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70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

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Implementation of a specific hygiene protocol reduces external ventricular catheter-associated infections

Implementierung eines spezifischen Hygiene-Protokolls reduziert EVD-assoziierte Infektionen

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  • presenting/speaker Kerim Beseoglu - Heinrich-Heine-Universität, Universitätsklinikum, Klinik für Neurochirurgie, Düsseldorf, Deutschland
  • Susanne Kolbe-Busch - Heinrich-Heine-Universität, Universitätsklinikum, Institut für Mikrobiologie und Krankenhaushygiene, Düsseldorf, Deutschland
  • Hans-Jakob Steiger - Heinrich-Heine-Universität, Universitätsklinikum, Klinik für Neurochirurgie, Düsseldorf, Deutschland
  • Thomas Beez - Heinrich-Heine-Universität, Universitätsklinikum, Klinik für Neurochirurgie, Düsseldorf, Deutschland
  • Rainer Kram - Heinrich-Heine-Universität, Universitätsklinikum, Klinik für Anästhesiologie, Düsseldorf, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocP216

doi: 10.3205/19dgnc551, urn:nbn:de:0183-19dgnc5512

Published: May 8, 2019

© 2019 Beseoglu et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Device-associated ventricular infection from external ventricular catheters (EVD) is a potentially life-threatening complication and is estimated with three to twelve infections per 1000 device days (DD). Pathogenic microorganisms reach the central nervous system directly from the surrounding skin or as contamination from handling of the catheter. A reduction of infection requires therefore a multimodal concept of measures consisting of device-associated technical aspects as well as guidelines and training for handling of the EVD system. Here, we portray our experience with a bundle of measures in a large neurointensive care setting.

Methods: We retrospectively analyzed our patient cohort after implementation of specific interventions consisting of:

  • Use of an antimicrobial body cleansing foam for body and head (Prontoderm® foam)
  • Use of an antimicrobial coated EVD (VentriGuard®, Neuromedex)
  • Use of chlorhexidine-containing wound dressing after 48 hours after implantation of EVD (Tegaderm™3M CHG)
  • Use of Luer access valve caps with 70% isopropyl alcohol (SwabCaps® B.Braun) as a disinfectant for the luer access valve.
  • Implementation of EVD care protocol with regular training for physicians and nurses focusing on handling the EVD system, drawing of CSF samples and application of medication.

We compared patients with EVD in two 12-month intervals before implementation (2014/2015; group A) and after implementation (2016/2017; group B). Ventricular infection was assumed only with microbiological evidence of intrathecal bacteria. Patients with preexisting cerebral infection (empyema, meningitis, abscess) were excluded.

Results: There were 20 (11.4%) infections in group A (175 patients) in 1612 DD and 13 (6.9%) infections in group B (186 patients) in 1615 DD. Length of EVD use correlated significantly with incidence of infection (p<0.01, 8.3 days vs. 14.9 days). Referring to DD a significant reduction of infections per 1000 DD between group A and B was evident (12.4 to 8.0 (p<0.01, χ² 23.8). Spectrum of pathogenic microorganisms did not differ between groups.

Conclusion: The consistent application of a specific protocol comprising measures of device handling as well as use of specific materials supports the reduction of EVD-associated infections.