■脑室引流(EVD)相关感染(ERI)是颅神经外科手术中常见的并发症,死亡率高。在印度等低收入和中等收入国家(LMIC)中,与ERI相关的风险因素没有得到很好的研究。识别风险变量是为ERI预防设计强大的循证护理包的必要条件。
■这是一项单中心前瞻性队列研究。在2年的研究期间,对有和没有ERI的患者进行了分析,并进行了文献综述,以确定与ERI相关的风险变量。医疗保健改善研究所(IHI)综合流程图用于开发ERI预防的概念护理包。
■在研究期间总共插入了211个EVD。根据IDSA标准确定了15个ERI(7.1%),平均感染率为11.12/1000EVD天。革兰阴性菌(GNB)是主要病原菌(12/15,80%),肺炎克雷伯菌(6/15,40%)是最常见的细菌分离。在多变量分析中,与ERI相关的风险变量是长期使用广谱的手术前抗菌药物预防,选择用于EVD插入的后颅测点,EVD持续时间>7天,EVD泄漏和定期监测脑脊液(CSF)采样。根据本研究中确定的风险变量和文献综述,针对ERI预防的概念护理包选择了关于插入和维护阶段护理要素的共识决定.
■提出了用于ERI预防的基于证据的概念护理包,用于进一步的多中心评估和验证。
■PonnambathDK,DivakarG,MamachanJ,BijuS,RajaK,AbrahamM.开发用于预防外部心室引流相关感染的循证护理组合:单中心前瞻性队列研究和文献综述的结果。印度J暴击护理中心2024;28(8):760-768。
UNASSIGNED: External ventricular drain (EVD)-related infection (ERI) is a common complication in cranial neurosurgery practice with high mortality. The risk factors associated with ERI are not well studied in low- and middle-income countries (LMIC) like India. Identifying the risk variables is a necessity to design robust evidence-based care bundles for ERI prevention.
UNASSIGNED: This is a single-center prospective cohort study. Patients with and without ERI during the 2-year study period were analyzed along with literature review to identify the risk variables associated with ERI. The Institute for Healthcare Improvement (IHI) comprehensive flowchart was used to develop the concept care bundle for ERI prevention.
UNASSIGNED: A total of 211 EVD were inserted during the study period. 15 ERI (7.1%) were identified based on IDSA criteria, with an average infection rate of 11.12 per 1000 EVD days. Gram negative bacteria (GNB) were the predominant pathogen (12/15, 80%), with Klebsiella pneumoniae (6/15, 40%) being the most common bacteria isolated. In multivariate analysis, the risk variables associated with ERI were use of broad spectrum pre-surgical antimicrobial prophylaxis for long duration, choice of posterior craniometric points for EVD insertion, EVD duration >7 days, EVD leak and surveillance cerebrospinal fluid (CSF) sampling at periodic intervals. Based on the risk variables identified in this study and literature review, a consensus decision on the care elements for the insertion and maintenance phases was chosen for the concept care bundle for ERI prevention.
UNASSIGNED: An evidence-based concept care bundle for ERI prevention is proposed for further multicentric evaluation and validation.
UNASSIGNED: Ponnambath DK, Divakar G, Mamachan J, Biju S, Raja K, Abraham M. Development of an Evidence-based Care Bundle for Prevention of External Ventricular Drain-related Infection: Results of a Single-center Prospective Cohort Study and Literature Review. Indian J Crit Care Med 2024;28(8):760-768.