393. CREATION OF A BUNDLE TO PREVENT EXTRAVENTRICULAR DRAIN-RELATED INFECTIONS
Session: Poster Abstract Session: HAI: Preventing Device-Associated Infections
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • evd poster 1016.pdf (252.4 kB)
  • Background: Extraventricular drains (EVD) or ventriculostomy catheters are used on patients with traumatic brain injury, hemorrhage and hydrocephalus to monitor intracranial pressure and drain cerebrospinal fluid (CSF) but may be a source of infections. Infection rates range from 0-22%, averaging about 10%.
    A community-teaching hospital that is a level I trauma center experienced 6 EVD infections (9.9 infections/1000 EVD days) from January 2014 through December 2014, prompting an investigation.

    Methods: Analysis of infected cases and investigation of practices revealed that two types of catheters (bolt and tunneled) were used and no standardized protocols existed for insertion, maintenance, removal, and specimen collection.  A multidisciplinary team consisting of neurosurgeons, nurses, infectious disease physicians and infection preventionists was created to discuss these problems and to establish a bundle to prevent EVD associated infections. The bundle included:  EVD need assessed daily. Only Attending or certified Neurosurgery residents performed insertions.  Insertion performed in OR when possible. Antibiotic prophylaxis administered prior to insertion. Operators perform hand hygiene and wear mask, hat, sterile gown and gloves during insertion, Aseptic techniques followed during insertion, maintenance, and removal. Tunneled catheter preferred over bolt. Impervious dressings used. Closed sterile drainage system maintained. Drainage system checked hourly for patency and leakage. Specimens obtained only when clinically appropriate. Results: The EVD bundle was implemented in January 2015. To ensure adherence with the bundle, daily rounds were conducted by the nurse manager, and periodic audits were made by infection preventionists.   From January through December, 2015, no new cases of EVD associated infections occurred. The infection rate decreased from 9.9/1000 catheter days to 0 (p=0.055). Additionally, the total number of tunneled EVDs increased from 35 to 51 (p<0.0001), while the total number of EVD days decreased from 606 to 370 (p<0.0001). The total number of EVDs was relatively stable (65 in 2014 and 59 in 2015). Conclusion: Implementation of an EVD bundle reduced the number of EVD days and eliminated EVD infections. 

    Mandavi Kulkarni, MD1, Teresa Chou, MPH, MS, RN, CIC2, Rochelle Petefish, BSN, RN, CCRN3, Kenji Muro, MD4, Allison Parasiliti, BSN, RN, CCRN3, Andres Socorro, BSN, RN, CCRN3 and James Malow, MD, FIDSA5, (1)Infectious Diseases, Advocate Illinois Masonic Medical Center, Chicago, IL, (2)Infection Prevention and Control, Advocate Illinois Masonic Medical Center, Chicago, IL, (3)Nursing, Advocate Illinois Masonic Medical Center, Chicago, IL, (4)Surgery, Advocate Illinois Masonic Medical Center, Chicago, IL, (5)Infection Prevention, Advocate Health Care, Chicago, IL

    Disclosures:

    M. Kulkarni, None

    T. Chou, None

    R. Petefish, None

    K. Muro, None

    A. Parasiliti, None

    A. Socorro, None

    J. Malow, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.