EVD Infection Control

External Ventricular Drains (EVDs) are placed to treat hydrocephalus by draining cerebrospinal fluid (CSF) from the ventricles in the center of the brain to a closed drainage system outside the patient.

Historically, EVDs have been associated with high rates of infection (5-20%).

Our group at Kaiser Permanente Redwood City has dramatically reduced the rate of EVD infections to near-zero levels by applying a commonsense "bundle" approach to infection control.

Inspired by the work of Peter Pronovost and colleagues in reducing central line infections, we introduced a new approach to the placement, dressing, and manipulation of EVDs in our neurological ICU.

We first showed over a 3-year period that introduction of our protocol dramatically reduced the EVD infection rate from 9.8% to 0.8%. (Only one infection occurred over the 3 years, in a patient who removed their own EVD). This work was published in 2013 in Neurosurgery: Flint AC, et al. A simple protocol to reduce external ventricular drain infections. Neurosurgery, 72: 993.

Over the following 4 years, there were zero infections. This reduced the overall infection rate over the seven-year protocol period to 0.3%. These findings were published in 2016 in World Neurosurgery: Flint AC, et al. A simple infection control protocol durably reduces external ventricular drain infections to near zero levels. World Neurosurgery, 2016 Dec 21. pii: S1878-8750(16)31354-7. [Epub ahead of print]

Given our results, we hope other centers will consider implementing our approach.

The protocol has two components:

  1. a set of procedures for the placement of the EVD and its dressing, and
  2. a set of procedures for any required manipulation of the EVD, such as drawing CSF, flushing, or administering intrathecal medications.


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