Impact of an educational intervention implanted in a neurological intensive care unit on rates of infection related to external ventricular drains.

Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE

Original Publication: San Francisco, CA : Public Library of Science

Catheter-Related Infections/*prevention & control ; Catheters, Indwelling/*microbiology ; Cerebral Ventricles/*surgery ; Cerebral Ventriculitis/*prevention & control ; Gram-Negative Bacterial Infections/*prevention & control ; Hand Hygiene/*organization & administration; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Catheter-Related Infections/microbiology ; Catheter-Related Infections/surgery ; Cerebral Ventricles/microbiology ; Cerebral Ventriculitis/microbiology ; Cerebral Ventriculitis/surgery ; Child ; Drainage/instrumentation ; Drainage/methods ; Education/organization & administration ; Education/statistics & numerical data ; Female ; Gram-Negative Bacterial Infections/microbiology ; Gram-Negative Bacterial Infections/surgery ; Hand Hygiene/statistics & numerical data ; Humans ; Intensive Care Units ; Middle Aged ; Neurology ; Quality Assurance, Health Care/trends

Background: Studies on the implantation of care routines showed reduction on EVD catheter-related infections rates; however zero tolerance is difficult to be achieved. The objective of this study was to assess the impact of an educational intervention on the maximal reduction on rates of EVD-related infections.
Methodology/principal Findings: The quasi-experimental (before-after intervention) study occurred in two phases: pre-intervention, from April 2007 to July 2008, and intervention, from August 2008 to July 2010. Patients were followed for 30 days after the removal of the EVD, and EVD-related infections were considered as only those with laboratorial confirmation in the CSF. Observations were made of the care of the EVD and compliance with Hygiene of the Hands (HH), a routine of care was drawn up, training was given, and intervention was made to reduce the time the EVD catheter remained in place.
Results: during the study, 178 patients were submitted to 194 procedures, corresponding to 1217 EVD catheters-day. Gram-negative agents were identified in 71.4% of the infections during the pre-intervention period and in 60% during the intervention period. During the study, EVD-related infection rates were reduced from 9.5% to 4.8% per patient, from 8.8% to 4.4% per procedure, and the incidence density dropped from 14.0 to 6.9 infections per 1000 catheters-day (p = 0.027). The mortality reduced 12% (from 42% to 30%).
Conclusions/significance: During one year after the fourth intervention, no microbiologically identified infection was documented. In light of these results, educational intervention proved to be a useful tool in reducing these rates and showed also impact on mortality.

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Date Created: 20130208 Date Completed: 20130719 Latest Revision: 20211021

20240104

PMC3563649

10.1371/journal.pone.0050708

23390486