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Reducing External Ventricular Drain (EVD) Associated Ventriculitis: An improvement project in a Level 1 Trauma Center

Published:September 15, 2022DOI:https://doi.org/10.1016/j.ajic.2022.08.029

      Highlights

      • Implementation of an EVD care bundle combined with continued engagement of an interprofessional team, point of care EVD bundle compliance rounding, real time clinician feedback and meaningful recognition led to significant reduction in EVD-associated ventriculitis rates.
      • Utilization of technology innovations to optimize documentation of insertion, maintenance, and removal of external ventricular drains, including an electronic insertion checklist, standardization of provider notes, an EVD orderset, a formal electronic case review process, and electronic tracking of EVD bundle compliance may enhance EVD-associated prevention programs.
      • Overcoming barriers to implementation of an external ventricular drain care bundle and ensuring sustained results can be achieved through ongoing surveillance of EVD-associated infections, sustained interdisciplinary rounding, dissemination of EVD bundle compliance, and meaningful recognition of clinicians providing care.

      Abstract

      Background

      : External ventricular drain (EVD)-associated infections have a negative impact on healthcare cost and patient outcomes. Practice variation in EVD management may place patients at increased risk for EVD-associated infection. This project aimed to evaluate the impact of implementing an interprofessional evidence-based EVD bundle of care on reduction of EVD-related ventriculitis rates.

      Methods

      : An interprofessional team developed an evidence based EVD care bundle and order set to eliminate practice inconsistencies. Standardization of EVD equipment and optimization of the electronic health record occurred. Education and competency validation were completed with neurosurgical providers and nurses. Interprofessional rounds occur weekly for observation, recognition, and in-the-moment education.

      Results

      : A pre/post intervention design was used to show that the rate of EVD-associated ventriculitis decreased from 8.8 per reported EVD days in 2019 to 0 per reported EVD days in 2021 after implementation of the EVD care bundle.

      Conclusion

      : Through an interprofessional team approach, reduction in EVD-associated infection rates is feasible with implementation of an evidence based EVD care bundle.

      Key words

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