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<p> Background: Although external ventricular drains (EVDs) are crucial in neurosurgical care, they carry a high risk of healthcare-associated ventriculitis, with reported infection rates. Numerous interventions were thought to aid in infection control, but there is still an ongoing increase in infection incidence. Recently, bundled interventions with standardized protocols, antimicrobial‐impregnated catheters, tunneling techniques, chlorhexidine dressings, and limited antibiotic prophylaxis have shown an interesting efficacy in shunt-related infection control. Methods: A systematic review was conducted using PubMed, Scopus, Google Scholar, Cochrane CENTRAL, and Web of Science to search for published articles on care bundles with at least three discrete preventive measures. Data analysis was performed using R software, estimating mean difference and risk ratios. Results: Seventeen studies (9 quasi-experimental, 6 retrospective, and 2 prospective cohorts) were included in this study. Implementation of bundle care was associated with a significant reduction in the following outcomes: infection risk and drain stay duration (pooled RR = 0.32; 95% CI 0.20–0.51; <i>p</i> = 0.0001; I²=73.7%), (pooled MD=-1.57; 95% CI -5.80–2.67; <i>p</i> = 0.0038; I²=0%), respectively. Interestingly, there was no significant difference in risk with bundle of care regarding mortality (pooled RR = 1.09; 95% CI 0.62–1.92; <i>p</i> = 0.6924; I²=63.5%). However, no significant differences were observed in ventriculitis rates or hospital stay duration, with <i>p</i> = 0.0509, <i>p</i> = 0.3855, respectively. Conclusions: Bundle of care implementation significantly reduced infection risk and drain days among patients with external ventricular drains, but failed to reduce ventriculitis, mortality, and hospital stay duration. These findings support approving standardized care bundles to improve outcomes, though further high-quality research is needed to assess their impact on specific complications like ventriculitis, mortality, and hospital stay.</p>

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Is there a way to reduce the infection associated with external ventricular shunts? A systematic review and meta-analysis of the recent bundle of care

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月19日

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  • Moustapha Ramadan,
  • Shrouk Fawze Mohamed,
  • Ahmed A. Abdulalim,
  • Anas Ashraf Elassal,
  • Aya Abdelsamad,
  • Belal Shehata,
  • Yasmeen Farag,
  • Mohamed Elshaer,
  • Samar Kolkas,
  • Nesrine Fathi Hanafi

摘要

Background: Although external ventricular drains (EVDs) are crucial in neurosurgical care, they carry a high risk of healthcare-associated ventriculitis, with reported infection rates. Numerous interventions were thought to aid in infection control, but there is still an ongoing increase in infection incidence. Recently, bundled interventions with standardized protocols, antimicrobial‐impregnated catheters, tunneling techniques, chlorhexidine dressings, and limited antibiotic prophylaxis have shown an interesting efficacy in shunt-related infection control. Methods: A systematic review was conducted using PubMed, Scopus, Google Scholar, Cochrane CENTRAL, and Web of Science to search for published articles on care bundles with at least three discrete preventive measures. Data analysis was performed using R software, estimating mean difference and risk ratios. Results: Seventeen studies (9 quasi-experimental, 6 retrospective, and 2 prospective cohorts) were included in this study. Implementation of bundle care was associated with a significant reduction in the following outcomes: infection risk and drain stay duration (pooled RR = 0.32; 95% CI 0.20–0.51; p = 0.0001; I²=73.7%), (pooled MD=-1.57; 95% CI -5.80–2.67; p = 0.0038; I²=0%), respectively. Interestingly, there was no significant difference in risk with bundle of care regarding mortality (pooled RR = 1.09; 95% CI 0.62–1.92; p = 0.6924; I²=63.5%). However, no significant differences were observed in ventriculitis rates or hospital stay duration, with p = 0.0509, p = 0.3855, respectively. Conclusions: Bundle of care implementation significantly reduced infection risk and drain days among patients with external ventricular drains, but failed to reduce ventriculitis, mortality, and hospital stay duration. These findings support approving standardized care bundles to improve outcomes, though further high-quality research is needed to assess their impact on specific complications like ventriculitis, mortality, and hospital stay.