EVD Infection Risk Factors: Observational Study at Hospital Kuala Lumpur
Journal name: The Malaysian Journal of Medical Sciences
Original article title: The Risk Factors of External Ventricular Drainage-Related Infection at Hospital Kuala Lumpur: An Observational Study
The Malaysian Journal of Medical Sciences (MJMS) is a peer-reviewed, open-access journal published online at least six times a year. It covers all aspects of medical sciences and prioritizes high-quality research.
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Mohamad Azhari Omar, Mohd Saffari Mohd Haspani
The Malaysian Journal of Medical Sciences:
(A peer-reviewed, open-access journal)
Full text available for: The Risk Factors of External Ventricular Drainage-Related Infection at Hospital Kuala Lumpur: An Observational Study
Year: 2010
Copyright (license): CC BY 4.0
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Summary of article contents:
Introduction
External ventricular drainage (EVD) is a critical intervention for managing cerebrospinal fluid (CSF) diversion, particularly in patients with conditions such as hydrocephalus and severe head trauma. While EVD is a valuable tool for monitoring intracranial pressure, it carries the significant risk of ventriculostomy-related infections (VRIs). This study, conducted at Hospital Kuala Lumpur (HKL) from December 2006 to December 2008, aimed to identify factors that may influence the incidence of EVD-related infections among patients subjected to this procedure.
Significance of Catheter Tunneling
One of the key findings of this study was the impact of catheter tunneling length on the rate of EVD-related infections. The research demonstrated that tunneling the catheter for more than 5 cm under the scalp significantly reduced infection risk compared to tunneling 5 cm or less. The odds ratio for infection in the longer tunneling group was 0.184 (P < 0.001), while a notable percentage of infections occurred among patients catheterized for more than 10 days. This suggests that standardizing the technique to include subgaleal tunneling longer than 5 cm, alongside limiting catheter duration to 10 days or less, could be crucial in minimizing infection rates in clinical settings.
Conclusion
The findings from this prospective observational study underscore the importance of surgical technique and duration of EVD placement in preventing infections related to external ventricular drainage. With a recorded infection rate of 32.2% among the assessed patients, the study highlights significant correlations between longer tunneling lengths and reduced infection risks. Implementing these standardized protocols at health institutions may enhance patient outcomes by reducing the likelihood of EVD-related infections, thereby improving the overall management of patients requiring cerebrospinal fluid drainage.
FAQ section (important questions/answers):
What is the main purpose of external ventricular drainage (EVD)?
EVD is primarily used to divert cerebrospinal fluid (CSF) and manage conditions like hydrocephalus, particularly following intraventricular or subarachnoid hemorrhage.
What was the infection rate observed in the study for EVD?
The study found that EVD-related infections occurred in 32.2% of cases, indicating a significant risk associated with the procedure.
How does tunneling length affect the risk of infection?
Tunneling the catheter for more than 5 cm significantly reduced the risk of infection to 11.5%, compared to 62.9% in those who had shorter tunneling.
What recommendations were made based on the study findings?
The study recommends standardizing the technique of subgaleal tunneling to more than 5 cm and limiting ventricular catheterization to 10 days or less to reduce infection rates.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “EVD Infection Risk Factors: Observational Study at Hospital Kuala Lumpur”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
1) Study (Studying):
The 'Study' refers to the prospective observational research conducted at Hospital Kuala Lumpur (HKL) focusing on external ventricular drainage (EVD) and its associated infection rates. The study seeks to evaluate surgical techniques and patient outcomes, ultimately aiming to improve the standard of care in neurosurgery for hydrocephalus and related conditions.
2) Blood:
'Blood' is significant in the context of the study as it pertains to the cerebrospinal fluid (CSF) system and the higher rates of external ventricular drainage-related infections noted in patients with blood in their CSF. Understanding the relationship between CSF composition and infection rates helps inform surgical decisions related to EVD insertion.
3) Male (Mālē):
'Male' is relevant as it indicates the gender distribution among patients in the EVD study. Although the frequency of EVD-related infections was noted to be higher among females, the balance of male and female patients helps provide a clearer understanding of demographics, surgical outcomes, and risk factors associated with infections.
4) Disease:
'Disease' refers to the medical conditions that necessitate external ventricular drainage, including hydrocephalus and infections. Identifying the underlying pathologies enhances understanding of the clinical context, risk factors, and overall success rates of EVD. Recognizing the interplay between disease severity and infection risk is crucial for improving patient care.
5) Table:
'Table' refers to the presentation of data within the study, summarizing findings and statistical analyses regarding EVD-related infection rates. Data tables are essential for visualizing results, enabling readers and researchers to quickly interpret associations between variables, such as tunnelling length and infection rates, fostering improved clinical guidelines.
6) Measurement:
'Measurement' is a key aspect of the study, highlighting the method used to evaluate the length of tunnelling for the EVD catheter. Accurate measurements are vital for establishing parameters that influence infection risks and understanding procedural protocols. Proper metrics contribute to the reliability of study findings and their implications for surgical practice.
7) Bleeding:
'Bleeding' represents a critical predisposing factor for requiring EVD, especially in traumatic cases or those involving subarachnoid hemorrhage. Recognizing bleeding's role in increasing intracranial pressure and potential infections allows healthcare providers to better assess patient risks and develop strategies to mitigate complications associated with EVDs.
8) Nostril:
'Nostril' is relevant in discussing exclusion criteria for EVD patients. CSF leakage from the nostril indicates complications during EVD placement. This term serves to delineate the importance of recognizing complications and ensuring that only suitable candidates undergo EVD, thus reducing infection risks and improving patient outcomes in neurosurgery.
9) Debate:
'Debate' signifies existing discussions in the medical community regarding catheter management, including when to remove or replace EVD systems. Addressing this controversial practice is necessary, as it directly affects infection rates and patient care. Understanding differing viewpoints can drive future research, protocol development, and best practices in neurosurgical procedures.
10) Kula (Kūla, Kūḻā):
'Kula' is a reference to the location of the study, specifically Hospital Kuala Lumpur, which conducted the research on EVD procedures. The setting is important as it establishes the context of the findings, including patient demographics, surgical practices, and local healthcare standards, while also contributing to broader knowledge in the field.
11) Post:
'Post' relates to the evaluations and assessments conducted after the EVD procedure. Post-operative monitoring is crucial for identifying any signs of infection early and determining the effectiveness of different surgical techniques. This aspect of care plays a significant role in improving patient outcomes and informing future clinical guidelines.
Other Science Concepts:
Discover the significance of concepts within the article: ‘EVD Infection Risk Factors: Observational Study at Hospital Kuala Lumpur’. Further sources in the context of Science might help you critically compare this page with similair documents:
Central nervous system, Predisposing Factor, Age-group, Hospital admission, Inclusion criteria, Exclusion criteria, Inclusion and exclusion criteria, Observational study, Chi square test, Prospective study, Statistical analyses, Cerebrospinal Fluid, Inclusive Criteria, Surgical technique, Subarachnoid hemorrhage, Hydrocephalus, Gram stain, Multiple regression analysis, Descriptive analysis, Fisher's exact test, Subarachnoid haemorrhage, Surgeons' experience, CSF culture, Intracranial Pressure, Health Institution, Univariate analysis, Intracranial pressure monitoring, Brain tumour, Posterior fossa, Burr hole, Cerebrospinal fluid shunt, CNS infection.