure is requested, it is important to follow a strict protocol and to use sterile techniques. Hydrocolloid dressings, SecurAcath, gauze, and film dressings were used to anchor the cover EVD in the studies.

PDF (English)

Riferimenti bibliografici

  1. Sussman ES, Kellner CP, Nelson E, et al. Hemorrhagic complications of ventriculostomy: incidence and predictors in patients with intracerebral hemorrhage. J Neurosurg. 2014;120:931-936.
  2. Srinivasan VM, O’Neill BR, Jho D, Whiting DM, Oh MY. The history of external ventricular drainage. J Neurosurg. 2014;120:228-236.
  3. Rekate HL. A contemporary definition and classification of hydrocephalus. Semin Pediatr Neurol. 2009;16(1):9-15.
  4. Le Roux P, Menon DK, Citerio G, et al. The International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care: evidentiary tables: a statement for healthcare professionals from the Neurocritical Care Society and the European Society of Intensive Care Medicine. Neurocrit Care. 2014;21(suppl 2).
  5. Walker CT, Stone JJ, Jacobson M, et al. Indications for pediatric external ventricular drain placement and risk factors for conversion to a ventriculoperitoneal shunt. Pediatr Neurosurg. 2012;48(6):342–347.
  6. Dorresteijn KRIS, Jellema K, van de Beek D, et al. Factors and measures predicting external CSF drain-associated ventriculitis: a review and meta-analysis. Neurology. 2019;93(22):964–972.
  7. Guanci MM. Ventriculitis of the central nervous system. Crit Care Nurs Clin North Am. 2013 Sep;25(3):399-406.
  8. Dorresteijn KRIS, Brouwer MC, Jellema K, van de Beek D. Bacterial external ventricular catheter-associated infection. Expert Rev Anti Infect Ther. 2020;18(3):219-229.
  9. Ross D, Rosegay H, Pons V. Differentiation of aseptic and bacterial meningitis in postoperative neurosurgical patients. J Neurosurg. 1988;69(5):669–674.
  10. Phan K, Schultz K, Huang C, et al. External ventricular drain infections at the Canberra hospital: a retrospective study. J Clin Neurosci. 2016;32:95–98.
  11. Jamjoom AAB, Joannides AJ, Poon MT, et al. Prospective, multicentre study of external ventricular drainage-related infections in the UK and Ireland. J Neurol Neurosurg Psychiatry. 2018;89(2):120–126.
  12. Gutiérrez-González R, Boto GR, Pérez-Zamarrón Á. Cerebrospinal fluid diversion devices and infection. A comprehensive review. Eur J Clin Microbiol Infect Dis. 2012;31(6):889–897.
  13. Dorresteijn KRIS, Jellema K, van de Beek D, et al. Factors and measures predicting external CSF drain-associated ventriculitis: a review and meta-analysis. Neurology. 2019;93(22):964–972.
  14. Gutierrez-Murgas Y, Snowden JN. Ventricular shunt infections: immunopathogenesis and clinical management. J Neuroimmunol. 2014;276(1–2):1–8.
  15. Rabin N, Zheng Y, Opoku-Temeng C, et al. Biofilm formation mechanisms and targets for developing antibiofilm agents. Future Med Chem. 2015;7(4):493–512.
  16. Lozier AP, Sciacca RR, Romagnoli MF, Connolly E, Sander J. Ventriculostomy-related infections: a critical review of the literature. Neurosurgery. 2002;51:170–82.
  17. Mohammadi E, Hanaei S, Azadnajafabad S, Tayebi Meybodi K, Habibi Z, Nejat F. The effect of external ventricular drain tunneling length on CSF infection rate in pediatric patients: a randomized, double-blind, 3-arm controlled trial. J Neurosurg Pediatr. 2021.
  18. Talibi SS, Silva AH, Afshari FT, et al. The implementation of an external ventricular drain care bundle to reduce infection rates. Br J Neurosurg. 2020 Apr;34(2):181-186.
  19. Ista E, et al. Effectiveness of insertion and maintenance bundles to prevent central-line associated bloodstream infections in critically ill patients of all ages: a systematic review and meta analysis. Lancet Infect Dis. 2016 Jun;16(6):724–734.
