Table 21.

Practice recommendation

Practice recommendation	Medical and operative management	Nursing care
Pre-operative and intra-operative	Peri-operative intravenous antibiotics Insertion of ventriculostomy only in the operative theatre Aseptic technique during entire operation with surgeons scrubbed and sterile gowned Scalp disinfected with 3 types of disinfectants (in sequel according to order of dis-infective power) before draped with sterile cloth If other neurosurgical procedures were performed in the same session, a separate skin incision and hole burr was used for insertion of EVD whenever possible Free drainage to room-air minimised upon immediate insertion of EVD to reduce pneumocephalus Percutanous tunnelling of at least 3cm before connection to external drainage system Catheter anchored to skin at site of percutanous tunnel exit	Patient’s head shaved for adequate exposure and reduce contamination from patient’s hair Aseptic technique during operative EVD insertion (nurse scrubbed and sterile gowned) with adequate sterile field. Sterile external drainage system assembled intra-operatively within the sterile field (by a gowned personal) The sterile ICP monitoring device was assemble in the external drainage system without direct contact with operative site External drainage system wrapped with anti-bacterial gel on sterile gauze and enclosed with water-proof material at all connection points Anti-septic gel applied to operative wound upon closure then dressed with sterile dressing
Post-operative (period which the catheter was in situ)	Post-operative care in ICU or HDU until ventriculostomy removed Patient monitored for symptoms or signs indicative of infection CSF and blood sampling at the slightest suspicion of infection Treatment of infection commenced when clinical features and laboratory test results suggest infection Revision of ventriculostomy NOT routinely performed unless clinically indicated Ventriculostomy removed as soon as the purpose of ventriculostomy had been fulfilled Ventriculostomy removal under strict aseptic technique and catheter tip routinely saved for bacterial culture	External drainage system maintained as a close system except during manipulation All manipulation of external drainage system keep to a minimal Aseptic technique (personal scrubbed and sterile gowned and establishment of a sterile field) when manipulation was required Sterile collection bag for CSF changed every once a week Upon manipulation of external drainage system CSF samplings from external system were performed