Effect of Bundled Care on External Ventricular Drain Infections: A Systematic Review and Meta-analysis.
Samuel Neal Blacker, Hemanshu Prabhakar, Elizabeth Olive Moreton et al.
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In 30 seconds
This systematic review and meta-analysis assessed whether infection-prevention bundles were associated with fewer external ventricular drain (EVD)-associated infections. It included 22 studies and 6330 patients: 3895 in bundle groups and 2435 in nonbundle groups. Bundle implementation was associated with lower infection risk (pooled RR: 0.46, 95% CI: 0.33-0.65, P <0.001). Hand hygiene and preinsertion antibiotics were the most commonly reported bundle elements. The authors also found that antimicrobial-impregnated catheters, tunneled placement, and structured education were more frequent in studies reporting infection rates below 5%.
Key findings
- Across 22 studies involving 6330 patients, bundles were associated with lower EVD infection risk (pooled RR: 0.46, 95% CI: 0.33-0.65, P <0.001).
- Heterogeneity across studies was moderate (I²=50.9%).
- Hand hygiene (100%) and preinsertion antibiotics (91%) were the most frequently implemented bundle elements.
- Antimicrobial-impregnated catheters, tunneled placement, and structured education were more common in studies with infection rates <5%.
Why it matters
EVD-associated infections are a preventable complication of a device used in acute intracranial care. The pooled association supports attention to coordinated infection-prevention practices, while the variation in bundle components highlights that bundles are not uniform. The findings also identify practices that merit consideration in prevention strategies, without establishing which individual elements account for the observed reduction.
What to keep in mind
The analysis combined studies with moderate heterogeneity, and the abstract does not establish that bundle implementation was randomised; the pooled association therefore does not prove causation.