  20. Fried HI, Nathan BR, Rowe AS, et al. The Insertion and Management of External Ventricular Drains: An Evidence-Based Consensus Statement: A Statement for Healthcare Professionals from the Neurocritical Care Society. Neurocrit Care. 2016;24(1):61-81.
  21. Resar R, Griffin FA, Haraden C, Nolan TW. Using Care Bundles to Improve Health Care Quality. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2012.
  22. Hong B, Apedjinou A, Heissler HE, et al. Effect of a bundle approach on external ventricular drain-related infection. Acta Neurochir (Wien). 2021 Apr;163(4):1135-1142.
  23. Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467-473.
  24. Fried HI, Nathan BR, Rowe AS et al. The Insertion and Management of External Ventricular Drains: An Evidence-Based Consensus Statement. Neurocrit Care. 2016;24:61–81.
  25. Frassanito P, Massimi L, Tamburrini G, et al. A new subcutaneously anchored device for securing external cerebrospinal fluid catheters: our preliminary experience. World Neurosurg. 2016;93:1-5.
  26. Frassanito P, Auricchio AM, Antonucci J, et al. Securing CSF catheters to the skin: from sutures and bolt system to subcutaneous anchoring device towards zero complications. Childs Nerv Syst. 2020;36(11):2749-2755.
  27. Velásquez C, Rivero-Garvía M, Mayorga-Buiza MJ, et al. Avoiding pullout complications in external ventricular drains: technical note. J Neurosurg. 2017;126(3):1003-1005.
  28. Souza RCS, Siqueira EMP, Meira L, et al. Retaining knowledge of external ventricular drain by nursing professionals. SciELO. 2020;11:1.
  29. Hussein K, Rabino G, Feder O, et al. Risk factors for meningitis in neurosurgical patients with cerebrospinal fluid drains: prospective observational cohort study. Acta Neurochir (Wien). 2019;161(3):517-524.
  30. Hong B, Apedjinou A, Heissler HE, et al. Effect of a bundle approach on external ventricular drain-related infection. Acta Neurochir (Wien). 2021;163(4):1135-1142.
  31. Whyte C, Alhasani H, Caplan R, Tully AP. Impact of an external ventricular drain bundle and limited duration antibiotic prophylaxis on drain-related infections and antibiotic resistance. Clin Neurol Neurosurg. 2020;190:105641.
  32. Walek KW, Leary OP, Sastry R, et al. Decreasing external ventricular drain infection rates in the neurocritical care unit: 12-year longitudinal experience at a single institution. World Neurosurg. 2021;150.
  33. Flint AC, Toossi S, Chan SL, et al. A simple infection control protocol durably reduces external ventricular drain infections to near-zero levels. World Neurosurg. 2017;99:518-523.
  34. Lord AS, Nicholson J, Lewis A. Infection prevention in the neurointensive care unit: a systematic review. Neurocrit Care. 2019;31(1):196-210.
  35. Sieg EP, Schlauderaff AC, Payne RA, et al. Impact of an external ventricular drain placement and handling protocol on infection rates: a meta-analysis and single institution experience. World Neurosurg. 2018;115.
  36. Walek KW, Leary OP, Sastry R, et al. Risk factors and outcomes associated with external ventricular drain infections. Infect Control Hosp Epidemiol. 2022;43(12):1859-1866.
  37. Zakaria J, Jusue-Torres I, Frazzetta J, et al. Effectiveness of a standardized external ventricular drain placement protocol for infection control. World Neurosurg. 2021;151.
  38. Waqar M, Chari A, Islim AI, et al. Chlorhexidine dressings could reduce external ventricular drain infections: results from a systematic review and meta-analysis. J Hosp Infect. 2021;117:37-43.
  39. Flint AC, Toossi S, Chan SL, et al. A simple infection control protocol durably reduces external ventricular drain infections to near-zero levels. World Neurosurg. 2017;99:518-523.
  40. Sakamoto VTM, Vieira TW, Viegas K, et al. Nursing assistance in patient care with external ventricular drain: a scoping review. Rev Bras Enferm. 2021;74(2).
  41. Tunkel AR, Hasbun R, Bhimraj A, et al. 2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. Clin Infect Dis. 2017;64(6)