{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T23:13:37Z","timestamp":1786662817723,"version":"build-2736575974"},"reference-count":14,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,1,23]],"date-time":"2023-01-23T00:00:00Z","timestamp":1674432000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,1,23]],"date-time":"2023-01-23T00:00:00Z","timestamp":1674432000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Neurol"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>External ventricular drainage (EVD) is frequently used in neurosurgical procedures for cerebrospinal fluid (CSF) drainage. It is, however, associated with high infection rates, namely secondary meningitis and ventriculitis. Based on a previous high prevalence of these infections among patients with EVDs, we have proposed and implemented a protocol in an effort to decrease the infection rate. The aim of this study was to measure the effect of hospital-wide implementation of the EVD handling protocol on secondary EVD infections.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Patients and methods<\/jats:title>\n                <jats:p>We included 409 consecutive patients who received a new EVD for other indications than infectious pathologies from January 2000 until June 2012. Patients above 18\u2009years of age were divided into pre- (<jats:italic>n<\/jats:italic>\u2009=\u2009228) and post-protocol (<jats:italic>n<\/jats:italic>\u2009=\u2009181) groups. Patient and disease demographics, as well as EVD data together with confounders for secondary meningitis were recorded in a database. Propensity score matching was then performed to create groups matched for sex, age, reason for drainage, type of shunt, time in situ and duration of surgery to place the EVD. Binomial logistic regression for confounder adjustment and regression discontinuity analyses were then performed on the matched cohort.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Infections occurred more frequently in the pre-protocol group (23% vs 9%, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009\u00a00.001). The incidence of infection was 33\/1000 drain-days pre-protocol and 9\/1000 drain-days post-protocol. Regression analysis in a propensity score-matched cohort (<jats:italic>n<\/jats:italic>\u2009=\u2009103 in the pre- and <jats:italic>n<\/jats:italic>\u2009=\u2009178 in the post-protocol groups) showed that the pre-protocol period was independently associated with more infections (OR 2.69; 95%-CI 1.22\u20135.95, <jats:italic>p<\/jats:italic>\u2009=\u20090.01).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The incidence of secondary EVD infections can be reduced significantly by the implementation of a strict hospital-wide EVD handling protocol.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12883-023-03080-2","type":"journal-article","created":{"date-parts":[[2023,1,23]],"date-time":"2023-01-23T09:03:48Z","timestamp":1674464628000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Impact of an external ventricular shunt (EVD) handling protocol on secondary meningitis rates: a historical cohort study with propensity score matching"],"prefix":"10.1186","volume":"23","author":[{"given":"Daphna","family":"Hoefnagel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5798-5360","authenticated-orcid":false,"given":"Victor","family":"Volovici","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellianne J.","family":"dos Santos Rubio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne F.","family":"Voor in\u2019t Holt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clemens M. F.","family":"Dirven","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margreet C.","family":"Vos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruben","family":"Dammers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,1,23]]},"reference":[{"issue":"3","key":"3080_CR1","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1007\/s00701-007-1458-9","volume":"150","author":"D Hoefnagel","year":"2008","unstructured":"Hoefnagel D, Dammers R, Ter Laak-Poort MP, Avezaat CJ. Risk factors for infections related to external ventricular drainage. Acta Neurochir. 2008;150(3):209\u201314 discussion 214.","journal-title":"Acta Neurochir"},{"issue":"1","key":"3080_CR2","doi-asserted-by":"publisher","first-page":"139","DOI":"10.3171\/2014.9.JNS131277","volume":"122","author":"NC Edwards","year":"2015","unstructured":"Edwards NC, Engelhart L, Casamento EM, McGirt MJ. Cost-consequence analysis of antibiotic-impregnated shunts and external ventricular drains in hydrocephalus. J Neurosurg. 2015;122(1):139\u201347.","journal-title":"J Neurosurg"},{"issue":"5","key":"3080_CR3","doi-asserted-by":"publisher","first-page":"1124","DOI":"10.1097\/00006123-200011000-00020","volume":"47","author":"CH Alleyne Jr","year":"2000","unstructured":"Alleyne CH Jr, Hassan M, Zabramski JM. The efficacy and cost of prophylactic and perioprocedural antibiotics in patients with external ventricular drains. Neurosurgery. 2000;47(5):1124\u20137 discussion 1127\u20131129.","journal-title":"Neurosurgery."},{"key":"3080_CR4","doi-asserted-by":"publisher","first-page":"518","DOI":"10.1016\/j.wneu.2016.12.042","volume":"99","author":"AC Flint","year":"2017","unstructured":"Flint AC, Toossi S, Chan SL, Rao VA, Sheridan W. A simple infection control protocol durably reduces external ventricular drain infections to near-zero levels. World Neurosurg. 