Table 1.
Characteristics of External Ventricular Brain Bundles
| Study | Study Quality |
Insertion Checklist |
OR placement preferred |
Full barrier precautions |
Second pair of gloves |
Hair Removal | Iodine/Chlor -hexidine |
Antiobiotic/ Silver-EVDs |
Tunneling | Occlusive dressing |
Routine Dressing Change |
Post- Procedure Antibiotics |
No Daily CSF Sampling |
Routine EVD Exchange |
Other | Pre-protocol infection rate |
Post-protocol infection rate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Bader et al. 1995 | very low | N | Y | Y | N | Shave | Y | N | N | Y | N | Y | Y | N | No irrigation or tubing changes; In lieu of CSF draws, send entire drainage bag using aspetic technique; Aspetic technique for zeroing/manipulation | 5/9 (55.5%) | 0/10 (0%) |
| Korinek et al. 2004 | low | N | Y | N | N | Use clippers on full scalp | Y | N | Y (3cm) | N | Y (q72H) | N | Y | N | Send drainage bag for infectious work-up and if positive do an aseptic draw from tubing | 16/161 (9.9%) | 10/216 (4.6%) |
| Dasic et al. 2009 | low | N | Y | Y | Y | Shave | Y | N | Y (minimum 10cm) | Y | N | N | Y | N | 10mg IT vanco after placement | 14/51 (27%) | 7/59 (12%) |
| Harrop et al. Part 1 2010 | low | N | N | Y | N | Use clippers | Y | N | N | Y | N | N | Y | N | 22/327 (6.7%) | 23/281 (8.2%) | |
| Harrop et al. Part 2 2010 | low | N | N | Y | N | Use clippers | Y | Y | N | Y | N | N | Y | N | 22/327 (6.7%) | 2/195 (1.0%) | |
| Honda et al. 2010 Part 1 | low | N | N | Y | N | Use clippers | Y | N | N | Y | Y (q48H) | N | N | N | Cap and mask for everyone in room; Sterile gauze/tegaderm at insertion site | 3.56/1000 EVD Days | 2/1000 EVD Days |
| Honda et al. 2010 Part 2 | low | N | N | Y | N | Use clippers | Y | Y | N | Y | Y (q48H) | N | N | N | Cap and mask for everyone in room; Sterile gauze/tegaderm at insertion site | 3.56/1000 EVD Days | 0.87/1000 EVD Days |
| Leverstein-Van Hall et al. 2010 | very low | N | Y | N | N | Use clippers on full scalp | N | N | Y (>5cm) | N | N | N | Y | N | Use aseptic technique for sampling; Used algorithim for diagnosis of suspected VRI | 20–37% | 9% |
| Amini et al. 2011 Rahman et al. 2012 Kubilay et al. 2013 |
low | Y | N | Y | Y | Use clippers | Y | Y | N | N | Y (q72H) | N | N | N | Checklist developed; RN can stop procedure if not adhering to checklist; developed Neuroscience Infection Prevention Team | 9.20% | 0.46% |
| Hill et al. 2012 | low | Y | N | Y | Y | Use clippers | Y | N | Y | Y | N | N | N | N | Weekly infection control rounds; Aspetic technique for zeroing/manipulation; Improved documentation; Increased surveillance | 16/1000 EVD Days | 1st year: 4.5/1000 EVD Days; 2nd Year: 1.3/1000 EVD Days; 3rd year 0/1000 EVD Days |
| Lwin et al. 2012 Part 1 | low | N | Y | N | N | Not indicated | N | N | N | N | N | N | Y | Y (Day 10) | Strict aspetic technique for all manipulations | 5/82 (6.1%) | 3/79 (3.8%) |
| Lwin et al. 2012 Part 2 | low | N | Y | N | N | Not indicated | N | Y | N | N | N | N | Y | Y (Day 10) | Strict aspetic technique for all manipulations | 5/82 (6.1%) | 0/73% (0%) |
| Flint et al. 2013 | low | N | N | Y | N | Use clippers on large area | Y | Y | Y (3–5cm) | Y | N | N | Y | N | Strict aspetic technique for all manipulations; chlorhexidine biopatch | 9/143 (6.3%) 7.35/1,000 EVD Days |
1/119 (0.8%) 0.79/1000 EVD Days |
| Camacho et al. 2013 | low | N | Y | Y | N | Use clippers on full scalp | Y | N | Y (5cm) | Y | Y (q24) | Y | Y | N | CSF draws only from distal point | 9.5% 14/1000 EVD Days |
4.8% 7/1000 EVD Days |
| Zakaria et al. 2013 | low | N | Y | N | N | Not indicated | Y | Mix | Y | N | N | N | Y | N | Weekly infection control rounds; Aspetic technique for manipulation | 54/234 (23.1%) 21.5/1000 EVD Days |
18/132 (13.6%) 13.7/1000 EVD Days |
| Chatzi et al. 2014 | low | Y | Y | Y | N | Not indicated | N | N | N | N | N | N | Y | Y (Day 7) | Unit-based reeducation twice monthly; Full barrier precautions/asepsis when accessing the drain | 28% 18/1000 EVD Days |
10.6% 7.1/1000 EVD Days |
| Angulo et al. 2015 | very low | N | N | N | N | Not indicated | N | Y | N | N | N | N | Y | N | 2.6/1000 EVD Days | 0.6/1000 EVD Days | |
| Phan et al. 2016 | very low | N | Y | N | N | Not indicated | N | N | N | N | N | N | Y | N | CSF draws ever 2–3 days; stopped prior routine EVD changes | 20.9% | 11.5% |