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Implementing an infection control bundle for the reduction of ventriculostomy-related infections in a neurologic critical care unit
Dissertation

Implementing an infection control bundle for the reduction of ventriculostomy-related infections in a neurologic critical care unit

Rebecca MacIntyre
Doctor of Nursing Practice (D.N.P.), Drexel University
2016
DOI:
https://doi.org/10.17918/etd-7228
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MacIntyre_Rebecca_2016952.44 kB
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Abstract

Nursing
Background: Ventriculostomy-related infections (VRIs), particularly ventriculitis, is a serious nosocomial infection associated with high morbidity and mortality. The use of bundles have been shown to reduce VRI rates in non-randomized, single center studies. A bundle is a set of evidence-based interventions that when implemented consistently, can improve outcomes. The purpose of this Doctor of Nursing Practice (DNP) project was to determine if the development and implementation of a best practice bundle for ventriculostomy insertion and maintenance would lead to a reduction in the incidence of VRIs in the Neurologic Critical Care Unit at Christiana Hospital. Utilizing the Stetler Model for Research Utilization, a best practice bundle of interventions was created based on synthesis of research findings. The bundle included interventions related to insertion, antibiotic use, dressing change procedure and frequency, and cerebrospinal fluid sampling. Methods: Institutional Review Board approval was obtained. Staff education was completed and the bundle was implemented. Baseline data from 12 months preceding bundle implementation was collected retrospectively (March 7, 2015 - March 7, 2016), and prospective data was collected for six month following bundle implementation (March 8, 2016 - September 8, 2016). VRIs were defined based on standard diagnostic criteria. The primary outcome measure was change in VRI rates pre and post intervention. A secondary outcome measured was the difference in the mean number of catheter days in those with and without a VRI. Findings: A Chi-squared test was used for the primary outcome measure, and a t-test for Equality of Means and a Pearson Correlation was used for the secondary outcome. The baseline VRI rate for the 12 months preceding the intervention was 5.76 per 1,000 catheter days. Following bundle implantation, the VRI rate was reduced to zero. Although reduced, statistical significance was not achieved given the overall low number of events. The mean number of catheters days in those with a VRI was 13.0 compared to a mean number 7.52 days in those without a VRI. Although varied, they are not statistically significant. A small correlation was identified between the number of catheter days and incidence of infection. Conclusion: The implementation of the best practice bundle for ventriculostomy insertion and maintenance led to a reduction in VRIs. Although not statistically significant, this is clinically significant for those patients who avoided a VRI and its associated complications.

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