2017;99:518\u201323.","journal-title":"World Neurosurg"},{"key":"3080_CR5","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1186\/s12879-014-0712-z","volume":"15","author":"M Ramanan","year":"2015","unstructured":"Ramanan M, Lipman J, Shorr A, Shankar A. A meta-analysis of ventriculostomy-associated cerebrospinal fluid infections. BMC Infect Dis. 2015;15:3.","journal-title":"BMC Infect Dis"},{"issue":"5","key":"3080_CR6","doi-asserted-by":"publisher","first-page":"632","DOI":"10.3109\/02688697.2011.578770","volume":"25","author":"WJ Kitchen","year":"2011","unstructured":"Kitchen WJ, Singh N, Hulme S, Galea J, Patel HC, King AT. External ventricular drain infection: improved technique can reduce infection rates. Br J Neurosurg. 2011;25(5):632\u20135.","journal-title":"Br J Neurosurg"},{"issue":"6","key":"3080_CR7","doi-asserted-by":"publisher","first-page":"993","DOI":"10.1227\/NEU.0b013e31828e8dfd","volume":"72","author":"AC Flint","year":"2013","unstructured":"Flint AC, Rao VA, Renda NC, Faigeles BS, Lasman TE, Sheridan W. A simple protocol to prevent external ventricular drain infections. Neurosurgery. 2013;72(6):993\u20139 discussion 999.","journal-title":"Neurosurgery."},{"issue":"2","key":"3080_CR8","doi-asserted-by":"publisher","first-page":"345","DOI":"10.3171\/2009.6.JNS09223","volume":"112","author":"MA Leverstein-van Hall","year":"2010","unstructured":"Leverstein-van Hall MA, Hopmans TE, van der Sprenkel JW, et al. A bundle approach to reduce the incidence of external ventricular and lumbar drain-related infections. J Neurosurg. 2010;112(2):345\u201353.","journal-title":"J Neurosurg"},{"issue":"1","key":"3080_CR9","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1007\/s00701-004-0416-z","volume":"147","author":"AM Korinek","year":"2005","unstructured":"Korinek AM, Reina M, Boch AL, Rivera AO, De Bels D, Puybasset L. Prevention of external ventricular drain--related ventriculitis. Acta Neurochir. 2005;147(1):39\u201345 discussion 45\u201336.","journal-title":"Acta Neurochir"},{"issue":"5","key":"3080_CR10","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1080\/02688690600999901","volume":"20","author":"D Dasic","year":"2006","unstructured":"Dasic D, Hanna SJ, Bojanic S, Kerr RS. External ventricular drain infection: the effect of a strict protocol on infection rates and a review of the literature. Br J Neurosurg. 2006;20(5):296\u2013300.","journal-title":"Br J Neurosurg"},{"issue":"6","key":"3080_CR11","doi-asserted-by":"publisher","first-page":"e34","DOI":"10.1093\/cid\/ciw861","volume":"64","author":"AR Tunkel","year":"2017","unstructured":"Tunkel AR, Hasbun R, Bhimraj A, et al. 2017 Infectious Diseases Society of America\u2019s clinical practice guidelines for healthcare-associated Ventriculitis and meningitis*. Clin Infect Dis. 2017;64(6):e34\u201365.","journal-title":"Clin Infect Dis"},{"issue":"26","key":"3080_CR12","doi-asserted-by":"publisher","first-page":"2725","DOI":"10.1056\/NEJMoa061115","volume":"355","author":"P Pronovost","year":"2006","unstructured":"Pronovost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 2006;355(26):2725\u201332.","journal-title":"N Engl J Med"},{"key":"3080_CR13","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h4672","volume":"351","author":"P Sedgwick","year":"2015","unstructured":"Sedgwick P, Greenwood N. Understanding the Hawthorne effect. BMJ. 2015;351:h4672.","journal-title":"BMJ"},{"issue":"6","key":"3080_CR14","doi-asserted-by":"publisher","first-page":"1707","DOI":"10.1097\/CCM.0b013e31824e0d46","volume":"40","author":"JF Timsit","year":"2012","unstructured":"Timsit JF, Bouadma L, Ruckly S, et al. Dressing disruption is a major risk factor for catheter-related infections. Crit Care Med. 2012;40(6):1707\u201314.","journal-title":"Crit Care Med"}],"container-title":["BMC Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12883-023-03080-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12883-023-03080-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12883-023-03080-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,23]],"date-time":"2023-01-23T09:04:54Z","timestamp":1674464694000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcneurol.biomedcentral.com\/articles\/10.1186\/s12883-023-03080-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,23]]},"references-count":14,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["3080"],"URL":"https:\/\/doi.org\/10.1186\/s12883-023-03080-2","relation":{},"ISSN":["1471-2377"],"issn-type":[{"value":"1471-2377","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,23]]},"assertion":[{"value":"31 May 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 January 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 January 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All human studies have been deemed exempt from IRB approval by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. The study was deemed exempt from IRB approval as it only used data routinely collected for quality assurance purposes.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"No identifying patient data is available in this study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers\u2019 bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"36"}}