Cargando…

External ventriculostomy-associated infection reduction after updating a care bundle

BACKGROUND: Despite the clinical benefits of external ventricular drains (EVD), these devices can lead to EVD-related infections (EVDRI). The drainage insertion technique and standardized guidelines can significantly reduce the risk of infection, mainly caused by gram-positive bacteria. However, gra...

Descripción completa

Detalles Bibliográficos
Autores principales: Rojas-Lora, Mariel, Corral, Luisa, Zabaleta-Carvajal, Ivan, López-Ojeda, Pau, Fuentes-Mila, Verónica, Romera-Peregrina, Iluminada, Lerma-Briansò, Cristina, Plata-Menchaca, Erika, Pavón, Alba, Sabater, Joan, Cabellos, Carmen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10349458/
https://www.ncbi.nlm.nih.gov/pubmed/37454149
http://dx.doi.org/10.1186/s12941-023-00612-z
_version_ 1785073910469885952
author Rojas-Lora, Mariel
Corral, Luisa
Zabaleta-Carvajal, Ivan
López-Ojeda, Pau
Fuentes-Mila, Verónica
Romera-Peregrina, Iluminada
Lerma-Briansò, Cristina
Plata-Menchaca, Erika
Pavón, Alba
Sabater, Joan
Cabellos, Carmen
author_facet Rojas-Lora, Mariel
Corral, Luisa
Zabaleta-Carvajal, Ivan
López-Ojeda, Pau
Fuentes-Mila, Verónica
Romera-Peregrina, Iluminada
Lerma-Briansò, Cristina
Plata-Menchaca, Erika
Pavón, Alba
Sabater, Joan
Cabellos, Carmen
author_sort Rojas-Lora, Mariel
collection PubMed
description BACKGROUND: Despite the clinical benefits of external ventricular drains (EVD), these devices can lead to EVD-related infections (EVDRI). The drainage insertion technique and standardized guidelines can significantly reduce the risk of infection, mainly caused by gram-positive bacteria. However, gram-negative microorganisms are the most frequent causative microorganisms of EVDRI in our hospital. We aimed to determine whether a new bundle of measures for the insertion and maintenance of a drain could reduce the incidence of EVDRI. This cohort study of consecutive patients requiring EVD from 01/01/2015 to 12/31/2018 compared the patients’ characteristics before and after introducing an updated protocol (UP) for EVD insertion and maintenance in 2017. RESULTS: From 204 consecutive patients, 198 requiring EVD insertion were included (54% females, mean age 55 ± 15 years). The before-UP protocol included 87 patients, and the after-UP protocol included 111 patients. Subarachnoid (42%) and intracerebral (24%) hemorrhage were the main diagnoses at admission. The incidence of EVDRI fell from 13.4 to 2.5 episodes per 1000 days of catheter use. Gram-negative bacteria were the most frequent causative microorganisms. Previous craniotomy remained the only independent risk factor for EVDRI. EVDRI patients had increased mechanical ventilation durations, hospital and ICU stays, and percutaneous tracheostomy requirements. CONCLUSIONS: A care bundle focusing on fewer catheter sampling and more accurate antiseptic measures can significantly decrease the incidence of EVDRI. After implementing the management protocol, a decreased incidence of infections caused by gram-negative and gram-positive bacteria and reduced ICU and hospital lengths of stay were observed.
format Online
Article
Text
id pubmed-10349458
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-103494582023-07-16 External ventriculostomy-associated infection reduction after updating a care bundle Rojas-Lora, Mariel Corral, Luisa Zabaleta-Carvajal, Ivan López-Ojeda, Pau Fuentes-Mila, Verónica Romera-Peregrina, Iluminada Lerma-Briansò, Cristina Plata-Menchaca, Erika Pavón, Alba Sabater, Joan Cabellos, Carmen Ann Clin Microbiol Antimicrob Research BACKGROUND: Despite the clinical benefits of external ventricular drains (EVD), these devices can lead to EVD-related infections (EVDRI). The drainage insertion technique and standardized guidelines can significantly