REMI 1926E. Care bundle for preventing external cerebral ventricular drainage-associated ventriculitis

Original article: Bundle of measures for external cerebral ventricular drainage associated ventriculitis. Chatzi M, Karvouniaris M, Makris D, Tsimitrea E, Gatos C, Tasiou A, Mantzarlis K, Fountas KN, Zakynthinos E. Crit Care Med 2014; 42(1): 66-73. [Summary] [Related articles]
Introduction: Up to 20% of external ventricular drains can become contaminated and cause ventriculitis. It usually happens after the first week and is associated with high morbidity [1]. The aim of this Greek study was to evaluate the impact of implementating a care bundle on the incidence of ventriculitis.
Summary: Prospective cohort study in two phases. A baseline first phase or pre-implementation, with the usual care for ventricular drainage (82 patients), and a second phase post-implementation of the care bundle (57 patients). The care bundle consisted of 4 measures: a) education of ICU staff on basic measures to prevent this infection, b) strict aseptic techniques during drain placement, c) avoiding manipulating the drainage and limit CSF sampling d) daily assessing withdrawal and, at the seventh day, systematic drainage replacement. The incidence of drainage-associated ventriculitis decreased in the post-intervention period related to the pre-intervention period (11% vs. 28%, P = 0.02), with a significantly lower rate of infection per 1000 drainage days (7 vs. 18, P < 0.001). Patients with ventriculitis had a significantly longer length of stay in the ICU than patients without ventriculitis (44 days [36-52] vs. 20 [17-23)], P < 0.001). The authors conclude that the application of this care bundle is effective to prevent ventricular drainage-associated ventriculitis.
Comment: While the first three measures appear well established, the fourth can be a matter of discussion [2]. Another option would be using the new silver or antibiotic-impregnated drains, but the evidence supporting it is unconclusive [3]. This is a new study confirming that the application of care bundles is effective in preventing infection, at least at the short term [4]; what happens long term is another question. As time passes, motivation decreases, and without a good educational program tracking, achievements can be lost.
Ferran Roche Campo
Hospital de Tortosa Verge de la Cinta, Tarragona.
© REMI, January 2014.
  1. Nosocomial ventriculitis and meningitis in neurocritical care patients. Beer R, Lackner P, Pfausler B, Schmutzhard E. J Neurol 2008; 255: 1617-1624. [PubMed
  2. Ventriculostomy-related infections: a critical review of the literature. Lozier AP, Sciacca RR, Romagnoli MF, Connolly ES Jr. Neurosurgery 2008; 62 Suppl 2: 688-700. [PubMed
  3. Antibiotic-impregnated catheters for the prevention of CSF shunt infections: a systematic review and meta-analysis. Thomas R, Lee S, Patole S, Rao S. Br J Neurosurg 2012; 26: 175-184. [PubMed
  4. Bacteremia Zero Working Group. Impact of a national multimodal intervention to prevent catheter-related bloodstream infection in the ICU: the Spanish experience. Palomar M, Álvarez-Lerma F, Riera A, Díaz MT, Torres F, Agra Y, Larizgoitia I, Goeschel CA, Pronovost PJ. Crit Care Med 2013; 41: 2364-2372. [PubMed] [REMI
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  • Plain language: interventions for external cerebral ventricular drainage associated ventriculitis
  • Syntax: external cerebral ventricular drainage AND ventriculitis
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