Implementation of External Ventricular Drain Insertion and Maintenance Protocol Checklist to Reduce Infections in the Pediatric Population

Abstract

BACKGROUND The External Ventricular Drain (EVD) is a device used by neurosurgery to remove cerebrospinal fluid from the brain. Research shows that EVDs are at high risk for infections. Infections in these devices can be devastating and have severe consequences, particularly in the pediatric patient population. Our goal is to provide a multidisciplinary protocol to standardize both the insertion and maintenance of the EVD to reduce external ventricular drain-associated infections. By providing these new guidelines, we surmise that infections will decrease and patients will experience better outcomes. METHODS An interdisciplinary team of physicians and nurses from the Neurosurgical, Infectious Disease and Critical Care fields collaborated to produce a comprehensive checklist regarding care of EVDs. This checklist will be followed by care providers (physicians and bedside nurses) when they manage an EVD. This form provides guidance during preoperative, intraoperative, and postoperative procedures and for dressing changes and CSF sampling. It will be kept in the patient's chart and filled out each time an EVD is placed or manipulated. Infection rates among this EVD pediatric population will be monitored and compared to infection rates prior to implementation of this new checklist. RESULTS The rate of EVD/shunt infections identified in the pediatric population decreased from 22% in 2016 prior to initiation of the task force (Dec 2017) to 11% in 2018 and 0 in Q2 and Q3. CONCLUSIONS A team approach including pediatic neurology leads to a standardized checklist bundle and continued attention to practices leads to improved patient outcomes and reduced infections in the pediatric population.