reduce the risk of infection, mainly caused by gram-positive bacteria. However, gram-negative microorganisms are the most frequent causative microorganisms of EVDRI in our hospital. We aimed to determine whether a new bundle of measures for the insertion and maintenance of a drain could reduce the incidence of EVDRI. This cohort study of consecutive patients requiring EVD from 01/01/2015 to 12/31/2018 compared the patients’ characteristics before and after introducing an updated protocol (UP) for EVD insertion and maintenance in 2017. RESULTS: From 204 consecutive patients, 198 requiring EVD insertion were included (54% females, mean age 55 ± 15 years). The before-UP protocol included 87 patients, and the after-UP protocol included 111 patients. Subarachnoid (42%) and intracerebral (24%) hemorrhage were the main diagnoses at admission. The incidence of EVDRI fell from 13.4 to 2.5 episodes per 1000 days of catheter use. Gram-negative bacteria were the most frequent causative microorganisms. Previous craniotomy remained the only independent risk factor for EVDRI. EVDRI patients had increased mechanical ventilation durations, hospital and ICU stays, and percutaneous tracheostomy requirements. CONCLUSIONS: A care bundle focusing on fewer catheter sampling and more accurate antiseptic measures can significantly decrease the incidence of EVDRI. After implementing the management protocol, a decreased incidence of infections caused by gram-negative and gram-positive bacteria and reduced ICU and hospital lengths of stay were observed. BioMed Central 2023-07-15 /pmc/articles/PMC10349458/ /pubmed/37454149 http://dx.doi.org/10.1186/s12941-023-00612-z Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Rojas-Lora, Mariel
Corral, Luisa
Zabaleta-Carvajal, Ivan
López-Ojeda, Pau
Fuentes-Mila, Verónica
Romera-Peregrina, Iluminada
Lerma-Briansò, Cristina
Plata-Menchaca, Erika
Pavón, Alba
Sabater, Joan
Cabellos, Carmen
External ventriculostomy-associated infection reduction after updating a care bundle
title External ventriculostomy-associated infection reduction after updating a care bundle
title_full External ventriculostomy-associated infection reduction after updating a care bundle
title_fullStr External ventriculostomy-associated infection reduction after updating a care bundle
title_full_unstemmed External ventriculostomy-associated infection reduction after updating a care bundle
title_short External ventriculostomy-associated infection reduction after updating a care bundle
title_sort external ventriculostomy-associated infection reduction after updating a care bundle
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10349458/
https://www.ncbi.nlm.nih.gov/pubmed/37454149
http://dx.doi.org/10.1186/s12941-023-00612-z
work_keys_str_mv AT rojasloramariel externalventriculostomyassociatedinfectionreductionafterupdatingacarebundle
AT corralluisa externalventriculostomyassociatedinfectionreductionafterupdatingacarebundle
AT zabaletacarvajalivan externalventriculostomyassociatedinfectionreductionafterupdatingacarebundle
AT lopezojedapau externalventriculostomyassociatedinfectionreductionafterupdatingacarebundle
AT fuentesmilaveronica externalventriculostomyassociatedinfectionreductionafterupdatingacarebundle
AT romeraperegrinailuminada externalventriculostomyassociatedinfectionreductionafterupdatingacarebundle
AT lermabriansocristina externalventriculostomyassociatedinfectionreductionafterupdatingacarebundle
AT platamenchacaerika externalventriculostomyassociatedinfectionreductionafterupdatingacarebundle
AT pavonalba externalventriculostomyassociatedinfectionreductionafterupdatingacarebundle
AT sabaterjoan externalventriculostomyassociatedinfectionreductionafterupdatingacarebundle
AT cabelloscarmen externalventriculostomyassociatedinfectionreductionafterupdatingacarebundle