External ventricular drain infection: the effect of a strict protocol on infection rates and a review of the literature

Br J Neurosurg. 2006 Oct;20(5):296-300. doi: 10.1080/02688690600999901.


External ventricular drains (EVDs), like any surgically-implanted foreign body, are at risk of infection. We present the results of a completed audit loop following introduction of an evidence-based protocol for their insertion and management. There were two phases over a 2-year period. Phase 1 was a retrospective audit of our EVD infection rate. Phase 2 was a prospective audit of the infection rate subsequent to the introduction of a protocol for the insertion and management of EVDs. In phase 1, the infection rate was 27%. In phase 2, the infection rate was 12%. This was a statistically significant reduction (p < 0.05, Chi-squared test). EVD infection is unfortunately a common clinical problem and associated with potential morbidity and mortality. This study demonstrates that adherence to an evidence-based protocol for their insertion and management is associated with a significant reduction in the infection rate.

Publication types

  • Review

MeSH terms

  • Catheters, Indwelling / adverse effects*
  • Central Nervous System Bacterial Infections / etiology
  • Central Nervous System Bacterial Infections / prevention & control*
  • Cerebral Ventricles / surgery
  • Cerebrospinal Fluid Shunts / adverse effects
  • Clinical Protocols / standards*
  • Drainage / adverse effects
  • Drainage / standards*
  • Encephalitis / etiology
  • Encephalitis / prevention & control
  • Evidence-Based Medicine / standards
  • Female
  • Humans
  • Intracranial Pressure
  • Male
  • Middle Aged
  • Monitoring, Physiologic / adverse effects
  • Prospective Studies
  • Retrospective Studies