Background and Purpose: External ventricular catheters (EVDs) are an essential modality used to treat and manage critically ill neurosurgical, neurology, and trauma patients. Although EVD’s benefits are well understood their use has been tempered by complications associated with the device. Chief among the complications are infections related to the catheter. In the fall 2013 it became evident that our Intensive Care Unit (NICU) had an outbreak of ventriculitis related to EVDs. Review of cerebral spinal fluid studies from 2012- 2013 revealed an average 6.4 ventricular catheter related infections per 1000 EVD days. A multidisciplinary team was created to create guidelines from insertion, to maintenance, accessing, and removal. The purpose of the team was to institute guidelines to reduce our rate of ventricular related infections.
Methods: A multidisciplinary team was formed that included an intensivist, neurosurgery physician, neurosurgery physician assistant, neurocritical care nurse practitioners, neurocritical care nurses, operating room nurses, an infection control nurse, and a pharmacist. The group review current policies and procedures. Only one policy was found that was created in 1992 and had never been revised. The work group reviewed current literature and policies and procedures from other institutions. Our initial policy was extensively revised, and two new policies were created. The new policies were approved by all members of the work group and presented and accepted by the medical executive committee. The new policies were instituted between September 2013 and April 2014. Educational in-services were provided to all members of the healthcare team responsible for insertion, maintenance, and removal of EVDs.
Results: After implementing and educating staff on the new policies we saw a significant reduction in infection rates related to EVDs. In 2014 we had 2.05 ventricular related infections per 1000 EVD days, and in the first 6 months of 2015 we currently have 0 ventricular related infections per 1000 EVD days.
Conclusion There was a significant reduction of catheter related ventriculitis after strict adherence to guidelines created by a multidisciplinary team.