Effectiveness of a multimodal strategy to reduce external ventricular drain–associated infection: A quasi-experimental study - 18/10/24

Doi : 10.1016/j.ajic.2024.06.026

Chaiwat Pongkaew, MD ^a, Raywat Noiphithak, MD ^b, Pataravit Rukskul, MD ^b, Pornchai Yodwisithsak, MD ^b, Dilok Tantongtip, MD ^b, Pree Nimmannitya, MD ^b, Prachya Punyarat, MD ^b, Gahn Duangprasert, MD ^b, Wadrawee Kaewwichai, RN ^c, Sirada Songphul, RN ^d, Watcharee Chancharoenrat, RN ^e, Kittiya Jantarathaneewat, PharmD ^f,^g, Chattrabongkot Chokaouychai, MD ^b, Sasikan Sukhor, MD ^b, Piyaporn Apisarnthanarak, MD ^h, Bernard C. Camins, MD ⁱ, David J. Weber, MD ^j, Anucha Apisarnthanarak, MD ^a,^e,^⁎
^a Division of Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Khlong Luang, Pathum Thani, Thailand
^b Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Thammasat University, Khlong Luang, Pathum Thani, Thailand
^c Neurosurgical Intensive Care Unit, Nursing Department, Thammasat University Hospital, Khlong Luang, Pathum Thani, Thailand
^d General Neurosurgical Unit, Nursing Department, Thammasat University Hospital, Khlong Luang, Pathum Thani, Thailand
^e Infection Control Department, Thammasat University Hospital, Khlong Luang, Pathum Thani, Thailand
^f Research Group in Infectious Diseases Epidemiology and Prevention, Faculty of Medicine, Thammasat University, Khlong Luang, Pathum Thani, Thailand
^g Department of Pharmaceutical Care, Faculty of Pharmacy, Thammasat University, Khlong Luang, Pathum Thani, Thailand
^h Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
ⁱ Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
^j University of North Carolina, Gillings School of Global Public Health, Chapel Hill, NC, USA

^⁎Address correspondence to Anucha Apisarnthanarak, MD, Division of Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Khlong Luang, Pathum Thani, Thailand.Division of Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Thammasat UniversityKhlong LuangPathum ThaniThailand

Résumé

Background

Infection is a serious complication in neurosurgical patients who undergo external ventricular drain (EVD) insertion.

Methods

We conducted a quasi-experimental study in patients who underwent EVD insertion to evaluate the impact of a multi-modal strategy to reduce the incidence of external ventricular drain associated infections (EVDAIs). The study was divided into 2 periods; (1) the pre-intervention period when techniques for EVD insertion and maintenance were up to the discretion of the neurosurgeons and (2) the post-intervention after implementation of a multi-modal strategy (cefazolin antibiotic prophylaxis, preoperative chlorhexidine showers, application of postoperative chlorhexidine-impregnated dressing, limited manipulation of the EVD, and meticulous EVD management). The primary outcome was the incidence rate of EVDAIs; secondary outcomes included in-hospital mortality rate, the hospital length of stay.

Results

In total, 135 patients were included. The incidence rate of EVDAIs was significantly reduced in the post-intervention period (5.6 cases/1,000 EVD-days) compared with the pre-intervention period (18.2 cases/1,000 EVD-days; P=0.026). There were no differences in all secondary outcomes analyzed. This multi-modal strategy was associated with high satisfaction among health care personnel.

Conclusions

Implementation of a multi-modal strategy was associated with a reduction in the incidence of EVDAIs. This was in line with our goal of promoting a new culture of safety despite being in a resource-limited setting.

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Highlights

•	Multi-modal strategy reduced EVDAI rates.
•	Multi-modal strategy did not reduce the hospital length of stay and the mortality.
•	Multi-modal strategy can be implemented without barriers by neurosurgical staff.

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Key Words : Bundle, Infection prevention, Healthcare-associated infections, Resource-limited settings, Neurosurgery

Plan

Background

Methods

Study design and population

Preintervention period

Implementation and training period

Postintervention period

Primary and secondary outcomes

Compliance to the multimodal strategy

Discussion

Limitations

Conclusions

	Funding/support: This work was supported by the Thailand Science Research and Innovation Fundamental Fund fiscal year 2024: Fiscal year 2024.
	Conflicts of interest: None to report.

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Vol 52 - N° 11

P. 1307-1313 - novembre 2024 Retour au numéro

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Effectiveness of a multimodal strategy to reduce external ventricular drain–associated infection: A quasi-experimental study - 18/10/24

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Methods

Results

Conclusions

Highlights

Plan

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