Impact of an External Ventricular Drain Placement and Handling Protocol on Infection Rates: A Meta-Analysis and Single Institution Experience

Object The authors explored the relationship among the duration of external ventricular drainage, revision of external ventricular drains (EVDs), and cerebrospinal fluid (CSF) infection to shed light on the practice of electively revising these drains. Methods In a retrospective study of 199 patients with 269 EVDs in the intensive care unit at a major trauma center in Australasia, the authors found 21 CSF infections. Acinetobacter accounted for 10 (48%) of these infections. Whereas the duration of drainage was not an independent predictor of infection, multiple insertions of EVDs was a significant risk factor. Second and third EVDs in previously uninfected patients were more likely to become infected than first EVDs. An EVD infection was initially identified a mean of 5.5 ±0.7 days postinsertion (standard error of the mean); these data—that is, the number of days—were normally distributed. Conclusions This pattern of infection is best explained by EVD-associated CSF infections being acquired by the introduction of bacteria on insertion of the drain rather than by subsequent retrograde colonization. Elective EVD revision would be expected to increase infection rates in light of these results, and thus the practice has been abandoned by the authors' institution.

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Chlorhexidine dressings could reduce external ventricular drain infections: results from a systematic review and meta-analysis

Journal of Hospital Infection ◽

10.1016/j.jhin.2021.06.006 ◽

2021 ◽

Author(s):

Mueez Waqar ◽

Aswin Chari ◽

Abdurrahman I. Islim ◽

Benjamin Davies ◽

Daniel M. Fountain ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

External Ventricular Drain

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Sentinel Lymph Node Status is a Main Prognostic Parameter Needful for the Correct Staging of Patients with Melanoma Thicker than 4 mm: Single-Institution Experience and Literature Meta-Analysis

Journal of Investigative Surgery ◽

10.1080/08941939.2017.1384871 ◽

2017 ◽

Vol 32 (2) ◽

pp. 151-161

Author(s):

Borgognoni L ◽

Sestini S ◽

Gerlini G ◽

Brandani P ◽

Chiarugi C ◽

...

Keyword(s):

Lymph Node ◽

Sentinel Lymph Node ◽

Meta Analysis ◽

Lymph Node Status ◽

Single Institution ◽

Prognostic Parameter ◽

Node Status ◽

Sentinel Lymph Node Status

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Role of Cerebrospinal Fluid Markers for Predicting Shunt-Dependent Hydrocephalus in Patients with Subarachnoid Hemorrhage and External Ventricular Drain Placement

World Neurosurgery ◽

10.1016/j.wneu.2018.09.159 ◽

2019 ◽

Vol 121 ◽

pp. e535-e542 ◽

Cited By ~ 2

Author(s):

Markus Lenski ◽

Annamaria Biczok ◽

Volker Huge ◽

Robert Forbrig ◽

Josef Briegel ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Subarachnoid Hemorrhage ◽

External Ventricular Drain ◽

Drain Placement

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Handwash versus hand-rub practices for preventing nosocomial infection in hospital intensive care units: A systematic review and meta-analysis

Canadian Journal of Infection Control ◽

10.36584/cjic.2020.009 ◽

2020 ◽

pp. 82-90

Author(s):

S Bello ◽

EA Bamgboye ◽

DT Ajayi ◽

EN Ossai ◽

EC Aniwada ◽

...

Keyword(s):

Systematic Review ◽

Intensive Care ◽

Adverse Events ◽

Nosocomial Infection ◽

Intensive Care Units ◽

Meta Analysis ◽

Healthcare Providers ◽

Length Of Hospital Stay ◽

Clinical Effectiveness ◽

Infection Rates

Background: Compliance with handwashing in busy healthcare facilities, such as intensive care units (ICUs), is suboptimal and alcohol hand-rub preparations have been suggested to improve compliance. There is no evidence on the comparative effectiveness between handwash and hand-rub strategies. This systematic review was to assess the effectiveness of handwash versus hand-rub strategies for preventing nosocomial infection in ICUs. Methods Studies conducted in ICUs and indexed in PubMed comparing the clinical effectiveness and adverse events between handwash and hand-rub groups were included in a systematic review. The primary outcome was nosocomial infection rates. Secondary outcomes included microbial counts on healthcare providers’ hands, mortality rates, patient/hospital cost of treatment of healthcare-associated infections (HCAIs), length of ICU/hospital stays, and adverse events. Studies were independently screened and data extracted by at least two authors. Meta-analyses of risk ratios (RR), incidence rate ratios (IRR), odds ratios (OR) and mean differences (MD), were conducted using the RevMan 5.3 software. Results: Seven studies published between 1992-2009 and involving a total of 11,663 patients were included. Five studies (10,981 patients) contributed data to the ICU acquired nosocomial infection rates. The pooled IRR was 0.71 (95% CI 0.61, 0.82; I2 = 94%). On sensitivity analysis, pooled IRR was 0.39 (95% CI 0.32, 0.48; 4 studies; 8,247 patients; I2 = 0%) in favour of hand rub. The pooled OR for mortality was 0.95 (95% CI 0.78, 1.61; 4 studies; 3,475 patients; I2 = 39%). The pooled MD for length of hospital stay was -0.74 (95% CI -2.83, 1.34; 3 studies; 741 patients; I2 = 0%). The pooled OR for an undesirable skin effect was 0.37 (95% CI 0.23, 0.60; 3 studies;1504 patients; I2 = 0%) in favour of hand rub. Overall quality of evidence was low. Conclusion: Hand rub appeared more effective when compared to handwash in ICUs.

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PEDIATRIC PYELOPLASTY: COMPARISON BETWEEN A LITERATURE META-ANALYSIS OF LAPAROSCOPIC TECHNIQUES AND OPEN SURGERY AT A SINGLE INSTITUTION

The Journal of Urology ◽

10.1016/s0022-5347(08)61044-7 ◽

2008 ◽

Vol 179 (4S) ◽

pp. 357-357

Author(s):

Stefanie Seixas-Mikelus ◽

Lawrence Jenkins ◽

Pierre Williot ◽

Saul P Greenfield

Keyword(s):

Open Surgery ◽

Meta Analysis ◽

Single Institution ◽

Laparoscopic Techniques

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