{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T06:32:27Z","timestamp":1778049147355,"version":"3.51.4"},"reference-count":58,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2013,3]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Ventricular infection after ventriculostomy placement carries a high mortality rate. Responding to ventriculostomy infection rates, a multidisciplinary performance improvement team was formed, a comprehensive protocol for ventriculostomy placement was developed, and the efficacy was evaluated.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>A best-practice protocol was developed, including hand hygiene before the procedure; prophylactic antibiotics; sterile gloves changed between preparation, draping, and procedure; hair removal by clipping for dressing adherence; skin preparation using iodine povacrylex (0.7% available iodine) and isopropyl alcohol (74%); full body and head drape; full surgical attire for the surgeon and other bedside providers; and an antimicrobial-impregnated catheter. A checklist of critical components was used to confirm proper insertion and to monitor practice. Procedure-specific infection rates were calculated using the number of infections divided by the number of patients in whom an external ventricular drainage (EVD) device was inserted \u00d7 100 (%). Data were reported back to providers and to the committee. Bundle compliance was monitored over a 4-year period.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>At the authors' institution, 2928 ventriculostomies were performed between the beginning of the fourth quarter of 2006 and the end of the first quarter of 2012. Although the best-evidence bundle was applied to all patients, only 588 (20.1%) were checklist monitored (increasing from 7% to 23% over the study period). The infection rate for the 2 quarters before bundle implementation was 9.2%. During the study period, the rate decreased quarterly to 2.6% and then to 0%. Over a 4-year period, the rate was 1.06% (2007), 0.66% (2008), 0.15% (2009), and 0.34% (2010); it was 0% in 2011 and the first quarter of 2012. The overall EVD infection rate was 0.46% after bundle implementation.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Bundle implementation including an antimicrobial-impregnated catheter dramatically decreased EVD-related infections. Training and situational awareness of appropriate practice, assisted by the checklist, plus use of the antibiotic-impregnated catheter resulted in sustained reduction in ventriculitis.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2012.11.jns121336","type":"journal-article","created":{"date-parts":[[2012,12,21]],"date-time":"2012-12-21T15:11:12Z","timestamp":1356102672000},"page":"514-520","source":"Crossref","is-referenced-by-count":70,"title":["Decreasing ventricular infections through the use of a ventriculostomy placement bundle: experience at a single institution"],"prefix":"10.3171","volume":"118","author":[{"given":"Zeynep","family":"Kubilay","sequence":"first","affiliation":[{"name":"Department of Critical Care Medicine, Geisinger Health System, Danville, Pennsylvania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shahram","family":"Amini","sequence":"additional","affiliation":[{"name":"Division of Critical Care Medicine, Department of Anesthesiology, University of Florida College of Medicine;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Loretta Litz","family":"Fauerbach","sequence":"additional","affiliation":[{"name":"Department of Infection Control, Shands Hospital at the University of Florida; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lennox","family":"Archibald","sequence":"additional","affiliation":[{"name":"Department of Infection Control, Shands Hospital at the University of Florida; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William A.","family":"Friedman","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Florida College of Medicine, Gainesville, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A. 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