๐Ÿ›ก๏ธ Infection Prevention Bundle

Evidence-based practices to reduce EVD-related infection

A structured, evidence-informed approach to reduce ventriculostomy-related infections (VRI) through standardized insertion and maintenance practices.

Insertion Bundle

Definition: Number of patients with EVDs for whom all elements of an insertion bundle are documented at the time of EVD placement.

Core Elements:

  • ๐Ÿงผ Use of strict sterile technique during insertion
  • ๐Ÿ’‰ Administration of periprocedural antibiotics prior to incision
  • ๐Ÿงช Use of antimicrobial-impregnated catheter
  • ๐Ÿ“ Tunneling of the catheter (โ‰ฅ 5 cm under the skin)
  • ๐Ÿ”’ Use of a closed drainage system
  • ๐Ÿฉน Application of a sterile (preferably chlorhexidine-impregnated) dressing
Tip

Key Principle: Full compliance with all bundle elementsโ€”not partial adherenceโ€”is required to meaningfully reduce infection risk.

Maintenance Bundle

Core Principles:

  • ๐Ÿง  Indication-based CSF sampling only
  • ๐Ÿšซ Avoid routine or unnecessary CSF sampling
  • ๐Ÿ”’ Minimize system access to prevent contamination
  • ๐Ÿ“ Maintain system upright to prevent backflow
  • โš ๏ธ Prevent accidental disconnection of the system
Tip

Key Principle: Each access of the CSF system increases infection riskโ€”minimize manipulation unless clinically indicated.

Why This Matters

Ventriculostomy-related infections are associated with increased morbidity, prolonged hospital stay, and higher healthcare costs. Standardizing insertion and maintenance practices reduces variability and improves patient outcomes.

Warning

Clinical Reminder: Infection prevention is a multidisciplinary responsibility involving anesthesia, neurosurgery, nursing, and ICU teams.

Note

Source:

Blacker SN, Prabhakar H, Moreton EO, et al. Effect of Bundled Care on External Ventricular Drain Infections: A Systematic Review and Meta-analysis. Journal of Neurosurgical Anesthesiology. 2025 Nov 17. PMID: 41243982

Fried HI, Nathan BR, Rowe AS, et al. The Insertion and Management of External Ventricular Drains: An Evidence-Based Consensus Statement โ€” A Statement for Healthcare Professionals from the Neurocritical Care Society. Neurocritical Care. 2016 Feb. PMID: 26738503