{"title":"减少室外引流相关感染的多模式策略的有效性:准实验研究","authors":"Chaiwat Pongkaew, Raywat Noiphithak, Pataravit Rukskul, Pornchai Yodwisithsak, Dilok Tantongtip, Pree Nimmannitya, Prachya Punyarat, Gahn Duangprasert, Wadrawee Kaewwichai, Sirada Songphul, Watcharee Chancharoenrat, Kittiya Jantarathaneewat, Chattrabongkot Chokaouychai, Sasikan Sukhor, Piyaporn Apisarnthanarak, Bernard C Camins, David J Weber, Anucha Apisarnthanarak","doi":"10.1016/j.ajic.2024.06.026","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Infection is a serious complication in neurosurgical patients who undergo external ventricular drain (EVD) insertion.</p><p><strong>Methods: </strong>We conducted a quasi-experimental study in patients who underwent EVD insertion to evaluate the impact of a multi-modal strategy to reduce the incidence of external ventricular drain associated infections (EVDAIs). The study was divided into 2 periods; (1) the pre-intervention period when techniques for EVD insertion and maintenance were up to the discretion of the neurosurgeons and (2) the post-intervention after implementation of a multi-modal strategy (cefazolin antibiotic prophylaxis, preoperative chlorhexidine showers, application of postoperative chlorhexidine-impregnated dressing, limited manipulation of the EVD, and meticulous EVD management). The primary outcome was the incidence rate of EVDAIs; secondary outcomes included in-hospital mortality rate, the hospital length of stay.</p><p><strong>Results: </strong>In total, 135 patients were included. The incidence rate of EVDAIs was significantly reduced in the post-intervention period (5.6 cases/1,000 EVD-days) compared with the pre-intervention period (18.2 cases/1,000 EVD-days; P=0.026). There were no differences in all secondary outcomes analyzed. This multi-modal strategy was associated with high satisfaction among health care personnel.</p><p><strong>Conclusions: </strong>Implementation of a multi-modal strategy was associated with a reduction in the incidence of EVDAIs. This was in line with our goal of promoting a new culture of safety despite being in a resource-limited setting.</p>","PeriodicalId":7621,"journal":{"name":"American journal of infection control","volume":null,"pages":null},"PeriodicalIF":3.8000,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Effectiveness of a multimodal strategy to reduce external ventricular drain-associated infection: A quasi-experimental study.\",\"authors\":\"Chaiwat Pongkaew, Raywat Noiphithak, Pataravit Rukskul, Pornchai Yodwisithsak, Dilok Tantongtip, Pree Nimmannitya, Prachya Punyarat, Gahn Duangprasert, Wadrawee Kaewwichai, Sirada Songphul, Watcharee Chancharoenrat, Kittiya Jantarathaneewat, Chattrabongkot Chokaouychai, Sasikan Sukhor, Piyaporn Apisarnthanarak, Bernard C Camins, David J Weber, Anucha Apisarnthanarak\",\"doi\":\"10.1016/j.ajic.2024.06.026\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Infection is a serious complication in neurosurgical patients who undergo external ventricular drain (EVD) insertion.</p><p><strong>Methods: </strong>We conducted a quasi-experimental study in patients who underwent EVD insertion to evaluate the impact of a multi-modal strategy to reduce the incidence of external ventricular drain associated infections (EVDAIs). The study was divided into 2 periods; (1) the pre-intervention period when techniques for EVD insertion and maintenance were up to the discretion of the neurosurgeons and (2) the post-intervention after implementation of a multi-modal strategy (cefazolin antibiotic prophylaxis, preoperative chlorhexidine showers, application of postoperative chlorhexidine-impregnated dressing, limited manipulation of the EVD, and meticulous EVD management). The primary outcome was the incidence rate of EVDAIs; secondary outcomes included in-hospital mortality rate, the hospital length of stay.</p><p><strong>Results: </strong>In total, 135 patients were included. The incidence rate of EVDAIs was significantly reduced in the post-intervention period (5.6 cases/1,000 EVD-days) compared with the pre-intervention period (18.2 cases/1,000 EVD-days; P=0.026). There were no differences in all secondary outcomes analyzed. This multi-modal strategy was associated with high satisfaction among health care personnel.</p><p><strong>Conclusions: </strong>Implementation of a multi-modal strategy was associated with a reduction in the incidence of EVDAIs. This was in line with our goal of promoting a new culture of safety despite being in a resource-limited setting.</p>\",\"PeriodicalId\":7621,\"journal\":{\"name\":\"American journal of infection control\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.8000,\"publicationDate\":\"2024-07-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American journal of infection control\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.ajic.2024.06.026\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American journal of infection control","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.ajic.2024.06.026","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
Effectiveness of a multimodal strategy to reduce external ventricular drain-associated infection: A quasi-experimental study.
Background: Infection is a serious complication in neurosurgical patients who undergo external ventricular drain (EVD) insertion.
Methods: We conducted a quasi-experimental study in patients who underwent EVD insertion to evaluate the impact of a multi-modal strategy to reduce the incidence of external ventricular drain associated infections (EVDAIs). The study was divided into 2 periods; (1) the pre-intervention period when techniques for EVD insertion and maintenance were up to the discretion of the neurosurgeons and (2) the post-intervention after implementation of a multi-modal strategy (cefazolin antibiotic prophylaxis, preoperative chlorhexidine showers, application of postoperative chlorhexidine-impregnated dressing, limited manipulation of the EVD, and meticulous EVD management). The primary outcome was the incidence rate of EVDAIs; secondary outcomes included in-hospital mortality rate, the hospital length of stay.
Results: In total, 135 patients were included. The incidence rate of EVDAIs was significantly reduced in the post-intervention period (5.6 cases/1,000 EVD-days) compared with the pre-intervention period (18.2 cases/1,000 EVD-days; P=0.026). There were no differences in all secondary outcomes analyzed. This multi-modal strategy was associated with high satisfaction among health care personnel.
Conclusions: Implementation of a multi-modal strategy was associated with a reduction in the incidence of EVDAIs. This was in line with our goal of promoting a new culture of safety despite being in a resource-limited setting.
期刊介绍:
AJIC covers key topics and issues in infection control and epidemiology. Infection control professionals, including physicians, nurses, and epidemiologists, rely on AJIC for peer-reviewed articles covering clinical topics as well as original research. As the official publication of the Association for Professionals in Infection Control and Epidemiology (APIC)