Angulo Melissa, Springer Lauren, Behbahani Mandana, Fagaragan Lolita, Tabbilos Snyder John, Alaraj Ali, Testai Fernando D, Amin-Hanjani Sepideh
Department of Patient Care/Nursing Services, University of Illinois Hospital & Health Science System, Chicago, Illinois, USA.
Department of Neurosurgery, Rush University, Chicago, Illinois, USA.
World Neurosurg. 2019 Feb;122:e1259-e1265. doi: 10.1016/j.wneu.2018.11.025. Epub 2018 Nov 14.
Infection is a life-threatening complication of ventriculostomy. The purpose of this quality improvement project was to develop a cost-effective, evidence-based intervention to reduce ventriculostomy-associated infection (VAI) rates.
In this retrospective study, patients undergoing ventriculostomy insertion between June 2008 and December 2016 were identified, and charts were reviewed. The study period between June 2008 and August 2010 constituted the baseline (phase 1) in which non-antibiotic-coated ventriculostomy catheters were used and cerebrospinal fluid (CSF) sampling was done daily. Then, 2 sequential interventions were implemented. Between September 2010 and January 2013, antibiotic-coated ventriculostomy catheters (AC-Vs) were used (phase 2). Then, between February 2013 and December 2016, the frequency of CSF sampling was minimized to twice a week (phase 3). The rates of VAI and operational costs, or cost incurred for the external ventricular drain catheter, antibiotics, laboratory analysis, and CSF sampling supplies, were compared for each phase.
The average infection rate for phase 1 was 3.3 infections per 1000 device-days. The VAI rates for phases 2 and 3 were 1.6 and 0.8, respectively. The use of AC-Vs and reduced CSF sampling resulted in a VAI rate decrease of 75.8% (P = 0.01). During 2014, there were no VAIs. The intervention produced an estimated $1.02 million in savings for the institution during phase 3. The average projected savings of this intervention was $175 per patient per day and reduced cost by 72%.
The use of AC-Vs in combination with decreased frequency of CSF sampling was cost saving and resulted in a significant reduction in device-related infections.
感染是脑室造瘘术一种危及生命的并发症。本质量改进项目的目的是制定一种具有成本效益、基于证据的干预措施，以降低脑室造瘘术相关感染（VAI）率。
在这项回顾性研究中，确定了2008年6月至2016年12月期间接受脑室造瘘术置管的患者，并对病历进行了审查。2008年6月至2010年8月的研究期为基线期（第1阶段），期间使用非抗生素涂层脑室造瘘导管，每天进行脑脊液（CSF）采样。然后，实施了2项连续干预措施。2010年9月至2013年1月期间，使用抗生素涂层脑室造瘘导管（AC-Vs）（第2阶段）。然后，在2013年2月至2016年12月期间，将CSF采样频率降至每周两次（第3阶段）。比较各阶段的VAI率和运营成本，即外部脑室引流导管、抗生素、实验室分析和CSF采样耗材产生的成本。
第1阶段的平均感染率为每1000个装置日3.3例感染。第2阶段和第3阶段的VAI率分别为1.6和0.8。使用AC-Vs和减少CSF采样导致VAI率下降75.8%（P = 0.01）。2014年期间未发生VAI。该干预措施在第3阶段为该机构节省了约102万美元。该干预措施的平均预计节省费用为每位患者每天175美元，成本降低了72%。
使用AC-Vs并减少CSF采样频率既节省了成本，又显著降低了与装置相关的感染。
