Surveillance of infection associated with external ventricular drains: proposed methodology and results from a pilot study

Lists

Humphreys, Hilary, Jenks, Peter, Wilson, Jennie ORCID: https://orcid.org/0000-0002-4713-9662, Weston, Vivienne, Bayston, Roger, Waterhouse, C and Moore, A (2017) Surveillance of infection associated with external ventricular drains: proposed methodology and results from a pilot study. Journal of Hospital Infection, 95 (2). pp. 154-160. ISSN 0195-6701

[thumbnail of JHI Neurosurveillance 2017Final version.pdf]

Preview

PDF
JHI Neurosurveillance 2017Final version.pdf - Accepted Version
Download (298kB) | Preview

Official URL: https://doi.org/10.1016/j.jhin.2016.09.008

Abstract

Background

The insertion of external ventricular drains (EVDs) is necessary in some neurosurgical patients, but increases the risk of meningitis/ventriculitis. While there are well-recognized risk factors, the proportion of patients who develop meningitis/ventriculitis varies partly due to differences in definitions. A multi-disciplinary working group was established to agree definitions for EVD-associated meningitis/ventriculitis, and a surveillance system was piloted in four centres in the UK and Ireland.

Methods

Definitions were agreed based on those published previously and on clinical and microbiological criteria. An agreed dataset was developed to monitor patients after the insertion of an EVD and until the EVD was removed and the microbial aetiology was recorded.

Findings

Four neurosurgical centres participated, with 61–564 patients surveyed in each unit. The vast majority of drains were cranial. Intracranial haemorrhage was the most common indication for the EVD insertion. Between 6% and 35% of EVDs were inserted by consultants rather than junior doctors. The proportion of patients who developed meningitis/ventriculitis varied from 3% to 18% and from 4.8 to 12.7/1000 EVD-days. Coagulase-negative staphylococci were the most common microbial causes.

Conclusions

Routine and ongoing monitoring of patients with an EVD in situ to detect meningitis/ventriculitis presents logistical difficulties, and few units do so. This pilot study suggests that a national system of surveillance with agreed definitions and a methodology to enable unit-to-unit comparisons of EVD meningitis/ventriculitis is both necessary and feasible. This will, in turn, inform quality improvement processes leading to the minimization of infection.

Item Type:	Article
Identifier:	10.1016/j.jhin.2016.09.008
Additional Information:	© 2017 Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/
Keywords:	External ventricular drains; Meningitis; Neurosurgery; Definitions; Surveillance
Subjects:	Medicine and health > Microbiology Medicine and health > Clinical medicine Medicine and health
Depositing User:	Jennie Wilson
Date Deposited:	02 Dec 2016 16:25
Last Modified:	06 Feb 2024 15:51
URI:	https://repository.uwl.ac.uk/id/eprint/2983