📊 QI Metrics

Quality improvement metrics for EVD safety and monitoring

Quality improvement metrics for EVD safety and monitoring.

firebaseDb = {
  const { initializeApp, getApps, getApp } = await import("https://www.gstatic.com/firebasejs/10.14.1/firebase-app.js");
  const { getFirestore } = await import("https://www.gstatic.com/firebasejs/10.14.1/firebase-firestore.js");

  const firebaseConfig = {
    apiKey: "AIzaSyD1FLnIrd86qOsFPLi5y1q_EIU0lhL5gxc",
    authDomain: "evdtoolkit.firebaseapp.com",
    projectId: "evdtoolkit",
    storageBucket: "evdtoolkit.firebasestorage.app",
    messagingSenderId: "1002374431151",
    appId: "1:1002374431151:web:fe3724bb1f39eb4744af5a"
  };

  const app = getApps().length ? getApp() : initializeApp(firebaseConfig);
  return getFirestore(app);
}

qiListItems = {
  const { collection, onSnapshot } = await import("https://www.gstatic.com/firebasejs/10.14.1/firebase-firestore.js");
  return Generators.observe(notify => {
    const unsubscribe = onSnapshot(collection(firebaseDb, "QIMetricsListItems"), snapshot => {
      notify(snapshot.docs.map(d => d.data()));
    });
    return unsubscribe;
  });
}

qiPearlItems = {
  const { collection, onSnapshot } = await import("https://www.gstatic.com/firebasejs/10.14.1/firebase-firestore.js");
  return Generators.observe(notify => {
    const unsubscribe = onSnapshot(collection(firebaseDb, "QIMetricsPearls"), snapshot => {
      notify(snapshot.docs.map(d => d.data()));
    });
    return unsubscribe;
  });
}

qiReportableEvents = {
  const { collection, onSnapshot } = await import("https://www.gstatic.com/firebasejs/10.14.1/firebase-firestore.js");
  return Generators.observe(notify => {
    const unsubscribe = onSnapshot(collection(firebaseDb, "QIReportableEvents"), snapshot => {
      notify(snapshot.docs.map(d => d.data()).sort((a, b) => (a.order ?? 0) - (b.order ?? 0)));
    });
    return unsubscribe;
  });
}

suggestedMetrics = qiListItems.filter(i => i.section === "suggestedMetrics").sort((a, b) => (a.order ?? 0) - (b.order ?? 0))

documentationItems = qiListItems.filter(i => i.section === "documentation").sort((a, b) => (a.order ?? 0) - (b.order ?? 0))

qiPearls = qiPearlItems.filter(i => i.section === "pearls").sort((a, b) => (a.order ?? 0) - (b.order ?? 0))

priorities = qiPearlItems.filter(i => i.section === "priorities").sort((a, b) => (a.order ?? 0) - (b.order ?? 0))

function bulletedList(items) {
  return items.length === 0
    ? html`<div class="fs-empty">Loading…</div>`
    : html`<ul>${items.map(i => `<li>${i.text}</li>`).join("")}</ul>`
}

Note

Source: The Suggested Metrics, Reportable Events, Documentation, Pearls, and Priorities below reflect the SNACC EVD Quality and Safety resources on the SNACC EVD Safety Campaign knowledge hub.

Suggested Metrics

bulletedList(suggestedMetrics)

Reportable EVD Safety Events

qiReportableEvents.length === 0
  ? html`<div class="fs-empty">Loading…</div>`
  : html`<div>${qiReportableEvents.map(e => `
      <div class="fs-ref-entry">
        <p class="fs-ref-title">${e.title ?? ""}</p>
        <p class="fs-ref-authors">${e.description ?? ""}</p>
      </div>
    `).join("")}</div>`

Mandatory Documentation

The following elements should be documented in perioperative and anesthesia records for patients with EVDs or ICP monitors:

bulletedList(documentationItems)

Quality Improvement Pearls

bulletedList(qiPearls)

Safety Priorities

bulletedList(priorities)

Global VRI Rate Data

Supplementary epidemiology (not part of the app content above): reported ventriculostomy-related infection rates by country from the published literature.

Note

Source: Blacker SN, Prabhakar H, Moreton EO, et al. Ventriculostomy-Related Infections by Country-Income Level: A Systematic Review and Bayesian Hierarchical Meta-analysis. Journal of Neurosurgical Anesthesiology. 2026 Jun 15. PMID: 42290525

Global VRI Rate: 8.64% [95% CI 7.44–9.97]

NoteVRI rates by country (click to expand)

Country	Studies	VRI Rate	95% CI
Croatia	1	43.3%	7.0–89.3%
Hungary	1	33.9%	3.4–86.2%
Greece	3	33.2%	14.3–56.2%
Ethiopia	1	30.2%	4.0–85.1%
Iran	2	23.4%	1.8–77.0%
Israel	1	22.0%	1.9–82.9%
UK	1	21.6%	1.5–77.6%
Thailand	1	19.4%	1.5–79.6%
Netherlands	7	18.9%	9.8–32.2%
Serbia	1	18.4%	1.1–77.4%
United Arab Emirates	1	18.4%	1.4–72.4%
Turkey	1	18.2%	0.9–88.0%
Switzerland	7	17.4%	5.6–34.8%
Brazil	4	15.0%	2.6–42.4%
New Zealand	2	13.8%	4.0–32.4%
Belgium	1	13.5%	1.0–64.5%
Sweden	5	13.3%	6.0–23.5%
Spain	4	12.8%	8.4–19.1%
United Kingdom	9	12.7%	7.0–21.4%
Denmark	5	12.2%	3.2–28.5%
Australia	5	11.4%	4.2–19.2%
Korea (South)	3	10.9%	5.7–19.1%
France	11	10.4%	6.9–15.2%
Austria	2	10.4%	2.5–28.7%
Taiwan	2	10.3%	0.7–49.1%
India	1	10.1%	0.4–43.5%
Canada	5	9.1%	4.4–17.9%
Italy	7	9.0%	3.7–17.6%
China	15	8.5%	5.4–12.4%
Norway	1	8.3%	0.3–68.4%
Germany	6	6.1%	1.1–18.9%
United States	46	4.6%	3.4–5.9%
Singapore	3	3.3%	0.8–7.0%

Tip

Reinforcing prevention: Whatever your unit’s VRI rate, revisit the Insertion Bundle (sterile technique, periprocedural antibiotics, antimicrobial-impregnated catheter, tunneling, closed system, sterile dressing) and Maintenance Bundle (indication-based sampling only, minimize system access, maintain system upright, prevent disconnection). See the Infection Prevention Bundle page for the full checklist.