Establishing External Ventricular Drain Best Practice Guidelines to Decrease Infection Rates

An external ventricular drain or EVD is one of the most common neurosurgical procedures. Its application allows for excessive cerebrospinal fluid (CSF) drainage, continuous measurement and monitoring of intracranial pressure, investigation of CSF dynamics, direct treatment and prevention of CSF leaks after neurosurgical operations. Nonetheless, its application is also associated with various complications. Undoubtedly one of the most significant risks of EVD placement is the risk of infection, which can result in ventriculitis, meningitis and even death. The organisation in which the quality improvement project took place is one of the leading institutions performing neurosurgical procedures in Ireland, establishment of EVD related infection rate was a crucial step for the institution and to guide the quality improvement project (QIP). A total of 116 patients received EVDs in 2019, however 3 patients were excluded due to pre-existing cerebral infection. This resulted in 113 patients being included in the study, of which 15 patients were identified to have EVD-related infection, establishing the EVD-related infection rate for 2019 to be 13.27%. The results from this study is higher than the mean incidence rate of 9%. The DMAIC (define, measure, analyse, improve, control) framework for quality improvement (QI) was used to formulate a QI plan to reduce the reduce EVD-related infections. QI tools such as stakeholder analysis, SIPOC analysis, driver diagram and fishbone diagrams were utilised to identify the root causes and guide the hospital to make improvements to the current model with the hopes of reducing EVD-related infection rates.