Nursing

Background: External ventricular drain (EVD) is commonly seen in neurosurgical intensive care unit. It is used to treat hydrocephalus and to monitor intracranial pressure in patient with intracranial pathology. EVD infection has always been a problem. Although the EVD infection rate of our Department being about 1% in the previous years, EVD infection and its associated clinical ventriculitis are causes of significant morbidity and mortality. We advocate the principal: “one case is too many” in our practice. Therefore, our Department has implemented an evidenced-based protocol on prevention of EVD infection since 1 January 2014. Our target being a zero EVD infection rate. Method: A clinical study protocol from the United States was adopted as reference. It is modified to fit our clinical setting. In the protocol, 2% Chlorhexidine in alcohol is used as disinfectant and a Chlorhexidine gluconate patch is applied to the EVD exit site. Other than the peri-operative antibiotics given, no routine prophylactic antibiotics were prescribed to patients with EVDs during the course of CSF drainage. Result: All EVDs inserted from 1 January 2014 to 31 August 2015 were included in the analysis. A total of 179 EVDs in 160 patients, with 1672 catheter-days were analyzed. The duration of EVD ranged from 1 to 33 days. Primary diagnoses including intracerebral haemorrhage, subarachnoid haemorrhage, traumatic brain injury and brain tumour. Through strict adherence to the protocol, there was no EVD catheter related infection identified. Conclusion: In summary, the objective of the protocol implementation to prevent EVD infection is achieved in the short term. We aim to provide the best and safest care to our patients. We will continue the current practices and monitor the result closely. N02