Impact of an External Ventricular Drain Placement and Handling Protocol on Infection Rates: A Meta-Analysis and Single Institution Experience.

Impact of an External Ventricular Drain Placement and Handling Protocol on Infection Rates: A Meta-Analysis and Single Institution Experience.

World Neurosurg. 2018 Apr 02;:

Authors: Sieg EP, Schlauderaff AC, Payne RA, Glantz MJ, Simon SD

Abstract
BACKGROUND: Numerous studies have looked at the impact of initiating an External Ventricular Drain (EVD) placement and handling protocols on infection rate dating back to the early 2000s.
METHODS: We performed a quantitative systematic review of the published literature; and, created our own protocol (including a mandatory checklist); and, present our single institution experience. Search terms "external ventricular drain protocol" or "external ventricular drain placement protocol" or "preventing infections in external ventricular drains" or "external ventricular drain infections" were entered into standard search engines in a systematic fashion. Articles were reviewed and graded independently for class of evidence. There were 10 relevant class IV articles and no discrepancies among article ratings (i.e., kappa=1). The published evidence was reviewed and evaluated using the GRADE criteria.
RESULTS: Meta-analysis showed a statistically significant drop in EVD infection rates with protocol initiation, although the overall quality of the body of evidence according to GRADE criteria was "very poor". Pre and Post-implementation infection rates were collected and analyzed in combination with the results from the literature review. In the eight months before protocol initiation (January 2015 to August 2015) our institution had a 12% infection rate; and dropped to 0% in the seven months following initiation.
CONCLUSIONS: While the quality of the literature supporting external ventricular drain placement protocols is poor, there is a consistent and substantial benefit in all published studies and this effect was recapitulated in our own meta-analysis-based prospective EVD protocol experience.

PMID: 29621608 [PubMed - as supplied by publisher]

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