• Alexander C Flint, Shahed Toossi, Sheila L Chan, Vivek A Rao, and William Sheridan.
• Division of Research, Kaiser Permanente Northern California, Oakland, California, USA; Department of Neuroscience, Kaiser Permanente, Redwood City, California, USA. Electronic address: alexander.c.flint@kp.org.
• World Neurosurg. 2017 Mar 1; 99: 518-523.

ObjectiveExternal ventricular drains (EVDs) historically have a high rate of infection, and EVD infections are a cause of significant morbidity and mortality. We have shown previously that a simple infection control protocol reduced the rate of EVD infections during a 3-year period, and the present study examines whether infection rates were durably reduced over an additional 4 years.MethodsRetrospective analysis of EVDs placed in the intensive care unit of a tertiary neurosurgical center over an additional 4 year follow-up period.ResultsIn the 4-year follow-up period, 189 EVDs were placed in 173 patients. The previously observed decrease in cerebrospinal fluid culture positivity from 9.8% in the baseline period to 0.8% in the first 3 years of the protocol period continued in the 4-year follow-up period (0%, 0 of 189 EVD placements, 0 per 1000 catheter-days; P < 0.001 compared with baseline). The previously observed decrease in the rate of ventriculitis from 6.3% to 0.8% also continued in the follow-up period (0%, 0 of 189 EVD placements, 0 per 1000 catheter-days; P < 0.001 compared with baseline). Over the total 7 years of protocol use, the rate of culture positivity was 0.3% (1 of 308 EVD placements, 0.29 per 1000 catheter-days) and the rate of ventriculitis was 0.3% (1 of 308 EVD placements, 0.29 per 1000 catheter-days). The only observed infection over 7 years occurred in a patient who removed their own EVD.ConclusionsA straightforward EVD infection control protocol substantially and durably reduces EVD infections to a near-zero rate.Copyright © 2016 Elsevier Inc. All rights reserved.

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