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PLoS One. 2013;8(2):e50708. doi: 10.1371/journal.pone.0050708. Epub 2013 Feb 4.

Impact of an educational intervention implanted in a neurological intensive care unit on rates of infection related to external ventricular drains.

Author information

1
Division of Infectious Diseases, Hospital das Clinicas, University of São Paulo School of Medicine, São Paulo, Brazil.

Abstract

BACKGROUND:

Studies on the implantation of care routines showed reduction on EVD catheter-related infections rates; however zero tolerance is difficult to be achieved. The objective of this study was to assess the impact of an educational intervention on the maximal reduction on rates of EVD-related infections.

METHODOLOGY/PRINCIPAL FINDINGS:

The quasi-experimental (before-after intervention) study occurred in two phases: pre-intervention, from April 2007 to July 2008, and intervention, from August 2008 to July 2010. Patients were followed for 30 days after the removal of the EVD, and EVD-related infections were considered as only those with laboratorial confirmation in the CSF. Observations were made of the care of the EVD and compliance with Hygiene of the Hands (HH), a routine of care was drawn up, training was given, and intervention was made to reduce the time the EVD catheter remained in place.

RESULTS:

during the study, 178 patients were submitted to 194 procedures, corresponding to 1217 EVD catheters-day. Gram-negative agents were identified in 71.4% of the infections during the pre-intervention period and in 60% during the intervention period. During the study, EVD-related infection rates were reduced from 9.5% to 4.8% per patient, from 8.8% to 4.4% per procedure, and the incidence density dropped from 14.0 to 6.9 infections per 1000 catheters-day (p = 0.027). The mortality reduced 12% (from 42% to 30%).

CONCLUSIONS/SIGNIFICANCE:

During one year after the fourth intervention, no microbiologically identified infection was documented. In light of these results, educational intervention proved to be a useful tool in reducing these rates and showed also impact on mortality.

PMID:
23390486
PMCID:
PMC3563649
DOI:
10.1371/journal.pone.0050708
[Indexed for MEDLINE]
Free PMC Article

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